Medical Insurance: An Intro
Do you have medical insurance? If not, you might want to consider getting one.
Medical insurance is a way of paying less or nothing for your medical bills when you get sick or hurt. It’s like having a backup plan for your health. In Kenya, getting sick can be very expensive and sometimes impossible to afford.
Did you know that every year, about 1.5 million Kenyans become poor because of paying for health care out of their own pockets?
Having medical insurance can help you save money, get better health care, and deal with any medical emergencies that might come up.
But how do you choose a medical insurance cover?
There are many options out there, and they all have different features like what they cover, how much they cost, what benefits they offer, what waiting periods they have, etc.
It can be confusing and overwhelming to compare them all. That’s why we are here to help. In this article, we will provide an overview of the best medical insurance covers in Kenya.
Best Medical Insurance Covers in Kenya
1. Jubilee Insurance Medical Cover
Jubilee Insurance is among the largest health insurance companies in the country, offering some of the best medical insurance covers in Kenya. This underwriter offers a variety of medical cover plans for individuals, families, groups, and corporates, with a network of over 4,000 hospitals, physicians, clinics, pharmacies, and health and wellness specialists.
The retail plans for individuals/families include:
I. J Care Individual/Family Health Cover– This plan covers individuals or a typical family of a couple and their kid(s). The principal member and/or the spouse must be between 18 & 64 years old, and the kids should be under-18. If schooling, then kids can be 25 years and below.
II. J Care Junior Plan: This plan is exclusively for minors (under-18 kids).
III. J Senior Health Cover: This plan exclusively covers individuals/couples that are between 65 years & 79 years, as of the time of joining. Kids can be added as dependents if they are under 18.
IV. J Care Johari: This is Jubilee’s affordable medical insurance cover for people with tighter budgets. It has 2 sub-plans with Inpatient benefits of Kshs 200k and Kshs 400k. You can access these hospitals.
2. UAP Old Mutual Medical Insurance Cover
The official name of this insurance company is now Old Mutual, after the UAP Holdings & Old Mutual merger. Old Mutual has a big presence in Kenya, as well as in more than 10 countries across Africa. It is also one of the oldest as it was founded in 1845 in Capetown, South Africa.
Their retail medical insurance covers in Kenya include:
I. Afyaimara Family Cover: This plan covers individuals or a typical family of a couple and their kid(s). The principal member and/or the spouse must be between 19 & 64 years old, and the kids should be under-19. If schooling, then kids can be 21 years and below.
II. Afyaimara Junior Cover: This plan is exclusively for children who are 18 and below. The cover can be extended up to a child who is 21 years if there is proof of their schooling.
III. Afyaimara Senior Cover: This plan exclusively covers individuals/couples that are between 65 years & 80 years, as of the time of joining.
IV. Afyaimara County Cover: This is UAP Old Mutual’s affordable medical insurance cover for people with tighter budgets. With its affordable rates, you can access these hospitals.
V. Afyaimara Executive Cover: This plan is for people with a big budget & who want to get the crème de la crème of benefits. The inpatient benefits here range from Kshs 10 million to Kshs 20 million with outpatient benefits ranging from Kshs 200k to Kshs 250k annually.
3. Madison Insurance Medical Cover
Madison is another popular and trusted medical insurance company in Kenya. Just like Jubilee and Old Mutual, Madison also offers a budget health insurance plan for low-income people. Madison’s health insurance packages include:
I. Madison Betterlife Premier Plan: This plan covers individuals/families and kids. The principal & spouse must be between 18 and 60 years to join. Kids must be under 18; but can be covered until 25 if there’s proof of their schooling and under the parent’s care. This plan differs from the Madison Betterlife Executive Plan (below) in the following main ways:
- Inpatient benefits are Kshs 3 million, Kshs 4 million, and Kshs 5 million.
- No co-payment is needed.
II. Madison Betterlife Executive Plan: This plan is just like the Premier Plan above, except for the following:
- Inpatient benefits are Kshs 1 million, Kshs 1.5 million, and Kshs 2 million.
- There’s a co-payment of Kshs 1,000 for outpatient visits at Nairobi Hospital, Aga Khan Hospitals, MP Shah, Mater Hospital, Karen Hospital, Gertrude’s Children Hospitals, and AAR Healthcare.
