This has been this talk in town in Kenya about health insurance being a solution for the rich. It is not far from the truth since in the recent past a health cover would cost an arm and leg.
However, this has changed with the coming of micro insurance. Private health cover is no longer an expensive luxury out of reach for everyday individuals and young families
Micro insurance serves everyone who has an insurance need and wants to commit not so much money as premium on a particular cover of their interest.
In medical insurance, a lot of entry-level private plans and micro insurance solutions have come up. Medical insurance is now very affordable to everyone with an income.
Everyone needs a health cover. Settling medical bills out of pocket or through relying on public facilities or standard state cover can stretch household budgets.
Today, I will take you through the most affordable health insurance in Kenya, comparing them to help you secure a reliable backup shield without breaking the bank.
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Mandatory SHA vs. Private Budget Covers
The Social Health Insurance Fund (SHIF), managed by the Social Health Authority (SHA), is the Kenya universal health baseline.
It is the primary and mandatory healthcare cover for every citizen and resident, by law.
SHA just provides essential outpatient and inpatient care, maternity services, and chronic disease management across public facilities.
Since it offers mass coverage, tens of millions of Kenyans, public healthcare faces immense pressure daily.
While SHA provides the legal and basic financial safety net, relying on it alone during emergencies can introduce a lot of pain and inconvenience.
This is where a private health cover fits in so well into your financial plan.
Individuals and families use private medical insurance not to replace SHA but to gain fast-ticket alternative healthcare.
A budget private health insurance will help you avoid the long queues, access private and mission facilities, and a direct ticket to fast treatment in case of emergencies. In case of an emergency you get admitted without cash deposits.
What to Check on Individual Budget Plans
- Inpatient and outpatient covers. Most micro health insurance covers focus on both inpatient and outpatient (in most cases optional) covers. However, their limits are low as compared to the usual medical covers to ensure affordability. On the other hand, entry-level health plans, for example Britam Milele Health Plan Essential Plan are very comprehensive with high inpatient limits, but still very affordable. Both entry-level and micro medical insurance covers, however, limit the hospitals you can visit when you or your family member get sick.
- Waiting periods. When you enroll in a medical cover, waiting periods must come into action. For general illnesses, it usually lasts 1 month. For pre-existing and chronic conditions treatment, you will wait for about 12 months. Different medical covers have different waiting periods. Be on the lookout.
- Hospital panels and copays. Both entry-level covers and micro insurance medical covers usually allow Tier III private hospitals, mission and government facilities. This to avoid premium inflation. These selected hospitals are often paired with a fixed co-pay. Co-pay is the amount you pay before you see a doctor, often referred to as the consultation fee. The purpose of co-pay is to avoid misuse of the medical cover. For micro insurance, it will be about KES 500 or lower.
The Top 5 Affordable Health Insurance in Kenya
Britam Bima Ya Mwananchi
Bima Ya Mwananchi (BYM) is one of the most affordable medical micro insurance.
The plan is designed for low income earners and it is suitable for both individuals and families.
The maximum family size you can cover with BYM is a family of 7 members and must be nuclear.
All members must be below 65 years of age. The plan renews annually until they are 70 years old (exit age). If you are above that, you can turn to Britam Essential Milele Health Plan. The Essential Plan accepts anyone below the age of 80, and once you enroll, you can renew for life (no exit age). In a few, we shall discuss Milele Essential Plan.
BYM inpatient cover ranges from KES 75,000 and KES 500,000.
The outpatient cover has 3 sets, KES 30,000, 50,000 and KES 75,000.
Other special benefits that come with Bima Ya Mwananchi include maternity, dental, and optical covers, radiology, psychiatric, pre-existing and chronic conditions benefits.
Last expense and fire cash benefits are also included.
For general illnesses, you will for 1 month. However, there's no waiting period for accidents.
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).
Bima ya Mwananchi has a list of hospitals selected in every county in Kenya and they include Tier II and Tier III hospitals. You will be provided with the list once you enroll or request.
To learn more about BYM, go to this page.
Britam Essential Milele Health Plan
The Essential Plan is the most affordable cover of the comprehensive Britam Milele Health Plan.
Therefore, the essential plan is very comprehensive covering a lot of conditions including psychiatric, mental health, annual checkups, pre-existing, chronic, and congenital conditions.
It allows you to visit Tier III private hospitals, mission and government hospitals.
The inpatient cover ranges from KES 300,000 to 10,000,000 while the outpatient cover ranges from KES 30,000 to KES 200,000.
The waiting period for general illnesses is 1 month, and 12 months for pre-existing and chronic conditions.
To learn more about Milele Health Plan, read it here.
Jubilee Health CoverBora
Jubilee Cover Bora is another medical micro insurance designed for low income earners.
