The Kenyan healthcare landscape has been changing over the past 15 years since the introduction of devolution in Kenya. Few space have go through rapid changes like healthcare. Devolution opened the door for cheap healthcare options to reach people in rural areas that previously had no access to good hospitals. This drive has been led by the opening up of medical insurance.
Medical insurance, also known as health insurance, is a financial product designed to help cover the costs of medical care. It provides protection against the financial risks associated with healthcare expenses by covering some or all of the costs related to medical treatments, procedures, and services.
Key Components of Medical Insurance
1. Premiums
- The amount you pay, typically on a monthly basis, to maintain your insurance coverage. Premiums can vary based on the type of plan, coverage level, and your personal health history
2. Deductibles
The amount you must pay out-of-pocket before your insurance begins to cover expenses. Plans with lower deductibles usually have higher premiums and vice versa.
3. Co-payments (Co-pays)
- Fixed amounts you pay for specific services, such as a doctor’s visit or prescription medication, after your deductible has been met. Co-pays help share the cost of medical services between you and your insurer.
4. Coinsurance
- The percentage of costs you share with your insurer after meeting your deductible. For example, if your plan covers 80% of a bill, you pay the remaining 20%. Coinsurance can apply to various services, including hospital stays and specialist visits.
5. Coverage Limits
The maximum amount an insurance plan will pay for covered services over a certain period, such as annually or over a lifetime. Plans may have different limits for different types of care (e.g., inpatient vs. outpatient).
6. Exclusions
Specific services or treatments that are not covered by the insurance plan. Common exclusions may include certain elective procedures, experimental treatments, or pre-existing conditions.
7. Network of Providers
- The list of doctors, hospitals, and other healthcare providers that have agreed to provide services at negotiated rates. Using in-network providers usually results in lower out-of-pocket costs compared to out-of-network providers.
Types of Medical Insurance
Individual Health Insurance
Coverage purchased by individuals for themselves or their families, rather than through an employer or other organization. Available through private insurance companies or government exchanges (like Kenya’s NHIF).
Group Health Insurance
- Coverage provided to a group of people, typically through an employer or organization. Often less expensive per person compared to individual plans due to the larger risk pool.
Government Health Insurance
Health insurance provided by the government, such as Kenya’s NHIF, which offers coverage to various segments of the population. Generally more affordable and accessible, but may have limitations on the range of covered services.
Short-Term Health Insurance
Temporary coverage designed to bridge gaps in insurance, such as between jobs or during transitions. Often provides limited coverage and may not cover pre-existing conditions.
Critical Illness Insurance
- Coverage specifically for severe illnesses like cancer, heart attack, or stroke. Provides a lump sum payment upon diagnosis of a covered illness.
Accident Insurance
Coverage for injuries and treatments resulting from accidents. May include coverage for emergency care, hospital stays, and rehabilitation.
Insurance Providers in Kenya
In Kenya, there are several affordable healthcare insurance options that cater to different needs and budgets. Here’s a detailed overview of available options:
National Health Insurance Fund (NHIF)
Basic NHIF Coverage: NHIF is a government-run health insurance scheme that provides comprehensive coverage for various medical services. Contributions are income-based, making it affordable for many. It covers inpatient and outpatient services, maternity care, surgeries, and more.
Special Schemes: NHIF offers targeted schemes for different groups such as:
- Low-Income Earners: Special reduced premiums for those in the informal sector or who are unable to contribute the standard amount.
- Elderly and Vulnerable Populations: Programs to support elderly citizens and other vulnerable groups with subsidized or free coverage.
Private Insurer
1. Jubilee Insurance
Overview: Jubilee Insurance is one of Kenya’s oldest and most established insurance providers. It offers a variety of health insurance products tailored to different needs.
Plans and Coverage:
- Jubilee Health Insurance: This includes various plans such as the Jubilee Health Insurance – Individual Plan and Family Plan.
- Coverage Includes: Outpatient and inpatient services, maternity care, emergency services, and surgery.
- Network: Wide network of hospitals and clinics, including both private and public facilities.
- Special Plans: Offers specialized plans such as Jubilee Kingfisher which covers high-end services and benefits.
Benefits:
- Comprehensive Coverage: Covers a broad range of medical services and conditions.
