The cost of healthcare has risen significantly in Kenya. If you have a family, you are the most hit and you are feeling it.
We live hoping that we and our families stay the way we are, healthy. And it shall be.
However, we must plan if things go sideways and either us or a member of our family get sick. A single medical emergency can drain a family’s hard-earned savings.
We must plan accordingly to prevent this by enrolling our families in medical covers designed primarily for families.
Health insurance plans specifically designed for families have features that work so well for groups under a single subscription. They work so well as a standalone, but you can combine them with other covers including SHA.
The transition to the Social Health Authority (SHA/SHIF) makes private family insurance a crucial “top-up” or standalone shield for comprehensive care. If you are looking for peace of mind and security, please carefully consider a family health insurance cover.
In this write-up, I will take you through the best family medical insurance plans in Kenya that shall cover your family adequately at different price points. It is a clear roadmap to understanding terms, comparing top providers, and picking the right package.
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Understanding Private Medical Insurance vs. SHA (SHIF)
SHA is a mandatory public cover, and it is so because it is our constitutional right to access healthcare.
SHA has basic limits and is accepted by almost all public and private hospitals in Kenya.
Since it is a basic cover, it is quite limited. It is therefore important to top-up SHA cover with a private family health insurance plan.
A private medical insurance helps you and your family access Tier 1 private hospitals and offers higher sub-limits for specialized care, faster approvals, and dental, optical and maternity extras.
Some go above those basics to providing mental health care, including substance abuse rehabilitation. They are a one stop shop for every healthcare you need.
You can enroll in private health insurance as a standalone, without need for any other cover, since they are designed comprehensive and standalone. However, if you care about opinion, I recommend a hybrid approach where you also consider SHA.
SHA will cover some basic medical expenses reserving your private medical cover limits for that day when a comprehensive medical cover is needed.
Key Components of a Family Medical Cover
In this writer-up, I shall keep mentioning some terms or components that you should be familiar with that are crucial and frequently used in comprehensive private medical insurance.
- Inpatient vs. Outpatient Limits: Inpatient limit is the amount of cover allocated to medical expenses you and your family incur when you get admitted to a hospital and a bed is given. On the other hand, outpatient limit is the cover that is allocated to medical expenses you incur when you visit the hospital for treatment without admission. Inpatient and outpatient limits are well defined in a private cover e.g. KES 500k to KES 10M for inpatient and KES 50k to KES 300k for outpatient. You should also note that you might see other inpatient sub-limits depending on the cover you take. Sublimits define how the amount of money you can use on a particular condition.
- Crucial Add-Ons (Riders): These are benefits that add value to your health insurance. They are optional and you cannot wish them away in a family medical insurance because they matter a lot especially to children and their mother. They include:
- Dental & Optical Limits: Dental and optical covers are crucial especially for children’s routine checkups.
- Maternity Cover: Maternity cover is very essential for growing families and it is one of the coverage in private health insurance that is subjected to waiting periods. Private medical covers refuse to take up running projects relating to this.
- Pre-existing & Chronic Conditions: Most private medical insurance covers define how limits and waiting periods apply to conditions like hypertension, diabetes, or asthma.
- Congenital & Neonatal Conditions: Congenital and neonatal condition terms are well covered in private health insurance plans and they are very essential for newborns.
Let us now jump to the crucial part of this write-up, directing you to the best family medical insurance covers in Kenya.
Top Family Medical Insurance Covers And Providers in Kenya
Britam (Milele Health Insurance Plan & Bima Ya Mwananchi)
Britam Milele Health Plan
Milele Health Plan is Britam’s most comprehensive cover, well designed for both individuals and families.
Its scope is wide, covering almost all conditions including mental health and substance abuse rehabilitation.
It is tiered into 5 categories to promote affordability. The most comprehensive and premium plan is the Platinum category, and features no sub-limits.
Platinum category is followed by Gold and then Silver categories. If you purchase any of these 3 categories for your family, you have a cover even for the Tier I hospitals including Karen Hospital, Agha Khan among others. Gold and Silver plans apply sub-limits in inpatient limits. Platinum cover does not apply sub-limits and any condition can “eat-up” the whole inpatient cover/limit.
The other two categories are the Bronze and Essential categories. They are the most affordable covers. Bronze allows you to visit Tier II and Tier III hospitals while the Essential category covers Tier III, mission, and government hospitals.
Britam Milele Health Plan Inpatient limit for all categories starts from KES 300k to KES 10M either shared or unshared (per individual).
The outpatient cover starts from KES 30k to KES 300k for all categories. When you select outpatient cover since it is optional, you can pick dental and optical covers ranging from KES 10k to KES 40k. Optical and dental covers are crucial for your kids.
The maternity cover ranges up to KES 300k and is subject to a waiting period.
If you are looking for Innovation, superb chronic/critical illness coverage, and budget-friendly tiered entry options, Milele Health Plan is definitely for you.
Britam Bima Ya Mwananchi
Britam Bima ya Mwananchi is the most affordable private medical insurance in Kenya for both families and individuals.
It is one of the micro insurance covers in Kenya designed for low income earners.
