Britam Bima Ya Mwananchi Review: Is This Kenya’s Best Affordable Medical Cover?

Britam Bima ya Mwananchi (BYM) is a health insurance plan targeting low to middle-income families and individuals looking for affordable health insurance in Kenya.

The health plan offers very affordable annual premiums as compared to premium medical insurance covers such as Britam Milele Health Plan. It starts from KES 17,000 for individuals and families up to KES 100,000.

Health costs keep on rising in Kenya and unexpected hospital admissions can wipe out your family savings. With changing national health schemes, such as NHIF to SHA, it is a wise decision to look for reliable and affordable health plan back-up. This is where Bima Ya Mwananchi by Britam fits in.

BYM is a low-cost micro-insurance product tailored for individuals, families, children (junior cover), and seniors.

In our review today, we intend to cover premiums, inpatient vs. outpatient options, hospital networks, and waiting periods.

• Britam Bima Ya Mwananchi Premium Calculator/Estimator

What is Britam Bima Ya Mwananchi?

BYM was invented with a philosophy of offering an affordable health insurance cover to the common citizen.

To be eligible for this cover, the member/applicant (represented as M in the plan) and the spouse must be between 18 and 65 years old at the time of entry or enrolment. The plan renews annually until they are 70 years old (exit age). Beyond this age, they can seek an alternative medical insurance cover such as Milele Health Plan. Britam however reserves the rights to renew cover, or not before expiry when the member and spouse reach this age.        

Children allowed under this plan are those between the age of 38 weeks and 18 years. Those above 18 years up to 24 years can be included if they prove they are students in school/college.

Under BYM, you can cover an individual (including seniors below age of 65), a family, or a child (junior cover). These are the various variants of Bima ya Mwananchi.

Core Benefits & Coverage Limits

Britam Bima Ya Mwananchi features an inpatient limit, which is the core feature, an output limit (an optional rider) and special packages that include dental, optical, and maternity limits including cesarean section limit.

1. Inpatient Benefit (The Core)

The inpatient limit is the core feature of this plan. Covers hospital stay bills, ICU/HDU, theater charges, and nursing care.

The inpatient shared limits range from KES 75,000 to KES 500,000 across 5 flexible plans.

A shared benefit means a share of the chosen impatient limit between the insured. For example, if it is a family medical cover, the inpatient limit in BYM is shared by the family members. A single family member can also exhaust the whole limit.

2. Outpatient Benefit (Optional Rider)

Outpatient limit is also a shared benefit and is matched with the chosen inpatient benefit.

It covers doctor consultations, lab tests, and basic pharmacy. Outpatient limits range from KES 30,000 to KES 75,000.

3. Special Packages

• Maternity Cover

The maternity benefit covers medical expenses related to pregnancy, childbirth, and postnatal care.

It shields expectant parents from high out-of-pocket costs by covering prenatal check-ups, delivery fees, and newborn care.

In Britam BYM, this cover limit is up to KES 20,000 to KES 30,000 depending on the inpatient and outpatient limits pair you have chosen.

• Dental Cover

Dental care covers routine dental consultations, gum disease, extractions, fillings, root canals, and dental X-rays. Dental care is covered strictly under the optional outpatient benefit, and is subject to a sub-limit based on the package you have chosen. It ranges between KES 3,000 to KES 7,000.

• Optical Cover

Optical treatment, like dental care, is tied to the outpatient limit and covers routine eye consultations, lenses, and frames.

It ranges from KES 3,000 to KES 7,000, depending on the package you have selected.

• Psychiatric Cases

Mental health is covered under both outpatient and inpatient wings of the Bima Ya Mwananchi plan but is always tied to the policy’s chronic illness waiting periods and sub-limits.

• Radiology

This sub-limit covers major scans including Endoscopy, Colonoscopy, CT scans, and Ultrasounds.

It is catered for in both outpatient and inpatient limits.

• Ambulance services for accidental

This is an emergency evacuation feature housed directly under the Inpatient Benefit. It is capped at a flat limit of KES 15,000 across all inpatient limits.

It has no waiting period since it is an accident benefit., and therefore, it is active from day one.

• Chronic & Pre-existing conditions

This benefit covers up to 50% of the inpatient limit.

Pre-existing conditions are illnesses, injuries, and health issues diagnosed with or having symptoms before starting a health insurance cover.

Chronic conditions are ongoing or long-term illnesses such as diabetes, hypertension and asthma before getting insured/covered.

• Last Expense/Funeral Cover

This is a built-in cash payout of Ksh 40,000 to the next of kin in the event of an insured member’s demise.

• Fire Cash Benefit

This cover features a one-time cash value of KES 5,000 in case an accidental fire destroys the insured residential property.

