Medical Insurance Claims Procedure

Medical Insurance Claims Procedure

MEDICAL INSURANCE ADMISSION, PRE-AUTHORISATION & CONFIRMATION GUIDELINES

 

Emergency/Non-Scheduled Admissions

The insured can be admitted by using his photo identity card and then our offices to be intimated as soon as possible by the hospital as initial emergency treatment is going on.

 

Preauthorization Form

A duly completed Admission Pre-Authorization Form should be sent by the Service Provider by fax to our offices not later than 24 hours of admission. On weekends or Public holidays the form should be sent within the next working day.

 

Non-Emergency/Scheduled Admissions

Non-emergency/Scheduled/Planned admissions require advance pre-authorization by Saham Insurance Company Ltd before admission.

  • A duly completed Admission Pre-authorization form or a medical report on the condition should be sent by the Service Provider/admitting Doctor to Saham Insurance Company Ltd
  • The patient should identify him/herself by producing a valid Saham Insurance Company Ltd photo-card (where the Service Provider is in doubt, call our office or Nurse/Medical Assessor).

    Our offices contact numbers during working hours Monday - Friday 8 a.m. to 5 p.m:

HEAD OFFICE: NAIROBI
Telephones: 254 020 2219486/2218244/2243681/2
Fax: 254 020 2215528
E-mail: medical@Saham.co.ke

 

BRANCH OFFICE: MOMBASA
Telephones: 254 041 2229214/2226331
Fax: 254 041 2223918
Email: msa@Saham.co.ke

During non-working hours/weekends and public holidays our Nurse/Medical Assessor can be contacted on 0720 717580

 

N.H.I.F Rebate

The Company's liability in claims settlement in Kenyan Currency shall be determined in accordance to the Policy Terms and Conditions. Benefits shall exclude National Hospital Insurance Fund.

 

The patient should therefore submit the NHIF card to the admitting hospital upon admission

 

SERVICE PROVIDERS - (FOR INPATIENT ONLY) HOSPITALS

We currently have credit arrangement with the following hospitals:

AGA KHAN HOSPITAL NAIROBI
AGA KHAN HOSPITAL MOMBASA
AGA KHAN HOSPITAL KISUMU
M.P. SHAH HOSPITAL NAIROBI
MATER MISERICORDIAE HOSPITAL NAIROBI
NAIROBI WEST HOSPITAL NAIROBI
NAIROBI WOMENS HOSPITAL NAIROBI
GURU NANAK RAMGARHIA SIKH HOSPITAL NAIROBI
AVENUE HOSPITAL NAIROBI
METROPOLITAN HOSPITAL BURU BURU,NAIROBI
GETRUDES GARDEN CHILDREN'S HOSPITAL NAIROBI
THE MOMBASA HOSPITAL MOMBASA
NAIROBI EQUATOR HOSPITAL NAIROBI
THE NAIROBI HOSPITAL NAIROBI
PCEA KIKUYU HOSPITAL KIKUYU
LIMURU NURSING HOME LIMURU
PANDYA MEMORIAL HOSPITAL MOMBASA
KIKUYU NURSING HOME KIKUYU
PARKROAD NURSING HOME NAIROBI
ST.JAMES HOSPITAL NAIROBI
PINE BREEZE HOSPITAL NAKURU
VALLEY HOSPITAL NAKURU
NAZARETH HOSPITAL BANANA KIAMBU, NAIROBI