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How to Pick the Ideal Health Insurance Cover in Kenya

Article by Maureen Kasuku
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Posted: June 27, 2020  

June 28th– Insurance Awareness Day. It is observed to sensitize people on the importance of protecting their assets, their health and that of their loved ones and also cushioning themselves against unforeseen adversities by taking up insurance covers tailored for their specific needs.

Data from Association of Kenya Insurers (AKI), reports that life and health insurance uptake in the country is only at 6%.  This largely due to the fact that the working class in Kenya is an income-sensitive population whose disposable incomes have dwindled over the years and with an impending recession, growth might be painfully slow.

On the flipside, Deloitte’s internal projections show the insurance industry is expected to experience growth in gross written premium in line with historically observed growth rates. It’s going to get cheaper to get health insurance which is the most sought after insurance product in Kenya.

Here are considerations to prioritize when choosing a health insurance cover for you and the family:

Budget

Don’t break the bank to obtain a health insurance cover. Have a payment plan if you can’t raise the whole amount at a go. Various banks in Kenya offer a good Insurance Premium financing (IPF) for all. Cheap is always expensive so do not jump into an offer before doing your due diligence. If the family can manage their outpatient requirements and costs, then chose a lower outpatient limit or do away with it so as to spend more on inpatient limit. 

Family’s health concerns

Before choosing your ideal medical cover in Kenya, consider your family’s current concerns and needs. These can include age as most insurance products have premiums linked to age of the family members. Another consideration is present ailments if any, as well as your family’s medical history.

Check for any pre-existing diseases/conditions or a surgery that predisposes the family member to infections and risk of reoccurrence. Insurances companies are very rigid about these things and lying about any of them will be considered insurance fraud with serious consequence.

Benefits and Cover Limits

Choose the amount (cover limit) wisely as it covers the medical expenses for a whole year. One might have the impression that the younger they are, the lower the sum insured they need and vice-versa which is not necessarily true.

The actual cover limit for the different benefits should be driven by your family health concerns more than your budgetary capacity. Lower limits have the risk of being depleted fast due to the ever-increasing cost of standard of care.

Most benefits have sub-limits of capped/bundled benefits such as pre-existing, cataract, first-ever emergency caesarean section, etc. put these benefits on a comparative scale when finalizing your selection of benefits.

Claim Process

An ideal cover should settle claims without unnecessary complications. Here, referrals from known people helps and getting some research done on the institution would go a long way

 Maternity benefits

It is vital for women to buy a health insurance in Kenya plan that offers maternity benefits. For maternity benefits, one should look into the waiting period applicable for claiming maternity expenses and consider the sub-limit. The policy should also cover outpatient expenses and check for exclusions related to the policy.

Post hospitalization Aspects

After hospitalization, some expenses may occur—the expenses include follow up with the doctor, medication and therapy.  

Renewal

Before buying health insurance in Kenya, look for policies which offer renewal option beyond the retirement age. There is a higher chance of suffering from diseases and illnesses when you are old compared to when you are young—a health policy which offers senior age coverage is what you should buy.

Medical Check-up

Look for a health insurance company in Kenya which insures the person for a free medical check-up if required at inception of cover or renewal time. This reduces extra costs involved in obtaining a cover.

Evacuation Options

Consider taking up an insurance that’ll cover air and road evacuations in case of accidents However, evacuation costs do take more from the sum assured right before hospitalization charges. One should consider an evacuation cover which are affordable to obtain and do not deplete your medical cover limits when needed most.

Insurance Companies in Kenya Offering Health Cover:

Jubilee Insurance

They have a product particularly tailored for individuals and families. With their innovative J CARE product, you have the option to choose where and how you will receive your treatment. On top of this, you will also have the “JubiCare App” with easy to use interface.

 Jubilee health coverage is available for all individuals aged between 1 month and 17 years for children and 18 to 60 years for adults. However, interested adults over 50 must have a medical examination from their certified centres before enrollment to the program.

 UAP Insurance

The company is not just a regular health insurance provider. You will have the option to choose from a plan that best suits your needs. Some health coverage plans offered by UAP insurance include:

 Afya Imara Junior: This is specially tailored to cover your children below the age of 19.

Afya Imara Executive: Offers a worldwide coverage plan that extends up to Ksh10 million for individuals and up to Ksh. 20 million for Families for inpatient services.

Afya Imara Seniors: This plan covers individuals between 66 and 80 Years of age.

Afya Imara County: You will be covered within county-level hospitals across Kenya.

Afya Imara: Covers treatment across Africa and overseas, get up to Ksh. 5 million for inpatient services.

Madison Insurance

This health insurance company in Kenya covers individuals between those ages of 3 months up to 70 years old. However, only individuals below 55 years of age can get enrolled in this health coverage plan. Also, their payment policy is quite flexible. There is no waiting time in case of accidents, 90 days for surgery, and 30 days for illness.

APA Insurance

They have an affordable and comprehensive health insurance plan called Jamii Plus & Afya Nafuu. This health coverage combines Pre-existing, accidental or reconstructive surgery, Chronic, Congenital, cancer treatment, HIV/AIDS-related conditions, organ transplant, lodger fees, among many more others. See below benefits

 Outpatient cover

Post hospitalization benefit

Maternity cover

Overseas inpatient referrals covered on credit under the listed hospitals

Dental & Optical Cover

Last expense cover

Personal Accident Benefit Cover

Britam Health Insurance

Their medical insurance is popularly known as Mediflex. It covers both inpatient and outpatient services. Britam health insurance plan exceeds just personal Insurance. It also offers its services to NGOs, any registered company, and Chamas with over 10 members.

Sanlam Kenya

It was formerly known as Pan Africa Life insurance. The company has its branches in all major towns in Kenya and is a market leader in life insurance. In the section of health insurance, the company partnered with Bonitas and Fedhealth medical schemes to provide a flexible medical plan for both individuals and families.

Heritage Insurance

This is another top health insurance company in Kenya. They enable you to choose from personal or family cover. Their plans are also diverse and include:

Resolution health insurance

Just like the other health insurance companies in Kenya. They also have individual and family packages to choose from. Plans include:

Harmony Plan: Provides high-quality in-patient services shared within a family.

Value plan: Provides high-quality, in-patient healthcare services for individuals.

Outpatient Plans: Provides a wide range of outpatient services for their clients.

Faraja Plan

 

*Association of Kenya Insurers

About the author

Maureen Kasuku

Maureen is our resident cat lady and Beyoncé stan. She writes about spas, brunch and ballet recitals but has never been to any. Moonlights as a social justice activist in her spare time. She knows things and is obnoxiously opinionated on the internet but not in real life

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