Health insurance, also called medical insurance, is the most common product in Kenya. It accounts for 27 percent of all company premiums, which totals over Sh.30 billion.
It’s no surprise that many people join health insurance companies, considering the ever-rising cost of personal medical care, both locally and abroad. Most employees get health coverage as a corporate perk, but self-employed citizens can also purchase medical insurance plans on their own.
While the government has established public medical insurance companies like NHIF, individuals still prefer private health insurance plans because of the limited benefits and constraints on the hospital network.
Top Private Health Insurance Firms
Private health insurers are known for their efficiency in meeting the needs of their subscribers. Here are some of the best private health insurance firms with proven service delivery;
AAR is one of the leading health insurance providers in Kenya. It has operations in Kenya, Uganda, and Tanzania. The firm collaborates with leading hospitals to provide outpatient services to its members and to the public. AAR insurance cooperates with these hospitals to provide inpatient healthcare services when the patients need special care or overnight admission.
AAR Insurance has its clinics under AAR Healthcare Limited where patients can get treatment. The members and hospitals are, however, not restricted to utilizing AAR healthcare facilities only. Some hospitals include AAR Healthcare, Agha Khan University Hospital, Gertrude’s, Medanta, etc.
AAR offers a complete medical package for people and their families. This includes specialized cases, care management teams, and a No Claims Discount to cultivate healthy living. While it’s primarily for medical insurance (personal and family covers), it also offers insurance services like doctor’s indemnity cover, school insurance, personal accident cover, etc. Their clientele includes both AAR members and non-AAR members.
AAR’s medical in-patient plans are unlike any others in the business in the following ways:
- It covers small optical benefits
- Separated into two: accidents and illnesses.
Some packages offered include:
- Doctor’s indemnity cover
- Business Enterprise medical plan
- Individual and Family medical plans
Jubilee Insurance is the most prominent insurance firm in East Africa. It has subsidiaries in Kenya, Tanzania, Uganda, Mauritius, and Burundi. It is highly rated in these countries in terms of risk and quality management, and leadership.
The firm is considered the biggest and leading insurer in EA, serving more than 1.9 million people in the region. It is also the biggest health insurance firm in East Africa. Jubilee’s medical plans are offered to corporates, SMEs and retail individuals, and families.
It has the following plans:
- Individual JCare
- Individual Johari
- JBiz SME Health Cover
- Corporate Health Cover
Old Mutual Holdings
Old Mutual Holdings, formerly known as UAP Insurance, has a lot of corporate and SME clients. They also have a retail enterprise that is growing gradually. They are the only insurance company that offers medical cover for people over 65 years old. Likewise, they also cover children under 18 years old without an adult being on the policy.
It also offers regular retail insurance for individuals and families, a premium high-end alternative with a maximum limit of Sh 20 million, and an economy option targeted at the county. The healthcare plans are as follows:
- Afyaimara: This cover is comprehensive to the entire family, from birth to 65 years, and is renewable for life. The minimum premiums cost Sh.30,433 per year, inpatient Sh.500,000 to Sh.10M, and outpatient low to medium costs.
- Afyaimara Junior: This cover is meant for those under 18 years and sometimes extends to 21 years. The expenses for outpatients are between Sh.50–150K and Sh.500K–5M for inpatients.
- Afyaimara Junior (Gertrude’s option): This is exclusive to Gertrude’s Hospital provider only. The minimum premium is Sh.29,711 annually.
- Afyaimara Senior: The cover is curated for people aged 65–80 years, with a minimum premium of Sh.58,055 annually.
- Afyaimara County: This cover is exclusive to county-level medical providers with a minimum premium of Sh.11,275 each year.
- Afyaimara Executive: Offers high cover limits per-person and per-family basis with custom price quotes.
First Assurance Company Limited
First Assurance Company, formerly Prudential Assurance Company PLC, is considered one of the top medical insurance firms in Kenya. It received the 27th International Europe Award for Quality in 2018. This illustrates the success and efficiency of this firm.
