DEFMIS
DEFMIS
DEFENCE FORCES MEDICAL INSURANCE SCHEME
e Karen Hospital- Kitengela, Ngong, Rongai (OPS) Kajiado County
Mercy Mission Hospital Baringo County
Tionybei Medical Clinic (Satellite Clinics-Marigat,
Kabartonjo, Kabarnet)
Baringo County
Tenwek Mission Hospital Bomet County
St Clares Kaplong Mission Hospital Bomet County
AIC Litein Cottage Hospital Bomet County
St.Damiano Mission Hospital
Bungoma County
New Elgon View Cottage Hospital
Bungoma County
St Joseph Mission Hospital - Migori Migori County
Samjomen Hospital Migori County
Akidiva Hospital Migori County
Royal Hospital Migori County
e Aga Khan Hospital Kisumu,Migori (OPS) Migori County
Moyale Nursing Home
Marsabit County
Marsabit County Hospital
Marsabit County
Marsabit Medical Clinic Marsabit County
Mombasa Hospital(referral Only) Mombasa County
Aga Khan Hospital-Mombasa-Referral Only) Mombasa County
(Changamwe, Nyali, Bamburi, Kuze)
e Aga Khan Hospital-MSA-(OPS) Mombasa County
Jocham Hospital Mombasa County
Family Health Option-Mombasa Mombasa County
AAR Health Care Kenya Ltd(out-patient Services) Mombasa County
Premier Hospital Mombasa County
Pandya Memorial Hospital Mombasa County
e Nairobi Womens Hosipital MSA Mombasa County
Gaichanjiru Mission Hospital Muranga County
Muranga County Referral Hospital
Muranga County
e Nairobi Hospital-(Referral Only) Nairobi County
(Galleria Karen,Gigiri, Capital Centre, Rosslyn Riviera,
Kiambu Mall-Kiambu Rd, South Field Mall - Embakasi)
e Nairobi Hospital Satellite Clinics (OPS) Nairobi County
e Karen Hospital (Referral Only Nairobi County
e Karen Hospital -CBD(OPS) Nairobi County
(Hurlingham Branch & Adams Arcade)
e Nairobi Women’s Hospital Nairobi County
MP Shah Hospital
Nairobi County
Nairobi West Hospital
Nairobi County
Metropolitan Hospital
Nairobi County
Coptic Hospital
Nairobi County
Nairobi County
St Francis Community-Health Hospital Kasarani
Nairobi County
Kenyatta National Hospital
Nairobi County
Baus Optical
Nairobi County
Omega Optical
Nairobi CountyCancer Care Kenya
(Kenya Airways Pride Centre Clinic, at MP Shah Hospital,
Village Market, CBD Clinic, Uyoma Street)
Nairobi CountyLions Sight First Eye Hospital
Nairobi CountyFamily Health Options
Nairobi CountyGerman Medical Centre-Upper Hill
Nairobi CountyBristol Park Hospital(Tassia Estate & Utawala)
Nairobi CountyRFH Specialist Hospital - Kangudo Road
Nairobi CountyAAR Health Care Kenya Ltd(Out-Patient Services)
Nairobi Countye Nairobi Radiotherapy Cancer Centre
Nairobi CountyOasis Healthcare Group Ltd
Nairobi CountyEquity Afya (Burburu & Kayole)
Nairobi CountyStarkey Hearing Technologies
Nairobi Countye Eagle Eye Laser Centre
Nairobi CountyOasis Mental Hospital
Nairobi CountyChiromo Lane Medical Centre
Nairobi Countye Spine Clinic Africa Ltd (Referral Only)
Evan’s Sun Rise Medical Centre Nakuru County
Nakuru County
Nakuru War Memorial Hospital
Nakuru County
Family Health Options,Nakuru
Nakuru CountyKabarak University Medical Centre
Nakuru Countye Karen Hospital - Naivasha (OPS)
Nakuru Countye Karen Hospital - Nakuru CBD (OPS)
(Hyrax Branch, CBD Branch)
Nakuru County
Nairobi Womens Hospital, Nakuru
Nakuru County
AAR Health Care Kenya Ltd