III. Madison Betterlife Budget Plan: This is Madison’s budget medical insurance cover for individuals/families with lower budgets. With its affordable rates, you can access these hospitals.
IV. Madison Betterlife Ignite Plan: This plan is exclusively for singles who are between 18 & 30 years old. It’s one of the best medical insurance plans for under-31 adults in Kenya. And with it, you do not have any co-payments, and you can access all of Madison’s panel of hospitals. Seriously, if you’re single and 30 yrs or below, consider taking it- It’s super cheap!
4. Britam Health Insurance Cover
Britam is another very reputable and popular insurance company, offering some of the best medical insurance covers in Kenya. It is also the only health insurance company to claim that it has a plan that covers pre-existing/chronic conditions up to the full limit. Normally, insurance companies will cover these conditions up to a certain sub-limit.
Across their retail medical plans, the principal & spouse must be between 18 and 75 years to join. Kids should be 17 years & below. If schooling, then kids can be covered until they are 25 years old.
I. Britam Milele Advantage Cover: This plan covers members’ pre-existing conditions up to the full limit of the cover. That is to say, if you take the 3 million Inpatient package, then your pre-existing conditions will be covered until 3 million- unlike the rest of the plans.
II. Britam Milele Premier Cover: This plan is just like the Milele Advantage one above, except that it does not cover your pre-existing conditions up to the full limit.
III. Britam Milele Essential 1 Cover: This plan requires a copay of Kshs 500 for all outpatient visits. And you can only attend Britam’s panel of Tier II & III providers. This means you won’t attend top-tier hospitals like Aga Khan, Nairobi Hospital, etc.
IV. Britam Milele Essential 2 Cover: This plan also requires a Kshs 500 co-payment for all outpatient visits. Here, you can only attend Britam’s panel of Tier III providers.
5. AAR Insurance Medical Cover
According to AKI’s Insurance Industry Report 2021, AAR was one of only 3 insurance companies (including Jubilee & UAP Old Mutual) that accounted for more than 50% of all 2021 medical insurance business in Kenya. So that should tell you that AAR has one of the best medical cover plans in Kenya.
Unlike other underwriters, AAR keeps it simple by having only one medical cover plan with Inpatient benefits ranging from Kshs 1 million to Kshs 40 million. Also, the principal & spouse must be between 18 and 64 years to join. Kids should be 17 years & below. If schooling, then kids can be covered until they are 25 years old.
Comparing the Best Medical Insurance Covers in Kenya
|Inpatient Benefit||Shared||Shared||Per Person||Shared||Shared or Per Person|
|Outpatient Benefit||Per Person||Shared or Per Person||Per Person||Shared or Per Person||Shared or Per Person|
|Can you buy Inpatient Benefits Alone?||Yes||Yes||Yes||Yes||Yes|
|Can you have Inpatient Benefits without Maternity?||Yes, you can opt out of Maternity||No, Maternity is a part of Inpatient||Yes, you can opt out of Maternity||Yes, you can opt out of Maternity||No, Maternity is a part of Inpatient|
|Maximum joining age for Seniors||79 years||80 years||No Seniors’ |
|75 years||No Seniors’ |
|Exclusive Kids’ Cover||Yes||Yes||No||No||No|
|Pre-existing Conditions||Covered to a lower limit||Covered to a lower limit||Covered to a lower limit||Milele Advantage plan covers to the full limit||Covered to a lower limit|
|Cancer Waiting Period||2 years||unclear||2 years||1 year||1 year|
|Organ Transplant Waiting Period||1 year||1 year||2 years||2 years||5 years|
|Maternity & Related Conditions Waiting Period||1 year||1 year||10 months||1 year||1 year|
|Gynecological Surgery Waiting Period||1 year||1 year||unclear||10 months||unclear|
Choosing the best medical insurance cover in Kenya is not an easy task. There are many factors to consider such as your health needs, budget, preferences, etc. You also have to compare and contrast different medical insurance plans to find the best one for you.
We hope this article has helped you get a better idea of some of the best medical insurance covers available in Kenya and how to choose one that suits you.
Remember that having health insurance can help you save money, access better healthcare services, and cope with any medical emergencies that might come up. It’s a solid backup plan for your health. So don’t wait any longer. Get yourself a medical insurance cover today!
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