The firm offers general, medical, and group life insurance cover. It provides a broad range of medical products under its medical insurance arm. The cost values for these packages range from Sh. 200,000 to Sh. 2.5 million. Its uniqueness comes from the fact that it also covers pre-existing conditions in addition to in-patient benefits.
The medical plans are as follows:
- Personal medical insurance: FirstMed
Personal insurance covers a variety of packages within a single package. For instance, you can get a Ksh.1 million package with the following benefits;
- Inpatient benefits per family at Ksh. 1 million
- Outpatient benefits per person at Ksh. 75,000
- Maternity benefit at Ksh.75,000
- Dental benefit-per person at Ksh.15,000
- Optical benefit-per person at Ksh.15,000
- Frames (one pair every 2 years) at Ksh.10,000
This cover has a policy waiting period where the waiting period for a medical claim is 30 days and zero days if the problem is linked to an accident. The prices are different with every plan. For the Ksh.5 million medical cover, the company provides pre-existing medical conditions, organ transplants, kidney dialysis treatment, psychotherapy, and more.
- Corporate Group Medical
This corporate medical plan covers more than 10 members. The main product is inpatient benefits, where the members enjoy benefits ranging from Ksh. 100,000 to Ksh. 5 million with no waiting period. The inpatient coverage includes:
- Emergency coverage for 90 days when the insured is outside the country
- Hospital lodger fee for guardians accompanying their child
- First CS cover at zero costs
- Aftercare insurance
- Psychiatric and Congenital covers
- Pre-existing, HIV and chronic conditions cover
This insurance firm serves both the Kenyan and Tanzanian markets. It has operated in Kenya for more than 50 years. Its plans cover reasonable costs for medical and surgical treatment incurred by members due to accidental bodily injuries, illness, or disease during the coverage period.
The following are some services covered by Medical Insurance:
- Surgicare – It covers the medical bills associated with surgical procedures including those related to cancer, heart, orthopedic, and vascular surgery. It costs up to Ksh. 3 million.
- G.A. assist – Provides assistance in an emergency that involves medical evacuations.
The family medical plan covers inpatients, inclusive of maternity benefits. It is also available to all GA-approved medical provider panels. The plan has no waiting period policy for accident-related problems. However, illness and surgical cases have waiting periods of 30 and 60 days, respectively.
GA enhanced inpatient cover:
- Costs Ksh.500,000 and Ksh.1 million
- Drugs and supplies are covered.
- Covers the surgeon’s fee, which may include anesthesia and theater charges
- Covers diagnostic tests
GA Enhanced Inpatient Cover
- Costs Ksh.2 million and 3 million options
- Has a waiting period of 30 days, exclusive of accident cases.
- Age limits are between 3 months—70 years (the last joining age is 55 years)
- The geographical limit of the cover is worldwide (except the USA and Canada), with up to 8 weeks of business trips or holidays
- The cancellation notice period is 30 days for either party.
- GA Insurance Ltd. must authorize all applications.
- Claims for reimbursement must be submitted within 60 days after the date of service.
- Full premium payment is required to obtain coverage.
Heritage Insurance Company is ranked among the top 10 insurance companies in East Africa. It offers short-term insurance, bolstering customer trust through its unique client services and outstanding claim settlements.
Heritage Flexi, blue cover, blue core, blue lite, and blue classic are some of the medical insurance plans available under its coverage. These products accommodate a variety of demands according to the requirements of clients.
- Heritage Flexi: It is flexible to cover either individuals (per-person basis) or family. Clients can choose and combine different benefits to meet their needs. This plan also allows the public sector, SMEs, and corporate firms to curate healthcare solutions that fit their employees.
- Blue cover: Blue health cover is a set of health insurance plans that covers a wide range of medical services to employer groups. It offers affordable prices to accommodate different income brackets.
