Types & Benefits Health Insurance Plans in Kenya

The health insurance sector in Kenya has several types of insurance policies targeting the general public. These plans are devised to meet the needs of Kenyans seeking insurance covers for their families and for companies requiring covers for their employees. Here are the key types of insurance policies that you will find in the Kenyan market.

1. Inpatient cover: Inpatient cover refers to policies that provide compensation for costs associated with hospitalization. Impatient covers come into effect when the policyholder is admitted to hospital. This cover is typically more expensive that other types of cover because in addition to the direct costs of treatment, it also covers policyholders from the liabilities associated with accommodation costs in the medical facility. Some insurance companies require policyholders to get clearance before accessing inpatient facilities. In these cases, the company seeks to make sure that the case requires hospitalization, and is not just a frivolous hospitalization request.
2. Outpatient cover: By far the outpatient cover is the most common type of health insurance cover. The outpatient cover protects policyholders from liabilities associated with access to outpatient facilities. In this case, a policyholder accesses health services in a hospital or clinic accredited by the insurance company and after receiving treatment the policyholder does not remain resident in the health facility. Outpatient covers tend to be cheaper than inpatient covers because all the costs incurred are treatment related. It does not have the accommodation component that usually inflates the cost of outpatient covers. However, outpatient covers do not usually exist on their own. Typically they are bundled with the outpatient cover
3. Low cost covers: In the recent years, some companies have developed low cost covers targeting the low-income segment of the country. These covers have low cost premiums and provide access to a limited range of inpatient and outpatient services. The most popular among these covers is the Linda Jamii cover targeting SMEs and other small groups. Low cost medical insurance covers in Kenya are provided by insurance companies that are willing to work with low cost hospitals. Some of them have co-payment plans to reduce the risk of frivolous visits to healthcare facilities
4. Medium and high cost covers: Medium and high cost covers are the most common types of health insurance covers in Kenya. Usually, these covers are paid for by employers in order to give their employees a health policy as part of the remuneration package. High ranking company employees are usually afforded higher cost covers while middle and low level workers get  medium cost covers. In practice, insurance companies have a graduated schedule showing the amount of premiums versus the cover limits. In some cases, the insurance companies give additional benefits that are otherwise found in a funeral cover, should a policyholder pass on.
5. Maternity cover: The maternity cover is also available in the Kenyan market. This cover is usually included as an enhancement of a basic health insurance policy. Maternity cover usually meets the costs of hospitalization, including delivery and any eventualities such as congenital illnesses that may result from the pregnancy. Due to its nature as an “assured risk”, the maternity cover in many ways is a customer retention element  used by insurance companies.