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4 Things To Look For In A Senior Citizens Health Plan

Posted on 2016-11-30
4 Things To Look For In A Senior Citizens Health Plan

When it comes to medical insurance, there is no substitute for the best. Health is the most precious form of wealth. It is no wonder that health care is one of the most expensive insurances in Kenya and the world over. Take an example of the USA where a young adult can pay up to a whooping KSh 80,000 a MONTH for their medical insurance premiums. It is estimated that close to 700,000 Americans go into financial bankruptcy each year due to medical debt.

In Kenya, many families are forced to deplete their savings and retirement pots, sell all valuable assets and fundraising among friends and family for medical bills for loved ones. There remains a particularly big gap in the local market for good comprehensive health insurance for senior citizens (over 65 years). Insurance companies only see this group as a risky business segment and therefore do everything to steer away from them leaving our dear loved ones exposed to healthy difficulties at a time when they need it the most.

Unsurprisingly, 58% of the 19 medical insurance companies made an insurance underwriting loss with the total medical insurance industry in a KSh 310 million loss. Luckily, not all is lost, there are several medical insurance providers who have undertaken to provide insurance for our senior citizen group. At 60 years, most Kenyans in public and private service are just hitting the long awaited retirement, they are also leaving behind the corporate medical insurance scheme which has covered them and family for all working careers.

Among the options for medical insurance for senior citizens is the National Health Insurance Fund (NHIF) which covers all employed and self-employed Kenyans for both in-patient and out-patient medical services in a wide network of government and private medical facilities. This is the most affordable cover option with monthly premiums as low as KSh 500 for the self-employed members. However, the scope of cover on the NHIF is limited and the panel of hospitals may be limited to primarily the government hospitals.

The second option is the private local medical insurance plans specifically designed for those over the 65 years mark. These medical insurance plans allow members to join over 60 years and cover once accepted is for life.

Lastly, the affluent market may consider the international medical insurance plans like aetna, bupa, axa, nowhealth and more. These are the most comprehensive and impressive medical covers affording high class medical cover for a wide range of conditions in the highest quality medical facilities and professionals both in Kenya and overseas. Unsurprisingly, they come at a very high cost, totalling in the thousands of dollars a year in premiums.

Having briefly explored the different options available for medical insurance for senior citizens, here are the four main factors to look for in these medical plans.

Age limit of entry and continuity for life on the scheme

This is first and foremost, the maximum age of entry for a new member and whether cover once accepted is for a lifetime. Most common medical insurance plans in Kenya have a maximum joining age of 65 years but cover once accepted is not for a lifetime! Once a member reaches 75-80 years, he/she is not considered for renewal which is unfortunate! This is the time when the elderly need the insurance the most. Confirm with your insurance agent or company the age limits for renewal once you are already on the insurance plan.

High inpatient and Medium Inpatient Limit

Most Kenyans want to take a health insurance plan with small to moderate in patient limits but very generous outpatient limits of hundred of thousands of shillings. This is because outpatient is the most ‘consumable’ part of the medical insurance plan. However for senior citizens, it is most advisable to take a high inpatient limit as high as your finances can allow. This is for two main reasons. Firstly, the senior citizens are more susceptible to small illnesses, pains, infections which require an admission to hospital facilities therefore requiring more frequent use of the in patient limit.

Secondly, the inpatient is magnitudes of times cheaper than the outpatient option, while you may be paying up to KSh 1 for every KSh 2 of medical expenses for outpatient cover, the rates for in patient cover as low as KSh 1 for every KSh 50 of medical expenses cover.

Chronic conditions and waiting periods program

Take note of the sub limits under the main in patient limit for the critical conditions, pre-existing conditions and newly diagnosed conditions. For senior citizens, these are the critical points. In addition understand and accept the waiting periods for the different conditions as set out by the provider. For ordinary health insurance plans, these points are not so critical but for the senior citizens, this is often the make it or break it. You don’t want to take on a medical plan and find that it only allocates less than KSh 50,000 for medical expenses for your pre-existing diabetes or high blood pressure, sum that is far less than sufficient.

Critical Illness and Last Expense cover

Most health insurance plans available in the Kenyan market don’t have these riders included by default but increasingly, the senior citizen health plans provide for funeral expenses. These help cover part of the cost in the eventual demise of the insured lessening the burden on the insured’s family and loved ones. This will pay KSh 50,000 – 500,000 in case of the death of the insured.

The second rider that makes a good senior citizen plan is the critical illness insurance cover. This will pay financial compensation to the insured if they are diagnosed with any of the specified critical illnesses or accident while on cover. Critical illnesses is one of the major risks that the elderly are susceptible to as their immune system slowly weakens.

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