St Joseph’s Mission Dispensary
Nandi County
e Aga Khan Hosp Kisumu-Kapsabet (OPS)
Nandi County
Kapsabet Healthcare Centre Nandi County
St Joseph Mission Hospital-Kilgoris Narok County
Medicatia Hospital Narok County
Premier Care Diagnostics Narok County
Narok Cottage Hospital Narok County
Kinara Hosp (Formely Nyamira MNH) Nyamira County
Charity Medical Centre Nyandarua County
Nyeri Level 5 Hospital Nyeri County
Family Health Options,Nyeri Nyeri County
Tumutumu Mission Hospital Nyeri County
e Consolata Hospital Mathari Nyeri County
Outspan Hospital Nyeri County
Lions Sight First Eye Hospital Nyeri County
e Karen Hospital- Karatina(OPS) Nyeri County
e Karen Hospital- Nyeri Nyeri County
Wamba Catholic Hospital Samburu County
County Medicare Ltd
Samburu County
Maralal Catholic Dispensary Samburu County
Bama Nursing Home Siaya County
Sagam Community Hospital Siaya County
Siaya County Referral Hospital Siaya County
Moi District Hospital Taita Taveta County
Dawida Maternity and Nursing Home Taita Taveta County
St Josephs Shelter of Hope Hospital Taita Taveta County
Taita Taveta County
e Aga Khan Hosp MSA-Voi (OPS)
Medina Diagnostic Ltd Hola Tana River County
PCEA Chogoria Hospital araka Nithi County
Kiminini Cottage Mission Hospital Transnzoia County
Cherang’any Nursing Home Transnzoia County
e Aga Khan Hosp Kisumu-Kitale (OPS) Transnzoia County
Lodwar Medical Centre Turkana County
Lodwar Tumaini Medical Services Turkana County
Moi Teaching & Referral Hospital Uasin Gishu County
Uasin Gishu CountyBaus Optical
Uasin Gishu County
St Mary’s Medical Centre
Uasin Gishu County
Elgon View Hospital
Uasin Gishu County
Family Health Options
Uasin Gishu County
Reale Hospital
Uasin Gishu County
AAR Health Care Kenya Ltd (Out-Patient Services)
Uasin Gishu County
St Lukes Orthopaedic & Trauma Hospital
Uasin Gishu County
Texas Cancer Centre
Friends Church Sabatia Eye Hospital Vihiga County
Reysane Medical Wajir County
Camel Medical Centre Wajir County
Ortum Mission Hospital West Pokot County
Friends Mission Hospital Lugulu
Bungoma County
e Aga Khan Hosp Ksm-Bungoma (OPS)
Bungoma County
AIC Kapsowar Mission Hospital
Elgeyo Marakwet County
St Michael Nursing Home-Runyenjes
Embu County
Consolata Hospital Kieni Embu County
Alliance Medical Centre
Garissa County
Medina Hospital
Garissa County
Homa Bay County Referral Hospital
Homa Bay County
Matata Hospital Homa Bay County
Kendu Bay Adventist Hospital
Homa Bay County
e Aga Khan Hospital Ksm-Homabay (-OPS) Homa Bay County
A.V.I Mater Care Isiolo County
Tanaka Nursing Home
Busia County
Holy Family Hospital, Nangina
Busia County
e Aga Khan Hospital Ksm-Busia (OPS)
Busia County
Galaxy Hospital Isiolo Isiolo County
Health Pact Medical Centre Isiolo County
Athi River Shalom Community
Kajiado County
e Nairobi Womens Hospital-Kitengela
Kajiado County
e Nairobi Womens Hospital-Ongata Rongai
Kajiado County
Equity Afya Ongata Rongai
Kajiado County
Kitengela Medical Services
Kajiado County
St Elizabeth Mukumu Mission Hospital Kakamega County
St Mary’s Mission Hospital
Kakamega County
e Aga Khan Hospital Kisumu - Kakamega
Kakamega County
Siloam Hospital
Kericho County
