Paying medical bills from your pocket is a dangerous way to live, especially where the decision is not of luck.
Even if you do not have deep pockets, nowadays there are micro-insurance medical covers that are very affordable.
Healthcare costs at top private hospitals are very high. In case you get a serious medical emergency or family member, that incidence can bring a major financial strain.
Today we are healthy and tomorrow we are not. Such is life and we live a reality.
For risks like medical expenses that can cause a sudden financial strain for households and SMEs, you do not retain such kinds of risks. You must transfer them and the best way to transfer such risks is to an insurer through their medical schemes.
This way you will have peace of mind and security knowing you or your family have a fund they can count on in case of a medical emergency.
Medical schemes create a pool of risks, and each member of the pool contributes according to the risk they are exposed to. When you are hospitalised the bills are paid from the pooled funds. Some members will get sick and others will not.
That’s why insurance companies ask you to pay a small premium as compared to the medical risk you are exposed to.
To ensure you and your family healthcare needs are well taken care of, today I will take you through the most comprehensive health insurance covers in Kenya that you must consider.
This write-up breaks down confusing sales language to present a clear look at structural limits, networks, and waiting periods across Kenya’s top private insurers.
Request A Medical Quote
Request A Health Insurance Cover Quote
Complete the form below and send your details instantly via WhatsApp.
How to Evaluate a Kenyan Health Insurance Cover
There are certain factors or things you should check when evaluating a health insurance cover in Kenya. They include:
- Bed Cap Limit: A plan might boast a high inpatient cover/limit only to put a hostile room limit. You should carefully check the bed cap limit for each and every plan. This is important because if one is admitted to a private tier I hospital with a high bed cost per night, you will be forced to pay the difference. That is not what we want here.
- Pre-existing & Chronic Illness Sub-limits: Again, high inpatient limits means nothing if you are getting very low pre-existing and chronic illness sub-limits. Some plans like Britam Milele Platinum Health Plan remove sub-limits completely to allow you to use your medical cover optimally. When evaluating a health insurance cover carefully check how the insurer treats isolated conditions like diabetes, hypertension, and cancer into smaller internal caps inside the main inpatient limit.
- Waiting Periods: Most covers have similar waiting periods for certain conditions. Accidents have no waiting periods. You get immediate coverage. Acute Illnesses take standard 30 days, chronic, pre-existing, congenital, and surgical such as fibroids and hernia take 1 year. Specialized conditions such as cancer and organ transplants take up to 2 years for the cover to take effect. Please note that I have just generalized the waiting period. A cover might come with different waiting periods. Be on the lookout.
- Co-payment: To discourage misuse of a health cover, insurers include a small amount that you pay before you see a doctor. This amount is higher in Tier I hospitals. However, you can avoid co-payment by paying a higher premium, usually a 10% additional mark-up of the annual premium amount.
Master Side-by-Side Comprehensive Comparison Table of The Top Health Insurance Covers In Kenya
This is a one-stop breakdown of the major Kenya insurers and their flagship health insurance covers.
