Terms of Reference.
- Background
Terre des hommes is the leading Swiss child relief agency. We are committed to improving the lives of millions of the world's most vulnerable children. Children are the first to suffer in times of war, natural disasters and because of poverty. At Terre des Hommes, our goal is to steadily improve the conditions of the most vulnerable children worldwide.
The Need/Purpose
TDH-Kenya Foundation provides nationwide health insurance coverage for its employees and their dependents. As of October 1, 2026, the organization has approximately 54 staff members based in Nairobi, Kiambu, Turkana (Kakuma), and Garissa (Dadaab and Garissa sub-counties). TDH-Kenya Foundation invites eligible insurance firms to submit detailed proposals for medical insurance coverage for its staff and their dependents. The staff number will be subject to change due to staff leaving and staff being hired.
NOTE: INSURANCE BROKERS ARE NOT ELIGIBLE TO PARTICIPATE IN THIS PROCESS.
- Membership Categories
- Annual Premium should be in categories of Member (M)- Member +4 (M+4).
- Medical Insurance coverage should be based on the following.
Outpatient coverage: Proposed annual limit Kes.300,000
Inpatient Benefits: Proposed annual limit Kes.3,000,000
Maternity (Delivery Coverage) for both Normal and C Section
Optical Coverage per family
Dental Coverage per family
Emergency Evacuation
Funeral/Last Expense per Member
Telemedicine Services
Geographical Area of Cover.
Territorial Limit -East Africa (Kenya, Uganda, Tanzania, Rwanda, Burundi, Somalia, and South Sudan
Scope of Work
For this assignment and for fair selection, the applicant underwriters should provide detailed quotations for the Insurance cover for the following categories of benefits at the minimum. Please note the list is not exhaustive.
- Outpatient Services Benefits – Proposed annual limit Kes.300,000
- Co Pay-Not applicable
- Routine outpatient consultation, General Practitioner Kes.3,500 and Specialists Kes.4,000 (Access to Specialists is not restricted to the bidders list of providers)
- Diagnostic Laboratory and Radiology services
- Prescribed physiotherapy.
- Prescribed drugs and dressings.
- Vaccines: KEPI & Baby Friendly up to 10 years of age within OP limit
- Private vaccines up to full outpatient limits.
- Travel vaccines covered up to Kes.20,000 for member and dependents
- Family planning-Covered up to Kes. 20,000
- Annual Check-ups Options: up to Kes.20,000 for the principal member & spouse once per year, for specific conditions
- Dental - up to Kes.60,000 per family – Routine consultation, examination, extraction, fillings, scaling and polishing, other approved dental procedures.
- Optical - up to Kes.60,000 per family, - examinations, prescription lenses and frames; frames limit Kes.40,000 replaceable annually.
- Chronic, pre-existing conditions & HIV/AIDS including cost of ARVs - up to the full out-patient cover limit per family per annum.
- Prescribed drugs and dressings.
- Ambulance Services (for emergency treatment only)
- Congenital conditions up to the full outpatient cover
- Elective circumcision
- Post-natal care for up to six weeks post-delivery.
- Antenatal and postnatal. Covered within the outpatient up to the full limit with No limitation on number of scans
- Counselling services-Covered to the full outpatient limit
- Home nursing care
- Health education
- Renal treatment
- Direct access to specialists
- Supplements Covered where they have direct action in managing a diagnosed condition.
- Chiropractic treatment- covered on referral by orthopedic surgeon
- Occupational & Speech therapy-on pre-authorization relevant to condition
- Prescribed External Appliances-on pre-authorization relevant to condition
- Soaps, Creams & Lotions for skin related conditions-Covered subject to pre-authorization within outpatient limit
- Terrorism - full outpatient limits
- Inpatient Services Benefits - Proposed annual limit Kes.3,000,000
- Hospital Accommodation Charges-Standard Private Room up to Kshs.28,000 net of SHIF.
- Doctor’s (Physician, Surgeon & Anesthetist) fees.
- ICU/HDU and Theatre charges.
- Drugs/Medicines, Dressings and Internal Surgical appliances.
- Pathology, X-ray, Ultrasound, ECG and Computerized Tomography, MRI Scans.
- Radiotherapy and Chemotherapy.
- In-patient Physiotherapy.
- Emergency Road and Air Evacuation subject to overall cover limit.
- Day care surgery
- Home nursing care
- Internal prosthesis
- Inpatient non- accidental dental cover - Kes.400,000 within inpatient limit. Benefits include Anesthetist’s fees, hospital and operating theatre costs, fillings, extractions, root canal treatment, and scaling or cleaning required for a medical condition and prescribed by the appointed dentist.
