If you get hospitalised now or any of your family members and get a hospital bill of KES 2,000,000, what will you do? Can you foot it with your income or savings? This is where a medical insurance cover comes in handy.
I am not trying to create fear in you. I am just trying to show you the eventualities of life. There are many certain things in life, and one of them is that we must get sick. It is an inbuilt body weakness, mostly amplified by our lifestyle. Sickness comes, accidents come, but are you ready? Let’s say you can foot that hospital bill. The next question will be, why spend all that money, maybe your fortune, when you can just pay a non-significant portion of it? Medical insurance cover is designed to amplify the little you pay as a premium to cater for huge hospital bills.
I help Kenyans make better financial decisions every day. I can help you too. Reach out for a quick, free quote or consultation on medical insurance cover.
What is an Insurance Medical Cover?
A medical insurance cover is a premium you pay, mostly a single yearly premium, to cover bills for a wide variety of diseases, conditions, and accidents. The little premium you pay is highly amplified to cover even the most expensive treatments.
Medical cover entails inpatient, outpatient, maternity, dental, and optical limits. Inpatient cover/limit is the basis of a medical cover, and all other covers are optional.
All these covers have a limit which you select, and these limits define or dictate the premium you pay. High limits attract high premiums.
Medical covers are flexible and cater for different budgets. Even those with low income can afford a cover. For instance, at Britam, we have Milele health cover tailored to cover all budgets. This cover has different categories reflecting different budgets, where the Essential category charges the lowest premiums, followed by Bronze, then Silver, Gold, and the most expensive/premier cover, which is Platinum.
If you take a low-budget option, any medical cover will limit the amount of Inpatient, outpatient, maternity, dental, and optical coverage you get. It also limits the types of hospitals you can access.
Hospital Tiers
In medical insurance cover, budgets determine the hospital you can access, and hospitals are divided into 3 tiers: Tier 1, Tier 2, and Tier 3. Tier 1 hospitals are those hospitals that offer the most advanced treatments and consultations, while Tier 3 hospitals are those hospitals that offer treatment for basic diseases, conditions, and injuries. Tier 2 hospitals are between Tier 1 and Tier 3 hospitals, and will offer good treatment to a range of diseases before referral to Tier 1.
Examples of Tier 1 hospitals include Nairobi Hospital, Agha Khan, Mater Hospital, and Karen Hospital.
Tier 2 hospitals include Nairobi West Hospital, Metropolitan Hospital, Meridian Medical Centre, Bliss Medical Centre, Avenue Hospital, e.t.c.
Tier 3 hospitals are government and mission hospitals, including government referral hospitals and include Kenyatta hospital, Kijabe, Coptic, St. Francis hospital, Uhai Neema, and many others.
Insurance companies provide a list of hospitals in their panel for each Tier. If you want to see them, just chat with me here, and I will provide you with Britam’s panel of hospitals. I also generate medical cover quotes for free.
Component of Medical Cover
Inpatient Cover
Inpatient cover refers to the limit assigned to a person when they are admitted and given a bed in a hospital.
It covers a wide range of diseases/conditions, and you can choose a wide range of limits ranging into millions, which you can decide whether to be shared or non-shared between/among the covered members.
For example, our Milele health cover has 6 limits which can either be shared or non-shared. It starts from 300k, to 500k, 1M, 2M, 5M, and 10M for each category (Essential, Bronze, Gold, Silver, and Platinum)
Outpatient Cover
This cover refers to hospital bills incurred in the same day appointments, tests, procedures, and don’t require an overnight hospital stay.
Medical covers are also designed to offer different outpatient limits, and these limits barely reach KES 500,000.
Outpatient cover can also be shared or non-shared, and that entirely depends on your budget.
Maternity Cover
Maternity cover caters for expenses for hospitalisation during childbirth. This includes normal deliveries, C-section deliveries, nursing costs, and other inpatient services.
Please note that pregnancy period clinics are covered under outpatient and inpatient covers.
Optical Covers
Optical cover refers to expenses related to the examination of your eyes and the recommendation of prescription glasses and contact lenses. This cover does not include eye cosmetic (any addition or rectification that enhances your look/beauty) changes. Some advanced eye procedures are covered under inpatient coverage.
Dental Cover
This refers to expenses related to preventive, restorative, and orthodontic dental care. Some advanced dental procedures are covered under inpatient care.
