Understanding Health Insurance in Kenya is crucial as it empowers individuals to make informed decisions about their healthcare and financial planning.
Health insurance is an arrangement between an insurance company and an individual. The company pays either fully or partially for the individual’s medical expenses, and the individual makes a monthly premium payment for that insurance.
Such a contract can last up to one year. When the individual is insured, the company pays for specific medical expenses linked to specific illnesses or pregnancies and covers preventative care.
Health insurance types in Kenya
Different health insurance plans include:
• PPO- Preferred Provider Organization- Employees are advised to use a network of preferred doctors.
• HMO—Health Maintenance Organization—Many healthcare providers only offer services through their contract with an HMO, which is best for small businesses.
• POS- Point Of Service plans- This combines the features of both PPO and HMO.
• EPO- Exclusive Provider Organization- It gives members a network of doctors they must use- except when dealing with emergencies.
Five broad areas that health insurance covers in Kenya:
• Inpatient services- An inclusion of hospital admissions soon after illnesses and accidents.
• Outpatient services- An inclusion of consultations and laboratory tests for those cases that are non-admission.
• Maternity services- Care that comes for pregnancy and pregnancy-related cases.
• Routine Dental services, cleaning, and extraction services.
• Optical/ eye services- Eye or optical health services.
How does health insurance work for me?
Health insurance plays a vital role in managing your health risks, as the insurance company covers your healthcare expenses, protecting you from unexpected medical costs.
Health insurance is a legally binding agreement between an individual and an insurance company.
The arrangement is such that the individual does not need to pay for all the medical expenses alone.
How does health insurance work?
- The individual pays a premium. This is generally done monthly to cover the insurance costs.
- Check for the deductibles- A deductible is the amount you must pay out of pocket before your insurance steps in to make payments.
- Sharing cost—You share the cost with your plan after you have paid your deductibles. The term used is “co-insurance.” When you get your insurance card, it will show both the deductible and the coinsurance.
- Preventive care—Most of the time, the insurance covers this 100%. It pays for annual checkups, flu shots, kids’ vaccinations, specific wellness screenings, and much more.
- Staying in-network to save money—In-network providers offer lower service rates to company members. To find these providers, visit the health insurance website. You could also call the company to get access to the list of providers.
- Additional programs and services at no cost—Your insurance plan will often include additional programs and services. These services are additional benefits of the cover, which you do not pay to access.
How to use your healthcare policy
Healthcare plans come with rules for using the card. Be sure to read and understand all the rules before signing in. Also, check the policy’s benefits and limitations.
When you get to your doctor, you will need to provide details about your policy to the doctor. The doctor then takes the same and copies it on their end.
When your treatment bill is out, the hospital bills the insurance company. Once the insurance pays, you are discharged from the hospital.
How to pay for health insurance in Kenya
Health insurance payments in Kenya are designed for your convenience, allowing you to pay via Mpesa, credit card, or cash, whichever method suits you best.
What do you do when you detect health insurance fraud?
It’s important to always monitor your health insurance statement. If you detect any irregularities, report them immediately to the IRA to safeguard against potential financial losses.
You can also talk to Liberty Health. The organization has a dedicated team that manages fraud issues.
While health insurance fraud can occur, it’s important to note that such cases are not rampant. By staying vigilant and monitoring your health insurance statements, you can ensure that your coverage remains secure.
List of insurance companies:
The Teeth Team has compiled a list of Kenya’s health insurance companies. We encourage these companies to contact the Teeth Team if they need to be added to the list.
This is a list of the health insurance companies in Kenya. If any companies are missing from the list, please contact us, and we will add them to our list.
Below are the Health insurance companies in Kenya, their website, and their location.
Name: National Health Insurance Fund Kenya Nhif
Website: https://www.nhif.or.ke/
Location: Nairobi, Ragati Road
Name: Britam Health Insurance
Website: https://ke.britam.com/
Location: Upperhill, Ragati Junction
Name: Cic Health Insurance
Website: https://cic.co.ke/
Location: Reinsurance Plaza Mezzanine Floor, Aga Khan Walk, Nairobi.
Name: Aon Health Insurance
Website: https://www.aonexpatinsurance.com/
Location: Aon House Mamlaka Road Nairobi
Name: Jubilee Health Insurance
Website: https://jubileeinsurance.com/ke/product/j-care-medical-cover/
Location: Jubilee Insurance House, Wabera Street
Name: Old Mutual Health Insurance
Website:https://www.oldmutual.co.ke/personal/
Location: Old Mutual Tower, Upper Hill Road
Name: AAR Health Insurance
Website: https://aar-insurance.com/ke/
Location: Real Tower, Upperhill, Nairobi
Name: Madison Health Insurance
Website: https://www.madison.co.ke/
Location: Madison House Upper Hill Close
Name: Equity Health Insurance
Website: https://equitygroupholdings.com
Location: South B, South C, Westlands
Name: Apa Health Insurance
Website: https://www.apainsurance.org
Location: Apollo Centre, Ring Road Parklands, Westlands
Name: Uap Health Insurance
Website: https://covered.co.ke/finance/uap-medical-insurance-afya-imara
Location: Queensway House, Kaunda St, Nairobi
Name: Kcb Health Insurance
Website: https://insurance.kcbgroup.com/health
Location: KCB Kencom House Nairobi
Name: Bupa Health Insurance
Website: https://www.bupa.com/
Location: Jalaram Rd, Empress Office Suites, 3rd Flr, Parklands Nairobi
Name: Sanlam Health Insurance
Website: https://www.sanlam.co.za/
Location: Pan Building Starehe, Kenyatta Ave
Name: Amref Health Insurance Kenya
Website: https://amref.org/enterprises/
Location: Lang’ata Road, Amref Health Africa Headquarters