- Inpatient non- accidental Optical Cover – Kes.400,000 within inpatient limit. Benefits - Eye Test, Frames, Contact & Optical Lenses - Frames, Lenses -Frames Limited to Kshs.40,000 replaced once every year.
- Accidental Dental & Optical Cover - full inpatient limit
- Circumcision – Kes.250,000.
- Maternity, Normal deliveries, Elective and Subsequent Caesarean shall be covered up Kshs.250,000 within inpatient
- Norma Delivery - Kes.250,000 within inpatient limit
- First Ever Emergency Caesarean Section & Subsequent Caesarean - Kes.250,000 within inpatient limit
- Maternity-related complications; before, during and after delivery - Kes.300,000 within inpatient limit.
- Routine antenatal check-ups
- Postnatal care for up to six weeks post delivery
- Neonatal and pre-maturity-related conditions – Kes.800,000
- Congenital conditions -Kes.500,000
- Psychiatric & Psychosocial hospitalization Family per annum – Kes.900,000
- Mentel health and Counselling (Employment Assistance Program)
- Hospitalization for pre-existing chronic conditions, HIV/AIDS and related illness – Kes.1,000,000 per family per year within the inpatient limit.
- Newly diagnosed Chronic conditions – Full inpatient limit.
- Covid-19 Cover - Kes. 1,000,000 per family - Group limit Kes.5,000,000
- Prescribed External Appliances -Kes.150,000 within inpatient -Included corsets, crutches, wheelchairs, motored appliances, hearing aid
- Post hospitalization benefit- Kes.50,000 for follow-up reviews following admission.
- Rehabilitation & Drug addiction including Alcohol related admission- Kes.150,000.
- Last Expense - A cash benefit from Kes.150,000 per person payable to the nominated beneficiary. Benefit is payable within 48 hours, subject to provision of complete documentation.
- Oncology, Organ Transplant, Acute Renal and Peritoned Dialysis Organ Transplant (cost of donor or securing the organ is excluded -Covered up the chronic limit
- Free Health Education webinars/workshops – 3 sessions per year
- Political Violence & Terrorism & Political - full inpatient limit and outpatient limits
- Emergency evacuation - Road & Air ambulance within the country
- Home nursing palliative or analgesic care - State payable lumpsum.
- Critical Illness Lump sum cash pay-out upon first diagnosis of either cancer, stroke, heart
- attack, kidney failure or paralysis. State payable lumpsum.
- External Appliances & Internal Surgical Appliances and Prosthesis (wheelchair, crutches, lumbar corset etc.). per family – provide limit
- Non-motorized wheelchairs & cress – provide limit
International Treatment
- Cover Outside territorial limit.
- Overseas referral - for treatment not available locally. Cover on credit is available at select providers
- Provide list of available providers
- Provide limit/ sublimit.
- Air ticket in economy class for a scheduled flight & accommodation for patient accompanying guardian in case the patient is a minor
- Days covered outside Kenya in any one visit
- Lodger fees for accompanying guardian i.e. accommodation and meals for a guardian accompanying a dependent below the age of 12 years and or a Children with special needs covered up to 18 years.
N.B. For each proposed benefit and sub-limit, bidders must indicate whether they accept the prescribed limit by responding Yes or No, where no limit is proposed bidders must propose a limit and specify any proposed extension beyond the stated limits.
Note to Quote:
Please quote rate applicable for:
- Short term Cover or prorata premium calculation
- refund of premium when staff leave
- refund policy of medical expense incurred when staff use other medical providers
- Please quote any free rider on cover
- Waiting Periods
- There should be 2 dedicated contact persons assigned to the Tdh Kenya team
- The insurer will provide smart cards to employees and their dependents for easy access to services or allow them to use their existing smart cards.
- Reimbursements- will be 100% of the total costs.
Duration of Cover
The successful company will enter into a two-year contract with TDH-Kenya, subject to annual review based on satisfactory performance.
Criteria for Proposal Evaluation
The following criteria will be used in the evaluation of all bids. The submission of the required documents will be used in the determination of the Completeness and Suitability of the Bid. Bids that do not meet all the mandatory requirements will be declared non-responsive and shall not be evaluated further.
Mandatory Requirements
- Certificate of Registration – Must provide a copy of the certificate of registration
- CR12 – Must provide a copy generated within the last 6 months
- Registration with Insurance Regulatory Authority (IRA) – Must provide valid IRA registration certificate for provision of medical insurance cover.
- KRA Certificate – Must provide a copy of the certificate...