Health insurance is a contract with a company. It covers healthcare costs, offering financial protection for sickness or accidents. For example, it pays for doctor visits and drugs. Also, it covers hospital stays and special equipment. Insurance also covers check-ups and preventive services like vaccinations and cancer screenings. These are free and promote early problem detection.

The medical insurance market in Kenya is rapidly growing. More people see its benefits. Also, more companies are offering plans. This growth means more options. So, people can find plans that suit their needs and budgets. Competition among companies leads to better services and lower premiums.

In Kenya, medical insurance ensures people and families get needed healthcare. The coverage varies by provider and plan. However, it usually includes:

1. Inpatient Care

2. Outpatient Care

3. Maternity Care

4. Emergency Services

5. Preventive Care

6. Chronic Disease Management

7. Specialized Care

8. Mental Health Services

9. Dental and Optical Care

10. Rehabilitation Services

• Type of Plan and Provider Network-Note that costs for out-of-network care might not count. They might not go toward your plan’s maximum out-of-pocket limit.
• Premiums-Understand how much you’ll pay per month. Remember, premiums aren’t the only costs. You’ll also pay deductibles and share costs. This includes co-pays and coinsurance.
• Deductibles-Know the amount you must pay out of pocket before your coverage begins. For example, if your deductible is $1,000, your plan won’t pay most expenses until you’ve spent $1,000. Check if preventive services are covered. Do this before reaching your deductible.
• Co-pay or Coinsurance-Know the extra costs. They go beyond your deductible. You must pay a percentage of costs for a service or medicine. Co-pays are flat fees for prescriptions or services.
• Coverage of Medicines-Check if your regular prescriptions are covered by the insurance plan. Each insurer has a formulary. It lists the covered medicines. Check if your medicines are covered. Then, understand their out-of-pocket costs. These costs can vary by tier.

Focus: Family plan features and affordability.

Britam Milele Health Plan

Britam Milele is a medical insurance plan for individuals and families. It covers hospitalization and post-hospitalization care. Moreover, it offers various plans to fit different needs and budgets.

a) Advantage Plan

• Lifetime Cover: Yes
• Access to Providers: All providers on the Britam Panel
• Coverage for Pre-existing Conditions: Yes
• Wellness Check-Up: Free annual wellness check-up for principal and spouse
• You get free accident and funeral expense coverage.
• Also, treatment for COVID-19 and cash for critical illnesses.
• Plus, referral treatment in India. Support for a healthy lifestyle and stress management.
• Telemedicine and online medicine delivery.
• Inpatient coverage starts at Kshs 300,000 and goes up to Kshs 10M.Minimum Annual Premium: Kshs 17,332

b) Premier Plan

• Lifetime Cover: Yes
• Access to Providers: All providers on the Britam Panel
• Coverage for Pre-existing Conditions: No
• Wellness Check-Up: Free annual wellness check-up for principal and spouse
• Get free accident and funeral coverage. Also, access COVID-19 treatment and help with severe illnesses. In emergencies, medical care in India is available. You’ll get tips for a healthy lifestyle and stress management. Use telemedicine and online pharmacy delivery. Inpatient Cover ranges from Kshs 300,000 to Kshs 10M.
• Minimum Annual Premium: Kshs 11,099

c) Essential 1 Plan

• Lifetime Cover: Yes
• Access to Providers: Medium and low-cost providers on the Britam Panel
• Coverage for Pre-existing Conditions: No
• Wellness Check-Up: Free annual wellness check-up for principal and spouse
• Enhance your benefits with: coverage for funeral expenses and COVID-19 treatment. You also get referrals for inpatient care in India. Plus, support for a healthy lifestyle and stress management. You also get access to telemedicine and a convenient online pharmacy. Inpatient Cover ranges from Kshs 300,000 to Kshs 5M. Minimum Annual Premium: Kshs 9,001

c) Essential 2 Plan

• Lifetime Cover: Yes
• Access to Providers: Mission and referral hospitals on the Britam Panel
• Coverage for Pre-existing Conditions: No
• Wellness Check-Up: Free annual wellness check-up for principal and spouse
• This plan covers funeral costs and COVID-19 treatment. It also includes referrals for inpatient care in India. It has support for healthy living and stress management. Additionally, it provides telemedicine and access to an online pharmacy.
• Coverage for inpatient care ranges from Kshs 300,000 to Kshs 2 million.
• The minimum annual premium is Kshs 8,127.