BYM offers solutions to the most basic treatments that every family struggles with, without going big in limits to prevent the premiums from sky-rocketting.
The inpatient limit starts from KES 75k to KES 500k.
The outpatient limit starts from KES 30k to KES 75k.
Both outpatient and inpatient limits in this plan are shared benefits.
Bima Ya Mwananchi accommodates a family of up to 7 members.
You can check the premiums for Bima Ya Mwananchi here by yourself.
Jubilee Health Insurance (J-Care)
Jubilee J-Care is yet another great family medical insurance cover in Kenya.
The cover is designed for both individuals and families with inpatient cover ranging from KES 500k up to KES 10M.
It also features optional outpatient, maternity, dental, and optical benefits.
It has six flexible plan options and J-Care Prestige is the most comprehensive cover. Other plans include classic, premier, advanced, executive, and royal.
All the six plans have sub-limits applied to their inpatient cover. That means, no plan offers a situation where a single condition can “eat-up” all the inpatient cover.
Outpatient cover limit starts from KES 50k up to KES 200k per person per year.
Dental and optical limits start from KES 5k up to KES 50k per person per year.
The maternity coverage ranges from KES 80k to KES 200k.
AAR Insurance Medical Plans
AAR offers medical plans dedicated to individuals and families.
They offer both outpatient and inpatient covers and are very comprehensive, and the cover you get will depend on your pocket.
There are six plans available namely: Platinum, Gold, Silver Plus, Silver, Bronze and Cover Me.
The inpatient limits range from KES 1M up to KES 40M.
Cover Me has the lowest inpatient limit of KES 1M while the platinum plan has the highest inpatient limit of KES 40M.
Those inpatient limits for all plans are subject to inpatient sub-limits.
The outpatient limits start from KES 50k to KES 250k, with Cover Me plan having the least while Platinum cover takes the lead.
Optical and dental limits start from KES 5k to KES 25k.
Old Mutual (Afyaimara Family Cover)
AfyaImara Family cover is an enhanced medical insurance cover for Families.
The cover offers inpatient, outpatient, dental, optical, and maternity covers, including chronic conditions.
The plan’s Inpatient limits range from KES 500k to KED 10M.
The outpatient cover is optional and ranges from KES 50k to KES 200k.
Afyaimara Family Comes in 5 options namely: Option I, Option II, Option III, Option IV, and Option V.
Option V is the most comprehensive with a maximum inpatient limit of KES 10M and outpatient of KES 500k.
Option I is the least comprehensive with a maximum inpatient limit of KES 1M and outpatient limit of 50k.
For Option III, Option IV and Option V dental and optical limits range from KES 10k to KES 15k.
Option I and Option II plans do not feature optical and dental limits.
Maternity covers range from KES 50k to 200k.
CIC Insurance Group Medisure Family
CIC Medisure Family inpatient ranges from KES 300k to KES 5M.
This family health insurance comes in 6 plans namely: Prestige, Premier, Superior, Comprehensive, Standard, and Essential.
Premier is their most comprehensive cover while Essential is the least and most affordable cover.
Premier cover inpatient limit is KES 5M while Essential has an inpatient limit of KES 300k.
Critical Things to Avoid When Buying a Family Cover
When you enroll in a health insurance cover, there are certain things you need to know.
I will list the most important things you must always remember so that you stay well guided.
- Do not ignore the waiting periods. For normal illness you wait for 30 days. 9 to 12 months for maternity, and 12 to 24 months for chronic illnesses and pre-existing conditions.
- Do not overlook the sub-limits. For inpatient and outpatient limits, in many instances you will find that each condition or Illness has a particular amount allocated to it and you cannot exceed that allocation. Those allocated amounts are called sub-limits.
- Carefully note the co-payment feature. Understanding “co-pay” requirements when visiting a hospital is important e.g. paying KES 1,000 out of your pocket per visit.
- Carefully note the panel matrix. Check if your preferred family hospital, e.g. The Nairobi Hospital, Aga Khan, Gertrude’s for kids, is on the specific plan’s active panel.
Key Secrets in Health Insurance
- You can cover more of your family, even children above 18 years. Every child in your household below the age of 25 is eligible to be in the cover as long as they are in school. You just need a letter from college to prove they are still in school.
- The outpatient element of Medical insurance cover is the one that makes health cover expensive. My recommendation is, just opt in for a very small inpatient limit for emergencies and instead focus more on the inpatient cover. The money that you will keep as a result of lowering the outpatient cover, put it in an investment account and you can use it for medical emergencies (chat on the WhatsApp link provided to open an investment account for emergencies)
How to Apply for Family Medical Insurance In Kenya
- Assess your family’s needs: (Age of members, maternity plans, regular prescriptions).
- Fill out the medical application form available above. I shall give you material disclosure to avoid claim rejections later.
- You might undergo a medical examination, usually for family members over 60 years old.
Health insurance isn’t an expense, but an investment in peace of mind and security.
Future medical expenses are not one of those risks you retain. They are those risks you must transfer to an insurance company so that they can handle the situation in case of enormous medical expenses.
To request a family medical insurance cover in Kenya, kindly fill the form provided above, and I shall get to you in no time.
