If you are torn between different medical insurance policies offered by various companies in Kenya, this article is for you.
You subscribe for a medical cover because you are in need of protection. You want the cover to take care of your medical expenses and those of your family members.
You obviously don’t want to make silly mistakes on matters concerning your health and the health of your family.
Why Health Insurance?
Some statistics for you. About 56% of Kenyans reading this article are car owners. 99.8% of these cars have valid insurance covers.
However, only 23.1% of this group is attached to a valid medical cover. And that’s a crisis right there! Your car is now covered and not your health.
We all agree that health is precious, but maintaining good health is a challenge in today’s time, especially, with the ever-increasing health costs in Kenya.
And is it necessary anyway? Well, with the many uncertainties surrounding our lives today, the chance to secure your life by seeking protection against health risks is real luck!
And so I would say, Health Insurance is a need. A basic need.
The Best Health Insurance Companies in Kenya
With many insurance companies offering medical covers, you would really need to do some homework before appending your treasured signature on the dotted line.
We dissect to the finest details all the top health insurance providers in Kenya, complete with their benefits and exclusions.
Below is a list of the 5 best health insurance companies in Kenya:
#1. Jubilee Medical Insurance
JCure is a choice for many Kenyans, partly because it takes care of pre-existing, chronic, psychiatric, congenital conditions and HIV/AIDS.
Jubilee Insurance has a number of options you can choose from, depending on your insurance needs and budget.
Anyone between the age of 1 month and 60 years is eligible for the JCure cover. Senior members (above 50 years) are required to undergo a medical examination before the cover can be confirmed.
Jubilee Medical Benefits
Caters for all accredited medical specialists' fees including surgical fees and theatre charges. Pays HDU and ICU costs, MRI/CT Scans and PET Scans after authorization.
Reconstructive and dental surgery costs after an accident. Inpatient Physiotherapy sessions. Post hospitalization medication and Discharge take-home medication covered.
Gynecological treatment covered. Pre-existing, congenital and chronic conditions. Major ailments like HIV/ AIDS and Cancer treatment covered.
Organ Transplant and Psychiatric conditions. Inpatient non-accident related eye treatment. Also takes care of funeral expenses.
#2. Madison Group Medical Insurance
Madison Alpha (the brand name for their medical cover) is a choice to many Kenyans.
This preference is partly due to Madison's provided access to a reliable network of service providers across the country.
If you have pre-existing chronic, non-chronic and HIV/AIDS-related illnesses, Madison will still get you covered.
Kenyans traveling overseas are covered for the first 45 days of travel for emergency treatment only.
Expectant mothers are covered for emergency cesarean sections. In case of death, Madison will provide a free last expense.
Madison Alpha Benefits
Admission in any NHIF accredited hospital. Accommodation for parent/ guardian accompanying a child below 8 years. Doctors; surgeons; and specialist’s fees fully paid. Laboratory investigations, X-rays, ultrasound, ECG, MRI scans catered for.
Prescribed drugs, dressings, surgical appliances, and nursing procedures covered. ICU and HDU costs covered. Radiotherapy, chemotherapy, physiotherapy sessions covered.
Gynecological treatment included. Prescription drugs and dressings. Maternity expenses: maternity-related complications, pre and postnatal care, cesarean section.
Dental Benefits: Cost of fillings, Root canal, X-rays, Tooth extractions including surgical extractions together with the anesthetic fee.
Optical Benefits: Eye testing, Expenses related to vision correction, supply and fitting of eyeglasses and frames. Prescription drugs and dressings. Immunizations and vaccinations for children (KEPI recommended)
#3. UAP/Old Mutual Medical Insurance
Afyaimara is the brand name used by UAP/Old Mutual for their health insurance policies.
Like most health insurance covers in Kenya, Afyaimara offers both inpatient and outpatient benefits and has flexible packages applicable to individuals, families, and SMEs.
The policy caters for among others maternity, optical, dental & chronic diseases.
If you are comfortable taking care of your outpatient medical expenses, you have an option of taking the inpatient cover only.
UAP/Old Mutual accepts installment premium payments and offers a volume discount for a package with over 10 principal members.