d) Health Cover for Children: Britam Milele Juniorz

• Standalone health cover dedicated to children.
• Provides access to various benefits tailored to their medical insurance needs.

a) Medisure Family Health Insurance

The last thing you want when you or a family member is sick is the stress of trying to pay for medical expenses. With our Medisure cover, you can count on the help you need. It will keep you healthier without making you miss out on life’s important things. Policyholders and their dependents are insured against the risk. It covers medical expenses from accidents or sickness.

Key Features

• Coverage applies to hospital bed accommodation charges.
• Pre-existing Conditions
• Diagnostics for Member and Spouse
• Major Organ Transplant Procedure: Coverage for major organ transplant procedures.
• In-patient Prescribed Services includes: physiotherapy, chemotherapy, radiotherapy, nursing care, drugs, dressing, and tests.
• Non-accident Maxillofacial and Ophthalmologic, Dental Surgery: Subject to authorization.
• Day Care Surgery: Coverage for day care surgeries.
• Resident Mother/Doctors Fee

Policy Limits

The policy limits range from Ksh 300,000 to Ksh 5,000,000 and come in six packages under the CIC Package:

Amount (KES)	CIC Package
5,000,000	Prestige
3,500,000	Premier
2,000,000	Superior
1,000,000	Comprehensive
500,000	Standard
300,000	Essential

b) Seniors Mediplan: Medical Cover for Comfort in Old Age

Seniors Mediplan is medical cover for senior citizens. They are the most vulnerable to illness, pain, and related medical conditions. The cover aims to protect them against medical expenses and provide comfort in old age.

Key Features

• Membership Eligibility & Onboarding
  • Eligibility for Principal Member and Spouse: From 60 years to 80 years. No age limit once joined.
  • Only one legal spouse can be included as a dependent of the principal member. Additional spouses can be added as principal members.
  • Child dependents are not eligible under this cover. Alternative cover is provided under the CIC Family Medisure cover.
  • New applicants need to submit a medical report before membership and cover eligibility can be confirmed. The cost of the medical examination is borne by the applicant at a hospital appointed by CIC.
  • Existing members can continuously renew their membership without age restrictions.
• Benefits Summary
  • In-Patient Coverage
  • Coverage for outpatient services.
  • Coverage for dental treatments.
  • Coverage for vision-related expenses.
  • Last Expense provides coverage for last expenses
  • Chronic Cover
  • Geriatric Panel
  • Annual Health Checks
  • Organ Transplant

Pacis Amani Medical Insurance is the best solution. It gives peace of mind to individuals and families about their healthcare needs. This plan offers cheap premiums. It also has many benefits. They protect against unexpected medical costs.

Key Features

• Outpatient Cover
• Outpatient Dental Cover
• Optical Cover
• Affordable Premiums
• Access to the Best Providers
• No Claim Discount offers a discount on premiums. It is for policyholders who do not make claims during the coverage period.
• Inpatient Cover
• Maternity Cover
• Pre-existing Conditions
• Chronic and Congenital Conditions

Focus: Network reach and coverage for common health concerns.

You and your family can get medical coverage from the Individual and Family Medical Plan. It covers everyone from routine check-ups to emergency care. This ensures your family’s health needs are met.

a) ShwAARi Medical Cover

ShwAARi Medical Cover offers an annual medical cover with a single limit for you and your loved ones. It provides peace of mind knowing that your medical expenses are covered under one plan.

b) Personal Accident Insurance Cover

It offers money for bodily injuries. The injuries must be from accidents. It gives you and your family financial protection. This is in case of accidents that were not expected.

c) AAR Insurance Protect

AAR Insurance Protect offers enhanced medical cover at a low price. It protects against accidents. It ensures that you and your family get the care you need without financial burden.

a) Protect My Family

They offer you peace of mind. They ensure your loved ones stay safe and comfortable. No matter what challenges life may throw.