| Feature | Britam (Milele Health Plan) | Jubilee (J-Care) | Madison Insurance (Betterlife) | CIC Insurance (Medisure) | Old Mutual (AfyaImara) |
| Max Inpatient Limit | Up to KES 10,000,000 (per individual or shared) | Up to KES 10,000,000 | Up to KES 5,000,000 | Up to KES 10,000,000 | Up to KES 10,000,000 |
| Max Inpatient Limit | Up to KES 200,000 | Up to KES 200,000 | Up to KES 200,000 | Up to KES 300,000 | Up to KES 200,000 |
| Daily Bed Limit Cap | Up to KES 28,000 | Up to KES 32,000 | Up to KES 20,000 | Up to KES 28,000 | Up to KES 26,000 |
| Pre-existing & Chronic Conditions Limit | No limit for Platinum Plan | KES 2,000,000 | KES 1,000,000 | Up to KES 1,500,000 | Up to KES 1,000,000 |
| Maternity Limit | Up to KES 300,000 | Up to KES 200,000 | Up to KES 200,000 | Up to KES 250,000 | Up to KES 200,000 |
| Co-payment Terms | Up to KES 1,500 | Up to KES 2,000 (Tier I Hospitals) | Up to KES 1,000 | Up to KES 2,000 | Up to KES 2,000 |
| Max Joining Age | Up to 80 Years | Up to 64 Years | Up to 64 Years | Up to 59 Years | Up to 65 Years |
| Exit Age Restriction | No Exit Age (Renewal For Life) | Exit at 65 Years | No Exit Age (Renewal For Life) | Exit at 65 Years | No Exit Age (Renewal For Life) |
| Pre-existing & Chronic Conditions/HIV/AIDS/ Cancer Treatment Waiting Period | 12 months | 12 months | 12 Months | 12 Months | 12 Months |
| Congenital Ailments Waiting Period | 12 months | 12 Months | 12 Months | 12 Months | 12 Months |
| Maternity Waiting Period | 10 Months | 12 Months | 10 Months | 12 Months | 12 Months |
| Unique Differentiating Factor | -Lifetime renewability-No limit on pre-existing and chronic conditions-5 plans to choose from | -6 plans to choose from | -3 plans to choose from | -7 plans to choose from | -5 plans to choose from |
Individual Breakdown of the Top 5 Medical Insurance Covers in Kenya
Britam Milele Health Plan
Britam Milele Health Plan is one of the most comprehensive health insurance covers in Kenya. The plan has a wide range of hospitals in its panel, including a variety of Tier I facilities.
The cover comes in 5 plans designed to accommodate different types of clients based on budget and individual preferences.
The 5 plans include Platinum, Gold, Silver, Bronze, and Essential plan.
Platinum is the most comprehensive cover with no sub-limits on pre-existing and chronic conditions.
Essential plan is the most affordable cover suitable for both individuals and families. It features Tier III private hospitals, mission and government hospitals.
The inpatient limit ranges between KES 300,000 to KES 10,000,000 per individual or shared between the family members. Maternity cover is up to KES 300,000.
The outpatient limit ranges between KES 30,000 to KES 300,000. Dental and optical covers range between KES 10,000 to KES 40,000.
The Milele allows a generous maximum age of 80 years and once enrolled, you can renew for life. No exit age.
Milele is suitable for individuals, families, SME, and corporations. There is a separate Milele cover for SME and corporates known as Milele SME.
Jubilee J-Care
Jubilee J-Care plan is yet another comprehensive medical insurance cover.
The cover offers an inpatient limit that ranges between KES 500,000 and KES 10,000,000. The maternity benefit ranges from KES 80,000 up to KES 200,000.
The outpatient limit starts at KES 50,000 up to KES 200,000 while dental and optical covers start at KES 5,000 up to KES 50,000.
J-Care comes in 5 plans: Prestige, Royal, Executive, Advanced, Premier, and Classic.
Prestige is the most comprehensive and expensive plan. Under this plan, pre-existing and chronic conditions cover is capped at KES 2,000,000.
Classic plan is their most affordable cover catering for low income earners.
The entry age for Jubilee J-Care is between 18 to 64 years and you exit when you reach 65 years.
J-Care is suitable for both individuals and families.
Madison Insurance Betterlife
Madison Insurance Betterlife is an insurance cover meant for families and individuals.
The cover entry age is between 18 to 64 years, and once you enroll you will remain in the cover for life subject to renewal.
The inpatient limit in Betterlife cover ranges between KES 500,000 to KES 5,000,000. The maternity cover is up to KES 200,000.
The Betterlife plan outpatient limit ranges from KES 50,000 to KES 200,000. Dental and optical benefits are up to KES 25,000.