- Blue core: Ideal for young and healthy populations looking for the assurance of knowing that major hospitalization will be covered. However, it does not cover out-country and outpatient services. It provides in-country insurance to families in Kenya for long-term care, hospitalization, and major illnesses.
- Blue lite: It offers outpatient benefits, long-term care, major illnesses, and hospitalization for the in-country populations.
- Blue classic: A significant alternative that covers more of Eastern Africa, including outpatient care, hospitalization, long-term care, and major illness benefits. This plan also includes international emergency evacuation and is ideal for frequent travelers in the East African Region.
- Blue plus: This travel insurance policy provides medical evacuation to any destination in the world, as well as outpatient treatment, hospitalization, and other benefits across Africa. This is especially useful for people who frequently travel throughout Africa.
- Blue elite: This is a worldwide health insurance plan that provides more extensive coverage for outpatient treatments, hospitalization, chronic care, and major sickness benefits. This option includes emergency evacuation coverage that is ideal for members and immigrants who frequently travel across national borders.
Allianz Kenya is a subsidiary of Allianz, one of the world’s largest insurance and asset management firms. The firm has offices in more than 70 countries across the world, making it one of Kenya’s leading medical insurance providers.
The policy will cover you for a wide range of healthcare services, regardless of where in the world you travel. You can choose to get treatment in the country of your choice within your coverage area. Emergency treatments outside your chosen zone are also covered by the policy. The worldwide medical plan is designed for individuals and companies with up to 50 employees who want an individual or lifelong health coverage.
Its cover is one of a kind as it can be obtained via the internet from its website. The following are some of the services covered:
- Inpatient and outpatient cover: involves doctor’s fees, hospitalization fees (and reimbursement if you pay out of pocket), home nursing and rehabilitation, pre-existing and long-term conditions, transplants, etc.
- Maternity costs: Covers natural and Cesarean deliveries and under 40 years of age patients’ infertility treatments.
- Dental cover: Includes expenses for general dental treatment, extensive restorative dental care, adult orthodontic work, and teeth whitening.
- Optical treatment: The expenses cover the fees for frames, glasses, eye tests, Lasik, contact lenses, and lens implants.
- Emergency assistance: includes repatriation and evacuation fees applying to accommodation and airfare for next-of-kin in case hospitalization lasts more than five days.
These are just some of the private health insurers in Kenya. Each company has its own unique benefits and features, so be sure to shop around and compare before choosing a plan.
Benefits of Private Health Insurance Offers
- In-Patient benefit: This includes the cost of a hospital stay overnight as well as other costs such as consultations, expert fees, bed charges, treatments, and operations. This is the most basic type of insurance coverage available. It is required on every private medical insurance policy in Kenya.
- Out-Patient benefit: This includes consultations, medications, and operations carried out on a day-patient basis at hospitals (i.e., not requiring overnight accommodation). It is an optional benefit that the insured can choose to add to his or her In-Patient insurance coverage.
- Dental benefit: This covers the cost of consultations, treatments, and operations for dental conditions. The dental benefit is an optional extra that the insured can decide to add to his or her In-Patient insurance coverage.
- Optical benefit: This covers the cost of consultations, tests, and operations for eye conditions. The optical benefit is an optional extra that the insured can decide to add to his or her In-Patient insurance coverage.
- Maternity covers: This covers the cost of pre-natal and post-natal care, consultations, ultrasound, newborn care, and delivery costs. The maternity benefit is an optional extra that the insured can decide to add to his or her In-Patient insurance coverage.
- Pre-existing conditions: These are medical conditions that you had before you took out your health insurance policy. Some insurance companies will cover pre-existing conditions, while others will not. It is important to check with your insurance company to see if your pre-existing condition is covered.
When selecting a private health insurer in Kenya, it is essential to consider the costs, packages, and benefits they offer. It is also critical to consider the size and network of hospitals and clinics they have.