Recommended Products:

1. Legacy Funeral Cover provides money to cover funeral expenses. It eases the burden on your family during tough times.
2. Hekima Plan offers complete financial planning. It is tailored to your family’s needs. It helps you achieve your long-term financial goals.
3. HeriAfya Medical Cover ensures access to quality healthcare for your family. It has full medical coverage for hospital stays, outpatient services, and more.

b) Cover My Employees

The solutions help you give financial security to your employees at scale. They do so with ease and flexibility.

Recommended Products

1. The Boresha Maisha Pension Plan provides employees with a retirement savings plan. It helps them to secure their financial future.
2. Group Life Cover offers life insurance to employees. It ensures financial protection for their families if they die.
3. Group Credit provides credit life insurance to employees. It covers outstanding loans if they die or become disabled.
4. Group Funeral Cover offers funeral cover to employees. It helps their families with funeral expenses in times of need.

Most employees are the main earners in their families. They worry about how their loved ones would be provided for if they die. Employers who offer Life Insurance boost their benefits. This coverage ensures employees’ peace of mind. If an employee dies on the job, their family receives financial support. This avoids using savings or borrowing from loved ones.

Features

• Most members are insured without being subjected to medical checkup.
• The insurance contract is between the employer and the insurance company.
• The cover is renewable every year.
• You do not have to use business cash to meet unexpected requests for money.
• It makes the employer more competitive and sought after by job seekers.
• It is inexpensive and simple to administer.
• Staff movements are allowed i.e., additions and deletions.
• Provides for loss of income when the breadwinner dies.

Value Adds

• Medical examination fees will be borne by Cannon Life Assurance.
• The Cover is offered on a 24 Hour Worldwide basis.
• We will waive Medical Requirements for members who had medical exams in the last 6 months.
• Claims will be settled within 5 days from the date the claim is fully documented.
• All last expense claims will be settled within 48 hours.
• The benefit covers insanity from a medical deficit. It is a permanent disability.
• Members with a Sum Assured below the Free Cover will not need a Medical exam.
• No exclusion on blindness.
• There is no exclusion on HIV/AIDS, passive terrorism, civil war, and commotion. Also, no exclusion on rebellion, insurrection, strike, and riot. Or, on political violence and warlike operations. There is also no exclusion on military or usurped power, or mutiny. And, this all comes at no extra cost.

Benefits

• Group Last Expense: Provides financial assistance to cover funeral expenses for employees.
• It offers life insurance to employees. It ensures financial protection for their families if the employees die.
• Credit Life Insurance provides it to employees. It covers their outstanding loans if they die or become disabled.
• Keyman Insurance offers coverage for key employees. Their loss would greatly impact the company’s operations.

c) Group Life Umbrella Insurance

As an employer, a “rainy day” means facing an employee’s Loss, Permanent Disability, or Critical Illness, or their spouse’s. Just like in life, an umbrella helps in tough times.

An umbrella policy helps you fill the void left by your standard primary policies. Umbrella insurance is extra liability insurance. Its main role is to cover liabilities that the existing policy can’t cover.

This solution is simple and cheap. It provides benefits to small and medium-sized groups of employers. These groups are registered as “clients.” The solution covers the employees if they die, become disabled, or have a critical illness.

SCOPE OF COVER

a) The death and PTD benefit is based on annual salary. It ranges from 1 to 5 times salary, as the client chooses.

b) As per market practice, the Critical Illness benefit will be 30% of the Death Benefit, with a limit of KShs. 6M for the platinum option, and KShs. 3M for the Gold & Silver options.

c) The funeral benefit limit is KShs. 100,000 for all options.

d) Keyman Insurance

Who is a ‘Keyman’?

A Keyman is anyone who plays a key role in the company’s operations. They are directly related to making profits. This includes:

• Partnerships, Executive Chairman, Managing Directors, CEOs
• Heads of sales and marketing
• Significant revenue generators
• IT and Finance directors
• Heads of product development who play a major role in innovation

Basically, anyone important to the company and plays a leading role is a keyman.

Features

Keyman insurance is a type of business protection insurance. It pays out an agreed cash sum. This happens if a key employee suddenly stops work. This can be due to death, permanent total disability, or critical illness.

