If you are a parent, Junior medical cover for your children is a must. It gives you the peace of mind you need from financial and emotional stress of sudden pediatric illnesses or unexpected hospital stays.
Insurers have made it easy to secure your children’s health insurance in Kenya by offering you alternatives. You can either take care of their health by enrolling in a family medical cover, which includes all your children as dependents or as a standalone junior medical cover, where no adult is covered.
Since I have extensively covered family medical insurance in a different article, today, I will concentrate on health insurance for children in Kenya. I will lay down the available options, key benefits, provider options, and common exclusions.
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Standalone Child Covers vs Family Medical Plans
Before we proceed, let me show some differences between the family medical and junior medical covers in Kenya so that you can make an informed decision on what solves your family medical needs.
Junior Medical Insurance
Junior medical insurance only covers children only, usually between birth/37 weeks to age 18 to 24 years. If above 18 years, they must prove they are still in school.
Junior medical insurance is suitable for parents who are in the employer's medical scheme, but their children are not included or those who need to supplement the cover they are already in. It is also suitable for guardians or people who want to cover children that are not directly attached to them.
Family Medical Plans
Family medical covers in Kenya cover principal members, spouses and children under them as dependents under one overall limit.
The cover is suitable for families seeking shared inpatient and outpatient covers.
Key Benefits to Look For in a Child Health Cover
Before enrolling in a junior medical cover, here are key benefits that you must carefully observe.
- Inpatient Care: This is the basis of any medical cover and and in junior medical cover it includes hospitalization fees, ICU/HDU, surgeon fees, lodger fees (accommodation for parent accompanying a child under 12 years). You should select an inpatient limit that meets the medical needs of your children.
- Outpatient Care: In health insurance for children in Kenya, outpatient care usually includes pediatric consultations, lab tests, and prescribed drugs. The outpatient should be enough to at least cover you especially when you do not have cash to spend with your children outpatient visits.
- Vaccination and Well-Baby Clinics: Check whether your junior medical cover includes coverage for both KEPI (government schedule) and baby-friendly/private vaccines such as rotavirus, pneumococcal, and flu shots.
- Congenital and Pre-existing Conditions: Carefully check the sub-limits and waiting periods within both inpatient and outpatient limits for pre-existing and congenital conditions.
- Dental and Optical Add-ons: Ensure the health insurance cover you choose for your children include routine checkups, fillings, and corrective lenses.
Top Standalone Health Insurance For Children in Kenya
Now let us go through the most comprehensive junior medical covers in Kenya.
| Insurer | Junior Medical Cover | Entry Age/Exit Age | Inpatient Limits | Outpatient, Dental & Optical Limits | Hospital Panel & Key Highlights |
| Britam Insurance | Milele Junior | -Entry age: 37 Weeks to 18 years.-Exit at 18 and Join Milele Health Plan. | Up to KES 5,000,000 | -Up to KES 150,000 outpatient limit-Up to KES 40,000 optical limit-Up to KES 40,000 dental limit | -Tier I, Tier II and Tier III hospitals.-Milele Junior has 4 plans for affordability: Advantage, Premier, Essential I, and Essential II. |
| Jubilee Insurance | J-Care Junior | Entry age: 0 to 17 years | Up to KES 10,000,000 | -Upto KES 200,000 outpatient limit-Up to KES 50,000 dental limit-Up to KES 50,000 optical limit | -Tier I, Tier II & Tier III hospitals-J-Care Junior has 6 plans: Prestige, Royal, Executive, Advanced, Premier, and Classic plans. |
| Old Mutual Insurance | AfyaImara Junior | -Entry age: 37 weeks to 18 years.-Children above 18 years and below 21 years are eligible as they show proof that they are in school | Up to KES 5,000,000 | -Up to KES 150,000-Up to KES 15,000-Up to KES 15,000 | -Tier I, Tier II, and Tier III hospitals-The cover has 4 plans available: Option I, Option II, Option III, and Option IV. |
| KCB Bancassurance (Cover provided by Jubilee Insurance) | Simba Health Junior | -Entry age: 0 to 18 years.-Children above 18 years and 24 years need to prove formal schooling. | Up to KES 8,000,000 | Up to KES 250,000 | -Tier I, Tier II, and Tier III hospitals-The cover has 6 options to choose from |
Britam Milele Junior
Britam Milele Junior health plan is one of the most comprehensive health insurance covers for children in Kenya.
The plan offers an inpatient limit of up to KES 5,000,000 depending on the plan you enroll in.
The outpatient limit ranges up to KES 150,000 while dental and optical limits range up to KES 40,000 each.
Both Milele Junior inpatient and outpatient limits are adequate to cover your kids adequately with no need for extra cover.
