In one of my previous articles, I discussed medical insurance cover. In this one, allow me to just focus on the various types of medical insurance available in Kenya.
Medical insurance in Kenya is usually provided through private, public, employer-based and specialised schemes. I work for and with Britam, and therefore, I will talk more about private plans. At least I know with certainty that private medical covers deliver. They are very effective and efficient.
The purpose of this write-up is to help you choose a medical cover that suits you best based on your needs. The government of Kenya replaced the National Hospital Insurance Fund (NHIF) with the Social Health Authority (SHA), and besides this national insurance cover, I am here to show you what else you need.
Types of medical insurance differ based on who provides the cover, who is insured, levels of services covered and the budget – informed by the premium charged.
There are so many factors that determine the type of medical cover you pick, some of which I have just highlighted above. They include premium costs, coverage limits, waiting periods, the hospital network included, pre-existing conditions coverage, and claim process efficiency.
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Types of Medical Insurance Covers in Kenya
Public Medical Insurance Covers
We can simply say that this type of medical cover is supported by the government of Kenya, in the name of the Social Health Authority. SHA is the current national health insurance body mandated to offer universal health coverage.
Every Kenyan citizen is entitled to SHA and is highly subsidised to accommodate everyone, including low-income households/earners. Those employed make mandatory contributions to the authority, and if you are self-employed, you are required to make your own contributions. I would advise you to make the necessary financial arrangements to have you covered in SHA. SHA will indeed cover you to a great extent, especially if you don’t have another medical insurance. If you already have a private medical cover, or you are considering taking one, SHA helps to cover part of your medical expenses, ensuring your private health insurance doesn’t deplete fast due to unnecessary charges already under the government’s universal health care. As I said, my bias is on private coverage, the one I deal with every day. Thus, allow me to leave this at that.
Private Medical Insurance Covers
If you need medical insurance that covers almost everything, and the only constraint is your budget, it is private health insurance.
Private medical insurance gives clear details of its scope (including diseases and conditions under coverage) and the premium you pay. Private medical covers are designed to include everyone based on their budget, but we can say they are not cheaper than the national health cover. Some have expensive premiums that can buy you a car, and others are more budget-friendly, just a few thousand.
Premium ones cover almost all conditions, and you can visit any hospital in Kenya, including the Tier 1 hospitals, up to international hospitals. They offer very high coverage limits for inpatient, outpatient, dental, optical, and maternity.
The budget ones are more premium/cost-friendly, and you just pay a few thousand. However, they are limited in scope with lower outpatient and inpatient limits. They barely have standalone dental and optical limits.
Private medical covers’ biggest advantage is that they offer a wide scope of coverage, and their claim process is effective and efficient. They pay immediately and are widely accepted; almost all hospitals accept them.
In medical insurance, there is what we call the waiting period. Waiting period refers to the time you have to wait before the medical cover takes effect from the time you subscribe/register for one. It is meant to reduce abuse of the cover. Private medical covers have short waiting periods.
Private health insurance covers are offered by insurance companies such as Britam Insurance, Jubilee Health Insurance, AAR Insurance Kenya, CIC Insurance Group, Madison Insurance, Old Mutual Insurance, and many others.
The biggest disadvantage of private health insurance is its premiums. They cannot be highly touted as affordable as the public cover.
Under the Private health insurance, we have other types of covers, and they include:
- Individual medical covers, designed to cater for single persons, are suitable for self-employed people and freelancers.
- Family medical covers, tailored to fit the needs of multiple family members, from the principal, spouse, to children. They give the option to either share the coverage limits amongst the family members or a standalone limit for each family member. They are often cheaper than individual medical covers.
- Corporate medical insurance, provided by the employer to employees. They fall under group plans and have lower rates/premiums because of the economies of scale. They mostly cover inpatient, outpatient, maternity, dental and optical.
- Junior medical covers, meant only to cover the young ones.
- Senior citizen covers, designed for older adults with higher health risks. As such, they have high premiums and longer waiting periods for pre-existing conditions.
- Micro health insurance, tailored to cover low-income individuals or households. They charge low premiums and just offer basic health insurance, and are often delivered through community programs.
Community-Based Health Insurance Cover
These are organised by community groups or cooperatives, where members contribute small amounts regularly. The amounts raised help to support healthcare expenses within the community.
These schemes are usually available in rural areas and in the informal sector.
International Medical Covers
International medical covers fall under private covers, and are designed to allow the insured/policyholders to receive treatments outside Kenya.
They are necessary where one wants to receive advanced specialised treatment or access advanced medical facilities.
They are meant for high-income individuals/professionals, business executives, and expatriates.
You can partition medical insurance cover in so many ways, but the way we have partitioned it is the simplest way to understand it.
And up to here, the choice is clearly defined. First, you have to pick the national insurance cover as it is meant for every citizen of Kenya, and you are entitled to it by virtue of being a citizen and a taxpayer. It is not a favour but a constitutional right.
Second, you choose a private medical cover to seal the health care gap left out by the national health insurance, based on your budget, preferences, and needs.
At Britam Insurance, we offer private medical insurance for everyone. We have a low budget cover, a junior medical cover, a corporate cover, an SME cover, and a middle to high-income medical insurance cover. By name, we have Bima Ya Mwananchi (BYM), Milele Health Cover, Milele SME, and Milele Junior.
If you need a free medical quote, just request it here. My WhatsApp link is provided below. Thank you for being here, and your company is much appreciated. Leave us a comment by asking a question or contributing to this topic. Goodbye for now.