- Extensive Network: Access to a large network of healthcare providers.
- Additional Benefits: Some plans include benefits like wellness programs and preventive care services.
Considerations:
- Premiums: Higher-end plans can be expensive, though there are more affordable options available.
- Pre-existing Conditions: May have limitations or exclusions for pre-existing conditions.
2. APA Insurance
Overview: APA Insurance, part of the Apollo Investments Group, provides a range of health insurance products designed to meet different needs and budgets.
Plans and Coverage:
- APA Health Insurance Plans: Includes plans like APA Flexi and APA Comprehensive.
- Coverage Includes: Outpatient and inpatient services, maternity, and emergency care. Plans can be customized to include additional benefits.
- Network: Extensive network of healthcare facilities across Kenya.
Benefits:
- Customizable Plans: Ability to tailor plans to specific needs and preferences.
- Variety of Options: Offers both basic and comprehensive coverage options.
- Affordable Plans: Competitive pricing with options to fit different budgets.
Considerations:
- Coverage Limits: Some lower-cost plans may have coverage limits or fewer benefits.
- Claim Processing: Ensure understanding of the claims process and any related requirements.
3. CIC Insurance
Overview: CIC Insurance provides a range of health insurance products designed to offer flexible and affordable health coverage.
Plans and Coverage:
- CIC Health Insurance Plans: Includes plans like CIC Life Health and CIC Medical Insurance.
- Coverage Includes: Outpatient, inpatient, maternity, and chronic illness management.
- Network: Access to a broad network of healthcare providers.
Benefits:
- Flexible Plans: Options to customize plans based on coverage needs.
- Affordable Pricing: Competitive premiums that cater to various income levels.
- Additional Services: Some plans include wellness and preventive care services.
Considerations:
- Policy Details: Carefully review the policy details to understand coverage limits and exclusions.
- Service Quality: Service quality can vary depending on the healthcare provider network.
4. Britam Insurance
Overview: Britam Insurance is a major player in Kenya’s insurance market, offering a range of health insurance products that cater to different customer needs.
Plans and Coverage:
- Britam Health Insurance: Includes plans like Britam Health Shield and Britam Health Cover.
- Coverage Includes: Comprehensive outpatient and inpatient care, maternity services, and additional benefits such as dental and optical care.
- Network: Extensive network of hospitals and clinics.
Benefits:
- Comprehensive Plans: Broad range of coverage options, including specialized services.
- Additional Features: Some plans offer benefits like telemedicine services and health management programs.
- Reputation: Established insurer with a strong reputation for reliability.
Considerations:
- Premium Costs: Premiums for comprehensive plans may be higher, but there are also more affordable options.
- Policy Details: Review policy terms carefully to understand coverage limits and exclusions.
5. Sanlam General Insurance
Overview: Sanlam General Insurance, part of the Sanlam Group, provides health insurance solutions designed for various customer needs.
Plans and Coverage:
- Sanlam Health Insurance: Includes plans like Sanlam Health Plan and Sanlam Health Saver.
- Coverage Includes: Outpatient, inpatient, maternity care, and chronic illness management.
- Network: Good network of healthcare providers.
Benefits:
- Affordable Options: Provides cost-effective plans for different budget levels.
- Comprehensive Coverage: Includes a broad range of medical services and treatments.
- Flexibility: Options to customize plans to fit specific needs.
Considerations:
- Policy Details: It’s important to thoroughly understand the terms and conditions of coverage.
- Customer Service: Evaluate the quality of customer service and claims processing.
6. Medico Insurance
Overview: Medico Insurance offers tailored health insurance solutions focusing on affordability and comprehensive coverage.
Plans and Coverage:
- Medico Health Insurance: Includes plans such as Medico Basic and Medico Comprehensive.
- Coverage Includes: Outpatient, inpatient, maternity services, and emergency care.
- Network: Network of accredited healthcare providers across Kenya.
Benefits:
- Affordable Coverage: Designed to be cost-effective while providing essential coverage.
- Variety of Plans: Options to choose from based on coverage needs and budget.
- Customer Support: Generally strong customer support and assistance.
Considerations:
- Coverage Limits: Basic plans may have certain coverage limits or exclusions.
- Plan Variability: Ensure the plan chosen aligns with personal healthcare needs.