How Much Does it Cost? (Premium Breakdown)

To understand or estimate the premium you will pay for a particular combination of inpatient and outpatient limits, and the benefits therein, the following premium calculators and tables will help with that.

Bima Ya Mwananchi by Britam rates heavily depend on age of the insured and, therefore offers 2 calculators/tables for those below 40 years and those above 40 years.

The premiums also depend on the family size (principal member only [M], M+1, M+2, up to M+6), and chosen coverage limits.

Entry-level inpatient options start at incredibly low annual payments, making it highly affordable and competitive.

Britam Bima Ya Mwananchi Premium Calculator & Table for Members Below & Above 40 years

Bima Ya Mwananchi Premium Calculator For Members Below & Above 40 Years

Table 1: BYM Premiums For Members Below 40 Years

Table 2: BYM Premiums For Members Above 40 Years

The Waiting Periods (Avoid Claim Rejection)

When enrolling in any medical insurance cover, it is very important to read through the fine print.

This ensures that your medical claims are honoured by the insurance company.

In Bima Ya Mwananchi, there is a 1 month waiting period for general illnesses and natural death. This means you cannot enroll today and start using the cover tomorrow for general illnesses and natural death.

You have to wait for one month and from there, any medical claim you make is honoured.

However, in accident scenarios, there is no waiting period. It allows immediate coverage for hospitalisation resulting strictly from an accident.

For maternity and pregnancy-related treatments, as well as chronic and pre-existing conditions, there is a 10-month waiting period.

For non-accidental major surgeries, the waiting period is 1 year (12 months).

NB: Please note that waiting periods are only applicable for members who do not have an active medical cover running, even if it is with another company. For members under cover or those renewing, there is no waiting period.

What is NOT Covered? (Exclusions)

Health insurance covers do not cover all treatments. In BYM, the following treatments are not covered.

• Cosmetic treatments or weight loss procedures.
• Expenses already recoverable under other sources (like basic SHIF/WIBA double dipping).
• Certain optical/dental items like braces, cosmetic scaling, or contact lenses.
• Nutritional supplements unless strictly medical.
• Expenditure incurred arising from any illegal or criminal act.        
• Test/examinations, colonoscopy, fiber-optic investigations, and HSG.
• Examination or check-ups such as general health examinations not related to diagnosis of sickness or accidental bodily injury.        

How to Use the Cover & Hospital Network

BYM has a co-pay element which is shared between you and the cover, typically a flat rate of KES 500 per outpatient visit at designated facilities.

Bima Ya Mwananchi is only accepted in Tier II and Tier III hospitals. Tier II hospitals are mid-range hospitals such as Nairobi West and Avenue Hospital. Tier III hospitals are mission and government hospitals such as Kijabe hospital and Coptic Hospital.

This health plan is not available for use in Tier I hospitals. Tier I hospitals are premium hospitals such as Karen Hospital, Nairobi Hospital, and Agha Khan Hospital. They charge premium rates which BYM cannot accommodate.

If you need a medical cover with Tier I hospital included, you can enroll in Britam Milele Health Plan. It is a comprehensive and a little expensive cover with higher limits. Milele Health Plan targets middle class and high net worth individuals.

When visiting a hospital for treatment, it is important to refer to the panel of hospitals approved by Britam.

I will share that panel of hospitals with you. Every region has an approved list of hospitals especially for inpatient treatment.

In case of an emergency (e.g. an accident) and you are taken to a hospital not in our panel, you must notify Britam within 24 hours through the helpline indicated behind the card.

Britam Bima Ya Mwananchi is an affordable health plan targeting low to middle-income individuals, especially those in areas where Tier I hospitals (premium hospitals such as Nairobi Hospital, Karen Hospital and Agha Khan) are not available.

The plan is quite comprehensive in its class covering even pre-existing conditions, built-in last expense and maternity.

However, due to its affordability, it offers low inpatient and outpatient limits easy to exhaust in case of serious illnesses or large family size.

Again, it has strict waiting periods on non-accidental surgeries.

Is it the most affordable cover in Kenya? Yes, it is the most affordable cover in Kenya under private insurance providers. However, SHA is the most affordable health insurance package and by default your are eligible since it is a constitutional right for every Kenyan. You just need to be a contributing member.

Who is it best for? Bima Ya Mwananchi by Britam is best suited to self-employed individuals, young families on a tight budget, or anyone looking for an affordable inpatient safety net alongside their statutory insurance.

On application, you will be required to provide recently taken passport size photo of  yourself and for each one of the dependants that you want insured, a copy of your ID and that of your spouse (and birth certificates for your dependants).