e Aga Khan Hospital Kisumu - Kericho
Kericho County
Kericho District Hospital
Kericho County
PCEA Kikuyu Eye Unit Hospital
Kiambu County
AIC Kijabe Mission Hospital
Kiambu County
St Matia Mulumba Mission Hospital
Kiambu County
AAR Health Care Kenya Ltd (Out-patient Services)
Kajiado County
AAR Health Care Kenya Ltd (Out-Patient Services)
Kiambu County
e Karen Hospital-ika (Out-Patient Services)
Kiambu County
Swiss Cottage Hospital
Kilifi County
Tawfiq Hospital Kilifi County
Kilifi District Hospital Kilifi County
Malindi Sub-County Hospital Kilifi County
New Kilifi Mwananchi Hospital Kilifi County
e Aga Khan Hospital MSA-Kilifi & Mtwapa
Kilifi County
Our Lady of Lourdes Kirinyaga County
ACK Mount Kenya Hospital Kirinyaga County
Nyangena Mission Hospital Kisii County
Tabaka Mission Hospital
Kisii County
e Aga Khan Hosp Kisumu (Out Patient Services)
Kisii County
e Aga Khan Hosp Kisumu
Kisumu County
St Monicah Mission Hospital
Kisumu County
St Joseph Mission Hospital-Nyabondo Kisumu County
Baus Optical Kisumu Kisumu County
Family Health Options Kisumu County
AAR Health Care Kenya Ltd (Outpatient Services) Kisumu County
Kisii Level 5 Hospital
Kisii County
Jordan Hospital - Muthale Kitui County
Muthale Mission Hospital Kitui County
Mutomo Mission Hospital Kitui County
Diani Beach Hospital
Kwale County
Mabatini Medical Centre
Kwale County
e Aga Khan Hospital MSA - Ukunda (OPS) Kwale County
Nanyuki Cottage Hospital
Laikipia County
Huruma Health Centre
Laikipia County
Unison Medical Centre
Laikipia County
Bishop U Kioko Mission Hospital Machakos County
Shalom Community Hospital
Machakos County
AAR Health Care Kenya Ltd, Syokimau
Machakos County
German Medical Centre Machakos County
Bristol Park Hospital Machakos County
Kilome Maternity & Nursing Home Makueni County
Al Siha Nursing Home
Mandera County
Blue Light Nursing Home
Mandera County
Bliss Health Care (Nanyuki)
Laikipia County
St eresa Mission Hospital(Kiirua)
Meru County
Maua Methodist Hospital
Meru County
Consolata Hospital Nkubu
Meru County
e Karen Hospital - Meru (OPS Meru County
e Mitunguu Hospital Meru County
Meru Jordan Hospital Meru County
e Nairobi Women’s Hospital, Meru Meru County
St Monica Health Centre Rapogi Migori County
19th Floor Nyayo House, P.O Box 21710-00100 Nairobi Telegrams: “DEFMIS”,
Nairobi Telephone:020 721 164/2721100 Ext 5626 Registry Oce-0202340489 (0800-1700Hrs Week Days)
Medical (24 Hrs)-Safaricom 0799 400 905 -Airtel 0787 101 876 Orange 0774 749 830/1
Bills section -0771 922 632 (0800-1700Hrs Week Days) Website: https://defmis.org
DEFMIS CONTACTS
Your Health care Partner in Retirement
DEFMIS ACCREDITED HOSPITALS
6. On dispatch of invoices to the scheme, please attach the following documents to ease processing of the claims:-
(a). DEFMIS claim form duly completed on all the spaces provided and stamped on doctor's certicate
(using doctor's or hospital stamp NOT accounts/billing stamp), the diagnosis is to be clearly printed/
written and the client or parent (in case of a minor) is to sign claimant's part on the claim form.
(b). DEFMIS pre-authorization form duly lled and stamped for all admissions and day case procedures.