Dental cover is also segmented according to different budgets, mostly ranging from KES 10,000 to 40,000.
Who Can You Cover Under Medical Insurance?
Anyone can be covered under medical insurance. You can choose to cover your whole family, or just cover the most vulnerable. You can also decide to cover members based on your own bias.
And because of these reasons, many insurance companies come up with niche-focused medical covers. You will find Junior only covers to cater for those who just want to cover their young ones, and covers dedicated to the whole family with options to leave out some members. You can choose to leave out your spouse (if single or they are far away, sijasema kitu mimi) or leave out some of your children (maybe cover the only vulnerable) and so on.
You can also choose to cover your parents, where you pay their premiums.
Britam has medical cover designed for the whole family or part of it, and we call it Milele Health Plan. We also have Milele Junior for covering only the young ones, and Bima Ya Mwananchi. I will cover our Bima Ya Mwananchi later on.
Medical Insurance Categorisation According To Budget
Insurance companies have come up with ways of covering everyone by including every budget. Regardless of your income, you will find a medical cover product specifically tailored to you.
There are high-end/premier medical insurance plans for high-income earners, covering a wider range of diseases/conditions than usual and mostly do not apply sublimits for each diagnosis. These medical insurance covers allow you to access all the premier hospitals, including Tier 2 & 1. Britam Milele has a category we call Platinum, which has no sublimits and covers a wide range of diseases/conditions.
Mid-range covers often have sublimits applied to each diagnosis, limiting the amount you can use of the allocated inpatient budget. They also allow access to Tier 1,2,&3 hospitals. Britam’s mid-range categories include Gold and Silver plans, with sublimits applied to each diagnosis.
Low-budget medical insurance covers have limits for each diagnosis and only allow access to Tier 3 hospitals. Their premiums are set low for affordability. Britam’s Milele Health Plan has a category known as the essential for low-income earners and for those in areas where Tier 1 & 2 hospitals are hard to find. Again, Britam has Bima Ya Mwananchi (BYM) health insurance cover for low-income earners. BYM accommodates both individuals and families.
Medical Insurance Cover Waiting Periods
If you are newly introduced to a medical cover, you are subject to a waiting period. This is to curb people taking advantage of the cover, where, when one gets sick, they enrol immediately and push the bills to the insurance company.
For outpatient, dental, and optical, you will be subjected to roughly a 30-day waiting period. For maternity, you will be subjected to a 10-month waiting period.
For Inpatient acute conditions, you will roughly wait for 30 days. Newly chronic, pre-existing, and congenital conditions have longer waiting periods. Longer waiting periods also apply to non-accidental surgeries. Accidental cases have no waiting periods.
If you have an existing medical cover, you are not subject to the waiting periods.
Co-pays in Medical Insurance Cover
Cover is an arrangement where the cost of medical consultation is shared between the insurance policy and the covered individuals/insured. This fixed fee is there to prevent abuse of the medical cover, where the individual covered will not necessarily visit a hospital without a good reason. It also helps you and the insurance company to avoid higher medical expenses by sharing the cost.
You can altogether eliminate co-pay by paying a higher premium for your cover.
Eligibility for Health Insurance Cover
For the principal and spouse, the minimum entry age is 18 years, and the maximum entry age is 80 years. There is no exit age, meaning you will remain covered all your lifetime. Most health plans consider children to be individuals between age 0 and 25 years.
If you are older than 55 years and above, you will be subjected to a medical checkup, and you are the one, in most cases, to foot the bill.
Required Documents
When seeking to be covered, the principal will produce the National Identity Card/Passport and Pin Certificate.
For the spouse, a National Identity Card/Passport is required.
For children, you need to produce their birth certificates or legal adoption papers/affidavit.
I shall leave at that. If you have any questions or contributions concerning medical cover or insurance in general, please post them in the comments section. I offer free quotes, including medical cover quotes. Feel free to ask or consult by chatting or calling me.
Hello there! I am David Ndiritu. I am a financial advisor at Britam. My role is to advise you on investments, savings, pensions, protection, medical insurance, education policies, and general insurance, including motor insurance. I am passionate about what I do, and I derive great satisfaction when we find a solution together to your financial goals. If you are looking for a financial solution related to insurance, investment, or pension, chat with me or give me a call. You can also ask for a QUOTE FREE OF CHARGE. Thank you, and I am happy you are here, my dear reader.