The policy has a lot of convenience to offer, with road evacuation available for all cover limits
With Afya Imara, you are at liberty to seek treatment in Kenya, Uganda, Tanzania, Rwanda, South Sudan, and the much-coveted India.
Afya Imara comes with a number of comprehensive benefits, covering pre-existing conditions, chronic conditions and HIV/Aids.
Accommodation costs for parent/guardian accompanying a child aged below 6 years are also taken care of.
Afya Imara Benefits
Inpatient expenses related to acute conditions or accidents covered. Pre-existing conditions and chronic conditions on full disclosure at the time of joining. Newly diagnosed chronic conditions after the inception of cover.
Cancer treatment including but not limited to oncology. HIV / AIDS and related conditions. Post-hospitalization treatment related to cause of pre-authorization.
Inpatient non-accident related eye treatments excluding surgery for refractive errors and laser treatment. Inpatient non-accident related dental surgery/treatment.
Gynecological treatment. Organ transplant after (cost of the donor or securing the organ is excluded). Diagnostic examinations. Prescription drugs and dressings. Immunizations and vaccinations for children (KEPI recommended).
Internal and external surgical implants, appliances, joint replacement and prostheses (excluding dental fixtures). Psychiatry and psychotherapy.
Illness related reconstructive/plastic surgery after three years waiting period and excludes cosmetic, obstetrics and gynecology related. Congenital defects and genetic disorders
+ Funeral expenses per member
#4. Heritage Medical Insurance
Standard private room in-patient accommodation. Accident and non-chronic in-patient specialists, theatre costs, ward and theatre medicines. Emergency ambulance services (in-country road/air ambulance).
High care and intensive care. Maternity (childbirth and post-delivery). Neonatal care (incubator, phototherapy, congenital conditions, prematurity). Psychiatric hospitalization.
Prosthesis. External medical appliances. Specialized Radiology. Hospitalization related to chronic conditions. Optical surgery. Dental surgery. Medicines to take home.
Cancer treatment (in- and out-patient). Organ transplants (in- and out-patient). Kidney dialysis (in- and out-patient). Out-patient maternity care (in addition to other day-to-day benefits)
#5. Britam Medical Insurance
Britam Milele is the brand name for Britam's most preferred medical cover for individuals and families.
To let you decide the right policy that suits your needs, Britam Milele is custom made with six plan variants available.
The maximum entry age is 70 years with no maximum exit age. Applicants aged over 50 years are eligible subject to a satisfactory medical test from a Britam appointed provider at applicant’s cost.
NHIF membership is compulsory requirement for all Britam Milele Health insurance cover.
Doctors, Physicians, Surgeons & Anesthetists Fees. Nursing Care, Drugs and Dressings. Surgical appliances and internal prosthesis. Theatre, ICU and HDU charges. MRI, CT Scans, Pathology and Diagnostic Tests whilst admitted.
Prescribed Physiotherapy whilst admitted. Daycare surgery under General Anesthesia. Home nursing care strictly on Britam’s approval caters for professional fees,( Max 60 days. Lodger fee for accompanying parent or guardian for children upto10 years age. Specialised Radiology.
Internal and external surgical implants, appliances, joint replacements and prostheses (excluding dental fixtures). Evacuation - Local Emergency Road/Air Ambulance charges must lead to an admission.
Overseas Treatment Cover that includes a wide array of hospitals in India. Accidental & Non-accidental related Dental treatment. Accidental & Non-accidental related Optical treatment including laser treatment. Family Planning.
Pre-Existing, Chronic Ailments, HIV/AIDS. Cancer Treatment, Radiotherapy and Chemotherapy. Psychiatric Treatment. Congenital, Prematurity & Neonatal Conditions Cover.
Post hospitalization treatment for surgical and accident admissions. Maternity Cover
+ Last Expense Benefit
6. Resolution Medical Cover
Guaranteed membership for Life. A 24 hour medical emergency call centre. Chronic conditions covered.
Maternity cover includes home deliveries and Lamaze classes. Ante-natal visits are covered from Out-patient benefit and not maternity limit, leaving the limit available for delivery bills.
New Babies born after 38 weeks of gestation to full term (and discharged from Hospital) can join immediately after birth. New Born Baby illness to cover babies born prematurely, illness after birth and before discharge.