The plan is an inpatient-only cover to protect both individuals and families.
The inpatient cover is up to KES 500,000 and includes maternity, mental healthcare, ICU, surgery, diagnostics, pre-existing conditions, and drug treatment.
It covers up to 5 family members.
The waiting period for pre-existing conditions is 12 months.
Jubilee Cover Nafuu
Jubilee Cover Nafuu is a simple, affordable outpatient only that covers both individuals and families.
It allows you to choose your preferred clinics
Cover Nafuu includes chronic and everyday illnesses and check-ups.
Madison Betterlife Budget
Madison Betterlife Budget Plan is designed for both individuals and families.
The inpatient limit ranges from KES 500,000 to KES 1,500,000.
The inpatient cover ranges from KES 100,000 to KES 200,000 depending on the plan.
The Betterlife Budget Plan has three options, Option I, Option II, and Option III. Option III is the most comprehensive one.
It covers a range of treatments including congenital, psychiatric, chronic, maternity, dental, and optical, and pre-existing conditions.
For outpatient services, the waiting period is 30 days.
Chronic and pre-existing conditions waiting period is 12 months.
The maternity waiting period is 10 months.
| Comparison Metric | Britam Bima Ya Mwananchi | Britam Milele Health (Essential) | Jubilee Health CoverBora | Jubilee Cover Nafuu | Madison Betterlife (Budget) |
| Plan Type | Micro-insurance | Traditional Retail Tier | Micro-insurance | Micro-insurance | Traditional Retail Tier |
| Core Target Audience | Informal sector, low-income individuals and families of up to 7 (M+6) | Individuals & families wanting long-term comprehensive cover | First-time buyers looking for pure emergency protection | Individuals seeking cheap, day-to-day outpatient care | Cost-conscious retail buyers and young families |
| Estimated Individual Premium / Year | Age-tiered | Age-tiered | Family-size-tiered | Family-size-tiered | Age-tiered |
| Inpatient Limit Range (KES) | KES 75,000 to KES 500,000 | kES 500,000 to KES 10,000,000 | KES 250,000 to KES 500,000 | Not Covered | Starts at 500,000 |
| Outpatient Coverage | KES 30,000 to 75,000 | Optional Add-on (KES 30,000 to KES 200,000) | Not Covered | - | Optional Add-on (KES 100,000 to KES 200,000) |
| Chronic / Pre-existing Cover | Included Subject to Waiting Period (12 Months) | Covered Under Sub-limits After 12 (Months) | Included Subject to Waiting Period | Excluded (Acute care only) | Covered under sub-limits after 12 months |
| Maternity, Dental & Optical | Included | Included From KES 80,000 to KES 300,000 | Excluded | Excluded | Included as optional extensions |
| Primary Hospital Network | Selected Low-Cost Panel | Tier III Private Hospitals, Mission, & Government Facilities | Selected Clinics | Specific Partner Clinics | Panel B / General Ward Bed |
| Co-payment Terms | Varies By Facility | KES 500 at standard hospitals | Varies By Clinic | Fixed per-visit clinic fee | KES 1,000 standard co-pay |
| Illness Waiting Period | 1 Month | 1 Month | 1 Month | 1 Month | 1 Month |
| Standout Unique Feature | Absolute lowest individual entry point into private inpatient care. | Affordable entry into structured retail policies with high renewability. | Pure inpatient security that strips away outpatient costs to maximize limit. | Fixed-rate outpatient companion for individuals utilizing SHA for inpatient. | Excellent balance of tiered benefits utilizing a clear co-pay system. |
Smart Hacks to Lower Your Health Insurance Costs
- Leverage the mission hospital network. Britam Milele Essential Plan routes you to highly capable mission facilities (for example PCEA Kikuyu, AIC Kijabe, and Coptic Hospital) which slashes your premium compared to plans with open luxury private panels.
- Split your risk. Consider pairing your budget medical insurance cover with SHA. SHA will handle just the typical doctor visits while the private cover will handle private hospital emergency admissions.
- For small medical expenses, pay from your pockets letting major/emergency outpatient expenses to be handled by your private cover. That way, your limits won't deplete early.
Don't let medical expenses burden you and take away your peace of mind.
Kenyan market has a variety of medical micro-insurance policies that are very inclusive regardless of your budget.
These covers are designed for both individuals and families at a very affordable price tag.
If you are a family, Britam Bima Ya Mwananchi is very suitable for you. It offers both inpatient and outpatient covers, and includes dental, optical and maternity cover. Though the dental, optical, and maternity limits are low, it works almost like the traditional tiered plans at an affordable rate.
If you want a very comprehensive package for an individual or family, Britam Milele Essential Plan or Madison Betterlife Budget Plan will do you justice.
