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Benefits of a Health Insurance policy

In health insurance, the term “benefit” has a distinct meaning to it, and usually refers to the specific commitments the insurance company makes to policyholders. If you bought a health insurance policy today, the following are some of the benefits you will enjoy.

  1. Covers cost of consultation: The cost of consultation varies widely in Kenya, from a few hundred shillings in low cost hospitals to a several thousand shillings in high end hospitals. The cost of seeing a doctor is usually covered by the insurance company, and is the first benefit you will have when you buy a health insurance policy.
  2. Covers cost of specialists: Specialists such as gynecologists, dermatologists, psychiatrists and others, usually have a higher consultation fee. In case a general doctor (general practitioner) refers you to a specialist, the insurance company will meet the cost associated with your visit to the specialist. You should however consult your insurer to find out whether they have an approved panel of consultants before seeing a specialist.
  3. Covers cost of lab-work: Health insurance policies usually cover the costs associated with lab tests. It is important to highlight this benefit because not all medical conditions will require medical testing before treatment can be administered. That said, some insurance companies will require you to notify them if certain tests are recommended so that they can issue their approval.
  4. Covers cost of medicine: Meeting the cost of drugs is also one of the benefits a health insurance cover should provide. In this case, the medicine may be obtained from the hospital’s pharmacy, or from a chemist accredited by the insurance company. In general, health care policies do not cover the cost of non-medical supplements and cosmetics, even if they are recommended by a doctor.
  5. Covers cost of hospitalization: In the event a policyholder is hospitalized, the insurance company will meet the costs associated with hospitalization. In this case, the insurance company will pay for accommodation (bed) as well treatment costs. Accommodation in a hospital increases the cost of healthcare because the hospital must operate several departments to support the patients. These departments include catering services, laundry services, among others. The hospital also must be in operation full time, which means hiring more staff members
  6. Covers cost of Ambulance: Some covers may include an ambulance  benefit. In this case, the insurance company provides an ambulance to take you to hospital should you need on. Some policies also include an air rescue component in partnership with air ambulance services. This benefit may require the payment of additional premiums.
  7. Cash Back for days hospitalized: In some cases, the policy may also include a “cashback” clause where the insurance company pays out a daily allowance for everyday the policyholder is hospitalized. The rationale is that long term hospitalization may lead to loss of income. The cash paid to the policyholder helps to even out loss of income during the days they are hospitalized.
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