(c). A detailed and stamped carbon copy/duplicate discharge summary for all inpatients.
(d). A copy of Letter of Undertaking for all admissions.
(e). Clear photocopies of both sides of the insurance card showing the details of the person treated and the
photocopy of the national ID card of the contributor/spouse.
(f). Itemized invoices stamped by the accounts department and signed by the client or parent
(in case of a minor).
(g). The invoices to be forwarded to the scheme within 14 days after treatment or discharge.
7. The Trust will be notied of admissions of its members on admission by phone call within 24 hours upon
admission. Pre-authorization form is to be lled immediately and send to DEFMIS for a letter of
undertaking processing.
8. In case a patient has to be moved to another healthcare facility, the Trust is to be informed. Please note that
the insurance does NOT cover the cost of ambulance unless it is an emergency and you must seek
authority from DEFMIS for approval.
The benets under the fund do not include the following situations and scenarios and no payment shall be
made from the fund thereof.
(a). Treatment abroad unless sanctioned by the board of trustees.
(b). Services rendered in facilities not prescribed as hereunder except in emergencies.
(c). Self-induced or inicted conditions or injuries.
(d). Cosmetic or plastic surgery unless certied by a doctor to be medically benecial and approved by the
Board of Trustees.
(e). General routine check-ups for information only not incidental to or necessary for diagnosis of a medical
Condition.
(f). Funeral and testamentary expenses in respect of deceased member.
(g). Injuries sustained in furtherance of a crime.
(h). Use of hospitals and healthcare facilities as old peoples home, hospice, sanatorium or a place of recovery
or convalescence of invalids or as hotel or residence with a view to getting comfort.
(i). Refund of a member’s contributions or part thereof in any case in lieu of medical service save as
expressively authorized by these Rules.
(j). Loans to members whatsoever.
(k). Sunglasses
(l). Contraceptives.
(m). Slimming tablets.
(n). Travel expenses.
(o). Sexual performance enhancement drugs.
(p). Wilful non-compliance to doctors prescribed treatment
(q). Caesarean section except when recommended by a doctor.
(r). Dental cosmetics and dentures.
9. EXCLUSIONS.
INTRODUCTION
The idea of forming DEFMIS was mooted in late 1996.
The health care provided by government to serving members ends immediately upon their retirement.
Retirees are vulnerable to poor health.
Between 1998-2003 accumulation of funds.
First DEFMIS contributions were received in August 1998.
First retired members started to enjoy DEFMIS health care services in 2003.
Fully paid up members were to contribute for a period of 15 years at the rate of 3.1% of their basic salary.
To date DEFMIS offers health care services to retirees and their dependants.
DEFMIS has a network of contracted health care providers who offer inpatient and outpatient services
to retirees and dependants countrywide.
DEFMIS STRATEGIC PLAN
The DEFMIS strategic plan provides a 5-year roadmap for updating its structure and operations, bringing it in
line with current corporate and market trends. Modernization will equip and enable the scheme to serve its
members professionally, in real time and maintain standards that support the nancial growth needed for
elevation to perpetual sustainability. It denes the vision, mission, core values and the motto.
VISION
To be the best and exemplary medical insurance scheme for retired members of the Defence Force and their
dependants by ensuring that members get quality health care.
MISSION
To ensure members have access to health care services whenever they might be by engaging reputable health
care institutions.
MOTTO
“Your health care partner in Retirement”
ELIGIBILITY FOR MEMBERSHIP
CORE VALUES.
Accountability: Express utmost responsibility in resource utilization, decision and actions.
Integrity: Conduct of all operations with transparency.
Teamwork: Implementation of the military esprit de corps necessary for a conducive work environment.
Professionalism: Maintain high standards of customer relations, staff development and operations.
Innovation: Endeavour to turn new ways, patterns and connections into ingenious solutions.
OBJECTIVE
To enroll all serving members of Kenya Defence Forces (KDF) into the Medical Insurance Scheme.
To manage and maintain a viable Medical Insurance Scheme for the benet of the retired members of KDF.
