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Protect the health of you and your loved ones by getting the best health insurance. Get health insurance to cover all charges for inpatient, outpatient, maternity, dental, optical treatments in wide range of medical providers and hospitals in Kenya and overseas.
Compare health insurance plans for individuals, families and senior citizens from all the leading providers in Kenya. Compare optional extras like outpatient, maternity cover and more online.
Our dedicated medical service team will answer any questions you have and give you expert advice on exclusions, excesses, and terms to help you get the best value medical insurance for you and your loved ones.
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Medical insurance in Kenya is a great tool that can protect the insured from high costs arising out of an illness or an accident provided they are covered on a health policy. This way, it is a great tool for financial planning. The policy is divided into two main categories:
In-patient cover - Which is termed as treatment to a patient who is admitted to a hospital for treatment that requires at least one overnight stay.
Outpatient cover - Treatment to a patient who attends a hospital or clinic for treatment without staying there overnight. Under this section, the insured can also purchase additional cover specifically for optical and dental treatment.
The joining age for most medical insurance policies in Kenya new members is from new born babies at the time of Hospital discharge to 75 years old depending on the health insurance company one opts for. Eligible candidates have the freedom to choose the plan they want it can be Inpatient cover alone or Outpatient cover alone or even both.
There are factors to take into consideration when shopping for a medical cover, one should look for a cover that meets most if not all of his/her basic need when it comes to treatment for example if it will take care of day care treatment, Maternity, antenatal and post-natal care for young ladies who are looking forward to having a child, pre-existing and chronic conditions, dental and optical not forgetting laboratory test and prescribed drugs among others.
There are waiting periods on most medical policies and they vary with different health insurance companies, This is an initial period of membership during which no benefit is payable for a certain procedure or service. Waiting period can also apply to additional benefits when you upgrade from one package or provider to another.
The majority of medical insurance companies in Kenya have opted to partner with hospitals, clinics and specialist providers outside the country for their clients, it is reliable and affordable compared to the local hospitals, clinics and providers. This has in away changed the dynamics in the industry with every company running to that direction to ensure they are better placed and keep their current clients.
It is wise to spread the risks that we carry by having a cover with a reputable health insurance company in Kenya With this, one is better placed to handle any unexpected costs that may arise out of an illness or accident, these can otherwise wreck financial havoc and deplete any little savings and investments that one may have accumulated.
When getting health insurance in Kenya, it’s not only about going for the cheapest medical plan in the market, it is important to clearly understand what benefits can be provided on the medical plan: Here is a writeup of the most common sections of the cover.
Hospital accommodation charges are covered net of the NHIF rebate per day. This also depends on what your cover bed entitlement is i.e. Ensuite, standard private or general ward bed.
Congenital is a state prevailing at or before birth regardless of cause. It is capped up to a particular limit depending on the inpatient limit you have taken. However it has a waiting period of one year or more depending on the Kenyan medical insurance company that offers your policy.
This is the period when one has been declared fit to go home but a he or she needs to undergo tests to monitor recuperation. Medical Insurance covers up to 60 days from discharge. Coverage limits depends on the package one has.
In medication process practitioners recommend various tests. Insurance cover extends coverage to these services but the laboratory must be in the approved panel of providers.
These are the various consultation fee paid to specialists e.g Neurologists and cardiologists, gynecologists. They are covered fully depending on the coverage limit.
These are various medical procedures or tests that can be done in a medical Centre without an overnight stay;
The Optical Plan extend to covers the following services;
The Dental Plan extends to cover the following services;
This is often the most asked about section of any affordable health insurance plan. When a couple suddenly realizes they are expecting a child, they immediately want to inquire about maternity insurance in Kenya and it’s cost. This maternity cover may be bought as an outpatient add-on while some other providers offer it as part of the inpatient plan like Resolution health insurance and AAR medical insurance.
One or two occasions one can be treated in a hospital outside the panel of providers, most providers reimburse 80% -20 % based on the approved rates in there panel of providers. i.e one can only compensated upto 80% of what they were to pay if one could have gone to the hospital approved by the insurer and accessible under your cover limits.
This is to discourage people seeking medical attention from providers outside the panel provided by your insurer.
The main exclusions are;
Waiting period is a duration where a policy holder for the first time has to delay before starting to use a cover.
Sometimes one can take a cover with higher limit and more benefits on renewal of existing policy, waiting period applies to the additional benefits.
Health insurance provider may waive the waiting periods on certain benefits. In case of an accident, there is no waiting period.
The following services quite often have waiting period;
Hospitals have been clustered into dispensaries, referral hospitals, private hospitals, Nursing Homes County and sub county hospitals, and national hospitals.
Dispensaries are government hospitals closest to the citizens. They offer simple outpatient services. Conditions which require more intensive observation, patients are often referred to more advanced hospitals in terms of services and specialists.
The health centers are hospitals that not only offer simple services like common cold but also offer the prevention services. These hospitals also operate as a referral hospitals from the dispensaries.
Nursing hospitals are hospital run by churches, organizations or individuals. They offer medical services that require more care and also the operational services.
Private hospitals are hospitals that are more organized with more specialized personnel. They offer all services including the consultation services.
We have another category of hospitals that is the sub county hospitals and county hospitals which act as the main referral centers for the small hospitals. The services here are more specialized and patients can get more comprehensive treatment while the county hospitals have extra services and resources i.e capacity to care intensive care services, they have life support machines and can carry more complex tests.
National hospitals provide all the health services which may not be available in these other hospitals.
This is the cost one is supposed to cater for anytime he or she visits specific hospitals and the reason is to discourage people to visit hospitals for unnecessary attentions.
Co-payment varies from on hospital to another and also depends on the health cover provider.
Overseas treatment is normally covered up to a certain limit normally it is on referral basis. The most common is South Africa and India. Most affordable Kenyan medical covers allow overseas treatment on referral. For many conditions, it may be cheaper and safer to have them treated overseas as the cost of medical treatment and hospitalization continues to increase here in Kenya. This is normally done on re-imbursement basis.
NHIF has empowered more citizens to access medical care. NHIF covers various services i.e.
When a policy holder is an NHIF member, he or she has added advantage because it can be used when seeking attention of the above services. Also health cover pays bed entitlement net of NHIF rebates.
Children are covered to a maximum of 21 years any children above 21 years to a maximum of 25 years can be covered as long as the show proof schooling. The student ID should give information about when one will complete his or her studies.
Last joining age vary from one provider to another. Members above 55 years are supposed to provide medical examination report before being given acceptance letter.
Most covers have last expense limit as from 50,000 to 250,000. This is payable on death of any declared family member but has a maximum of 2 claims per a year.
Insurance companies have 24 hour emergency lines.
These are health covers created and controlled to offer international healthcare solutions for individuals who constantly move across the world i.e, employees of international organizations, multinationals, and small & medium enterprises. These international health insurance packages are much more expensive that ordinary Kenyan health insurance covers owing to the executive level services they offer.
Some of the main providers in Kenya include AXA PPP, BUPA, AETNA, NowHealth, Allianz and many others.
The main difference between the local covers and international covers is that the international covers’ scope of cover is internationally that means one can get services anywhere in the world without limited to which hospitals and panel of providers to visit.
International health covers are often seek by individuals who work, live and do business outside their country of origin but time and again travel back to their mother country to either visit family, friends and even business. As well family members may visit. In this regard an individual may want to cover his or her family comprehensively against any risk while they are on the foreign land.
Services in international and local covers can be the same.