Family Medical Cover v2
MED-FAMILY · Medical line · Inpatient + outpatient family medical with maternity option.
Covers
| Cover | Code | Default limit | |
|---|---|---|---|
| Inpatient | IP | KES 1,500,000 | mandatory |
| Outpatient | OP | KES 150,000 | optional |
| Maternity | MAT | KES 150,000 | optional |
| Dental & Optical | DENT | KES 40,000 | optional |
Eligibility rules
| Field | Rule | Reason |
|---|---|---|
| family_size | in 1, 2-4, 5+ | family size band known |
Pricing
| Base rate | 4.5% of sum insured |
| Minimum premium | KES 38,000 |
| Factor: family_size | 1 ×0.8 · 2-4 ×1 · 5+ ×1.3 |
| Factor: outpatient | yes ×1.25 · no ×1 |
| Levy: Stamp Duty | KES 40 |
Intelligence configuration
| Domain | Autonomy mode |
|---|---|
| Underwriting | RECOMMEND |
| Claims | RECOMMEND |
| Renewal | RECOMMEND |
| Communication | AUTO |
| Payments | RECOMMEND |
off → no intelligence · assist → prepare work · recommend → propose actions · auto → execute within authority.
Version history
| Version | Status | Effective |
|---|---|---|
| v2 current | active | 01 Oct 2025 → present |
| v1 | retired | 01 Oct 2024 → 01 Oct 2025 |
Policies stay bound to the version under which they were issued — history is never silently modified.
Underwriting rules
| Referral threshold | KES 3,000,000 |
| pre_existing | no +0 · declared +25 |