To receive from the Ministry of Defence monthly contribution through check-off system.
To maintain, control and manage the fund in a transparent manner in the best interests of the beneciaries.
To pay for health care services legitimately rendered to beneciaries.
To establish jointly or in consultation with ministry of health, a comprehensive network of health care
Facilities throughout the country.
To invest the surplus of the fund in protable and nancially sound ventures.
DEFMIS STRATEGIC OBJECTIVES
Strategic objective 1:
To review the current management structure, adopt an establishment and necessary infrastructure.
Strategic objective 2:
To diversify investments in order to reduce the risk factor and enhance the nancial base.
Strategic objective 3
To provide quality services through timely response and clearance of medical claims, efficient
customer care services and enlisting approved and standardized medical facilities.
Strategic objective 4
To improve management information system, through the use of information and
communication technologies.
Strategic objective 5
To initiate an efficient and effective nancial management system.
BENEFITS
Inpatient-100% health care cost-max Kshs 2 million per family per year
Outpatient-75% remainder-25% members-max kshs 400,000/= per family per year.
Contributor/Spouse covered for life, children up to 21 years of age.
When a serving contributor retires pre-maturely before making full contribution for a period of 15/20 years,
he/she may pay the remaining balance at will:
Access to benets on retirement after total payment of the required premium.
Contributor nominates one spouse and a maximum of four dependants ( Children).
The scheme settles members’ hospital bills within 30 days from the date of discharge.
Dental cover-Kshs 30,000/= per family in a year.
Optical cover-Ksh 20,000/= per family in a year.
All service personnel who joined the Armed Forces/Kenya Defence Forces prior to 1st September 2004
may join DEFMIS at their discretion. They are however advised to voluntarily enrol in view of the
proven benets of membership post retirement.
Service personnel who join the Armed Forces/Kenya Defence Forces after 1st September 2004 shall be
automatically enrolled as contributing members of DEFMIS.
The following guidelines stipulate the requirements to be met when seeking/processing request
for overseas treatment.
A member shall forward a letter of request to DEFMIS addressed to the
Trustees and attach the following documents:
(a) 1st opinion letter of case introduction from primary doctor or hospital.
(b) 2nd opinion expert advice from relevant consultant.
(c) 3rd opinion comment from admitting overseas hospital, with cost implications.
DEFMIS will prepare a brief for the Assistant Chief of Defence Forces in-charge of
Personnel and Logistics (ACDF P & L) for convening the Medical Advisory Committee
(MAC) meeting. The Membership of MAC is stipulated in the Trust Deed.
(a) The outcome of the MAC meeting is forwarded to DEFMIS for communication to member.
(b) Accepted cases are forwarded to the Trustees for funding approval.
(c) Members will be informed on cases that have not been approved.
(d) Funds are prepared and forwarded to the relevant hospital, member will be informed accordingly.
(e) Member departs for treatment.
Time factor should be considered when applying for authorization.
(a)Stable cases will be processed within one month.
(b)Urgent cases are forwarded to the Trustees promptly.
The Trust Deed does not provide for post facto (refunds after treatment/management) refunds.
PROCEDURE FOR OVERSEAS TREATMENT
PROCEDURES FOR ATTENDING TO DEFMIS PATIENTS AND EXCLUSIONS
1. The hospital shall positively identify the members of the Trust (Scheme) before providing medical
services by use of:-
a. The schemes New membership card
b. National ID card.
Note.The card has a picture of the member, national ID card number, membership number and list
of names of dependants with expiry dates, which must be produced before providing medical services.
2. All patients will be seen as Hospital patients.
3. All patients are required to pay 25% of the total outpatient bill which must be reected on the invoice
and receipt attached. For all inpatients and day case procedures done under general anaesthesia,
the scheme will pay 100% of the bill.
4. All day case procedures done under local anaesthesia will require the client to pay 25% of the total bill.
5. After receiving the medical services, the client is required to sign the invoice as a conrmation that it
is correct.