Madison Insurance Betterlife has 3 plans: Premier, Executive, and Budget Plan. Within each plan, there are 3 options.
Premier plan option III is the most comprehensive one with a pre-existing and chronic conditions limit of KES 1,000,000 per family.
The Budget Plan option I is the most affordable designed for low income earners.
CIC Insurance Medisure
CIC Medisure boasts an inpatient cover of up to KES 10,000,000. Maternity benefit is up to 250,000.
The cover outpatient limit is up to KES 300,000, the highest in this list. Dental and optical covers range between KES 5,000 to KES 30,000.
CIC Medisure offers 7 plans: Platinum, Prestige, Premier, Superior, Comprehensive, Standard, and Essential.
Platinum is their most comprehensive and expensive plan. In this plan, pre-existing and chronic conditions cover is capped at KES 1,500,000.
Medisure has a built-in personal accident cover for the principal member.
The plan is suitable for individuals and families.
Old Mutual AfyaImara
AfyaImara by Old Mutual is comprehensive and suitable for individuals and families.
It offers 5 covers namely: Option I, Option II, Option III, Option IV, and Option V.
Option V is their most comprehensive cover and comes with an inpatient of KES 10,000,000. The pre-existing and chronic conditions are capped at KES 1,000,000.
The outpatient cover for Option V is KES 200,000 while dental and optical covers are KES 15,000 each.
The maternity benefit for all plans ranges between KES 50,000 to KES 200,000.
Option I of AfyaImara is the most affordable one and features an inpatient cover of KES 500,000 and an outpatient limit of KES 50,000. Dental and optical benefits are not offered under this plan.
Since we have seen what each of the above top medical covers in Kenya by different insurers offer, let us now jump to this question.
Which Cover Fits Your Exact Needs?
Generally, no cover fits your exact needs. You have to compromise here and there in different areas.
However, I can recommend a good cover for you. During my interactions with you later on when you contact me, I will hear out your needs and tailor a cover that best fits you and your needs.
- If you are looking for a comprehensive cover regardless of your budget, choose Britam Milele Health Plan. This cover is designed for everyone, from high net-worth individuals to low income earners. Milele Platinum plan (for high net-worth individuals) removes many sub-limits in certain conditions such as pre-existing and chronic conditions, letting consume all your inpatient cover in one single condition. If you are a low income earner, Essential plan is so compressive and yet very affordable. Again the entry maximum age is high accommodating a lot of people and once enrolled, you can renew for life. You won’t be kicked out.
- Jubilee J-Care and Old Mutual AfyaImara are also very comprehensive with a wide range of hospitals in their panel. You won’t go wrong choosing any of the 2 covers. Jubilee cover also has hospital panels across East Africa.
- Madison Betterlife and CIC Medisure are also very popular with individuals and families. Their cover is quite adequate enough to cater for everyone’s medical needs. Madison Betterlife co-pay is flexible depending on the plan you chose and if that is a factor to you, go for it.
Like I have said, no medical insurance cover is one fit all. Reach out to me via the form provided above or the listed WhatsApp link so that I can listen to your needs and plan a medical cover that fits you.
Thank you for being here.
Crucial Frequently Asked Questions
- Can an insurer change my premium rate if I fall sick frequently?
Yes. However, this happens during renewal. The insurer will send you a renewal notice at the end of your medical cover, sometimes with revised premium rate. You either decline or accept to renew with the new premium rate.
The same happens when you rarely use your medical cover. You will be offered a discount during renewal time.
- Can I retain my private health cover if I am fully registered under SHA?
Yes. SHA is the mandatory public medical cover. However, due to its limited medical coverage, it is advisable to enroll in a private medical cover to come through where it falls short.
Again, due to the sheer number of those enrolled in SHA, sometimes the cover service is slow. During a medical emergency, it may not keep up. This is where your private medical cover comes to save the day.
A private medical cover is comprehensive and services are top-notch.