Dental Illness is covered. Lodger fee for parent accompanying children upto 10 years of age.
Value Plans with a Worldwide Travel Cover Benefit.
Outpatient consultations and diagnostic examinations covered. Injections and procedures performed at a primary care level in a doctor’s consultation room fully covered.
Prescribed medicines, X-rays, laboratory, scans and MRI taken care of. Antenatal & Postnatal care, minor trauma treatment.
Well baby check-ups inclusive of KEPI Immunization Programme.
HIV services such as adherence and nutritional counseling, follow-up every 3months, prevention of mother to child Transmission (PMTCT), ARV’s and Monitoring, treatment of opportunistic infections.
7. CIC Medical Cover
Hospital bed accommodation charges covered, less the NHIF rebate amount. Diagnostics for member and spouse covered.
Declared pre-existing conditions. Major organ transplant procedures. Non-accident maxillofacial and ophthalmologic, dental surgery .
In-patient prescribed physiotherapy, chemotherapy, radiotherapy, nursing care, prescribed drugs/medicine, dressing and diagnostic tests.
Day care surgery. Resident mother/ doctors fee.
8. AAR Medical Insurance
Cover for medical injuries resulting from political violence. Local & International rescue & evacuation services. Nutritional Advice to policyholders. A 24 hour call center and 5 Health camps and health alerts.
Pathology, diagnostic tests and procedures, radiology, radiotherapy and chemotherapy. Access to a personal consultant for the platinum cover. Cancer tests and consultation.
Dental treatment including simple extractions, difficult extractions, fillings, scaling and polishing, gum surgery, Root canal Treatment, Pulpotomy & Minor Oral surgery.
Optical services such as prescribed lenses, contact lenses, Dioptric power +/- 0.25 D and more, and frames.
Prenatal and Postnatal Care.
Maternity services including both normal, elective or emergency CS delivery. Parent/Guardian accommodation when insured child is under age of 8 years ( Lodger fee) for both local and international hospitals.
Organ Transplant. Post hospitalization discharge medication of up-to 14 days.
Re-constructive surgery, Accidental damage to natural teeth, Accidental damage to eyes and Etopic pregnancy.
9. APA Health Insurance
Pre -existing, Chronic, Congenital, HIV/AIDS related conditions, cancer treatment, organ transplant, lodger fees, accidental dental/reconstructive surgery among many more others.
Cover for Pre-Existing, Chronic, Psychiatric, congenital and HIV/AIDS including related conditions. Country wide Provider Network. Overseas inpatient referrals covered on credit under listed hospitals
Cover for inpatient dental and optical treatment Post hospitalization benefit and Funeral expenses benefit. Free Personal Accident benefit for Principal member.
10. Allianz Health Insurance
If you travel intensively for work or often move from country to country, Allianz Care & Health has an our international health insurance cover for you. The cover takes care of your treatment both at home and abroad.
Inpatient services costs including hospital and doctor’s costs, cash reimbursement if you pay your own hospitalization expense, post hospital outpatient services such as rehabilitation and home nursing, inpatient psychiatric treatment, pre-existing and chronic conditions not forgetting organ transplant if the need occurs.
Outpatient services costs including general practitioner and specialist fees as well as prescribed medicine and other supporting medical services such as laboratory tests, outpatient surgery, hormone replacement therapy, pre-existing or diagnosed chronic conditions.
In addition to this cost of acquiring artificial limbs, emergency assistance, evacuation and repatriation has been included. What’s more, prescribed alternative treatments costs like osteopathy, acupuncture, chiropractic, and homeopathy among others are covered as long as they are done by registered practitioners
Maternity costs for both natural and caesarean (whether elective or non-elective) deliveries in a registered hospital, as well as infertility treatment for patients under 40 years and trying for the first time
Dental costs including routine dental treatment, major restorative dental treatments, teeth whitening and adult orthodontic work after age 16
Optical treatments costs including costs of glasses, frames, contact lenses, lasik surgery & lens implants
Emergency assistance, evacuation and repatriation expenses including round trip airfare and accommodation for your spouse or next of kin in the event of hospitalization lasting more than 5 consecutive days, repatriation of mortal remains, compassionate visit in case of death of a close family member, second medical opinion and dispatch of medicines unavailable locally.