You will enjoy Tier I, Tier II and Tier III hospitals depending on the plan you enroll in. Milele Junior medical cover has 4 plans: Advantage, Premier, Essential I, and Essential II.
Advantage is the most comprehensive cover of all, followed by Premier Plan. They both offer Tier I, Tier II, and Tier III hospitals.
The Essential I and Essential II plans are more affordable. Essential I allows you to visit Tier II and Tier III hospitals while Essential II just allows access to Tier III hospitals only.
The starting price for all plans with the minimum inpatient cover of KES 500,000 and an outpatient limit of KES 50,000 start at:
- Advantage Plan: KES 59,655
- Premier Plan: KES 43,052
- Essential I: KES 35,449
- Essential II: KES 33,705
Milele Junior accepts children between the age of 37 weeks to 18 years. Upon obtaining the age of 18 years, the new adults are transferred to Britam Milele Health Plan.
Jubilee J-Care Junior
Jubilee J-Care Junior is yet another suitable medical cover for your children.
The cover offers an inpatient limit of up to KES 10,000,000 and an outpatient cover of up to KES 200,000. Dental and optical benefits range up to KES 50,000 depending on the plan you select.
J-Care Junior has 6 plans. Prestige is the most comprehensive cover followed by Royal, Executive, Advanced, Premier, and finally Classic plan.
Only kids between the age of 0 to 17 years are eligible.
Old Mutual AfyaImara Junior Medical Cover
AfyaImara Junior features an inpatient limit of KES 5,000,000 and an outpatient of KES 150,000. Dental and Optical range up to KES 15,000 depending on the plan you have choosen.
The cover has 4 plans: Option I, Option II, Option III, and Option IV. Option IV is their most comprehensive cover while Option I is the least comprehensive.
AfyaImara Junior covers children from the age of 0 years (after discharge from hospital)
up to the age of 18 years. It extends to those above 18 years but up to a maximum of
21 years, with a show of schooling.
KCB Simba Health Junior
KCB Simba Health Junior is a bancassurance junior health cover tailored in collaboration with Jubilee Insurance.
The cover Inpatient limit ranges up to KES 8,000,000 while the outpatient cover goes up to KES 250,000.
Simba Health Junior has 6 plans and the entry age is between 0 to 24 years. However, children above 18 years must prove formal schooling.
Social Health Authority (SHA) vs Private Child Cover
It is essential to have SHA. It is your constitutional right and will definitely help you with some basic cover for you and your family.
SHA will supplement your private junior medical cover. Private covers are important since they go beyond SHA limits or procedural delays.
A private cover will also help you access premium children services in specialised pediatric facilities such as Gertrude’s Children’s Hospital, Aga Khan, and Nairobi Hospital.
Junior Medical Cover Waiting Periods and Common Exclusions
When you enroll in a junior medical cover, these are the waiting periods and exclusions you are likely to see.
Standard Waiting Periods
- General illnesses have a waiting period of 28 to 30 days.
- Surgical procedures usually have a waiting period of 60 days.
- Pre-existing and congenital conditions come with a typically waiting period of 12 months.
Common Exclusions
The following items are usually excluded from junior medical cover in Kenya.
- Cosmetic procedures or weight management.
- Self-prescribed medications or diagnostic devices, such as home BP/glucometers.
- Experimental or non-registered alternative treatments.
How to Buy Child Health Insurance in Kenya
- Before you buy health insurance for your kids, identify the medical needs of your children. Identify whether you just need impatient alone or Inpatient and outpatient combined.
- Also, compare the hospital panel to ensure that your plan includes pediatric centers close to your residence.
- After identifying your children's medical needs and scrutinising the hospital panel, prepare documents required in enrollment. The documents may include: Parent/guardian National ID and KRA PIN and child’s birth certificate or birth notification.
- Finally, submit your application and pay the required premium.
- The next thing is to fill the medical proposal form that the underwriter assesses. The underwriter may accept or decline your application.
- If your application, read your policy document sent to you and comply with the waiting periods. Also note the exclusion included in your policy document.
Frequently Asked Questions in Junior Medical Cover
- Can I buy health insurance for a newborn baby immediately after birth?
Yes, you can. The entry age for junior medical cover is between 0 or 37 weeks after hospital discharge.
- Does child health cover pay for Gertrude's Hospital?
Yes, it does. However you must purchase a premium junior medical cover that includes Tier I hospitals such as Gertrude’s Hospital. One of such covers with Tier I hospitals is Milele Junior Advantage and Premier Plans
- Can a child stay on a junior policy after turning 18?
Yes, but yojr policy must state so. Children above the age of 18 years and below the age of 24 years can be included, but must prove formal schooling.
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