• Proceeds to the Company: The payout goes directly to the company, not the individual.
• Larger Sum Insured: The sum insured is typically larger, often running into millions.
• Critical Component of Business Plan: For many companies, Keyman insurance is critical. It is key for planning and handling future operations.
• Purpose of Payout: The payout can be used for various purposes:
  • An injection of cash for financial reassurance
  • Shoring up profits
  • Covering the cost of temporary staff or recruitment
  • Repaying company debt or overdraft
  • Buying the deceased person’s shares to prevent shareholding issues.

Benefits

Types of Keyman Insurance

1. Profit Protection pays out a cash sum. It helps shore up profits or for training and recruitment.
2. It pays out cash for repaying company debt. It is useful if directors have personal guarantees or second mortgages.
3. Ownership Protection pays out a cash sum. It is to buy out a deceased or critically ill director’s or partner’s shares. It ensures a smooth transition and ownership stability.

Focus: Extensive plans with high limits.

Health Insurance Products

1. International Health Cover: “Care and Health” is an international medical insurance plan. It is comprehensive and premium. It is crafted for extensive coverage.
2. CoverBora Medical Cover is affordable hospitalization insurance. It is tailored to meet the unique needs of people seeking budget-friendly solutions. It helps manage the emotional and financial burden of a critical illness. It offers support during challenging times.
3. J-Care Johari Medical Cover is comprehensive and affordable. It covers both inpatient and outpatient services.
4. J-Junior Medical Cover is a stand-alone plan for children aged 0-17. It provides tailored health insurance for young ones.
5. J-Care is a comprehensive family medical insurance. It provides extensive coverage for you and your family. It ensures all your healthcare needs are met.

Health Covers

a)Enhanced Family Health Cover (Jamii Plus): Everyone wants a healthy, stress-free life. A healthy family is a happy family. So, we get medical insurance. It covers health needs and brings peace of mind.

b) Family Health Cover(Afya Nafuu): APA’s Afya Nafuu covers hospital bills for you and your family after an illness or accident. It ensures emergency medical costs are paid.

c) Cancer Care ( Femina): There are two common threats to women’s lives today – Breast Cancer and Cervical Cancer. Femina covers the costs of diagnosing and treating these cancers. It provides critical support for women’s health.

e) International Health Cover: goes beyond normal health insurance. It combines world-leading tech with a personal touch. APA Insurance partners with global providers. They offer broad coverage. It ensures you get top-notch healthcare anywhere.

What’s in it for you?

• Family Coverage: Protect yourself and your family, including children, under one comprehensive plan.
• Access Countrywide Providers: Enjoy a vast network of UAP Old Mutual medical providers. They are across the country.
• Choose from flexible packages. They are tailored for individuals, families, groups, and the self-employed.
• Suitable Options: Select a health cover suitable for your specific needs and budget.

General Conditions

• You have to wait 28 days for illness claims. You have to wait 60 days for non-accident surgical claims.
• Persons over 60 years require a medical report for eligibility.
• Eligible dependents include one spouse and children from 0 to 18 years old.

Exclusions

• Infertility treatment, cosmetic surgery, weight management treatments, and drugs.
• Participation in professional and hazardous sports.
• Treatment not by a registered medical practitioner, self-referred or self-prescribed treatment.
• Expenses recoverable under other insurances.
• Experimental treatment, declared pandemics, epidemics, and natural disasters, among others.

Focus: Affordable basic plans.

Key Products and Features: They are very affordable health plans. They cover key medical services. They are great for those looking to save money. It provides good customer service and a quick claims process.

Affordable plans with decent coverage for everyday medical needs. Responsive customer support and a user-friendly claims process.

Choose medical insurance carefully. First, compare options to find a plan that matches your budget and health needs. Review what each plan offers and its cost to avoid surprises. Consider your family’s health and finances. Look at the services, available doctors, and treatment expenses. Finally, thoroughly research your options. This ensures confidence in your choice and peace of mind during tough times.

1. Health Insurance for Freelancers and Self-Employed in Kenya
2. Understanding the Insurance Regulatory Authority (IRA) in Kenya