Health Insurance in Kenya: What Is It?

Health insurance is a means of paying for health care. Kenyans with health insurance plans are protected from paying the full costs of medical services whenever they are injured or sick. Just like home insurance or car insurance, health insurance covers the cost of the insured person’s medical and surgical expenses.
Depending on the terms of the medical insurance, the insured person (subject) either pays the medical costs out-of-pocket and is subsequently reimbursed or the Kenyan insurance company reimburses the medical costs directly. Once the subject chooses a medical insurance plan and agrees to pay a certain rate (premium) every month, the health insurance company agrees to pay a portion of the covered medical costs. The subject’s payments for health insurance are usually based on the discounts the provider negotiates with doctors and hospitals.

Need for Medical Insurance

Medical costs rise in Kenya year after year. In fact, inflation in health care is much higher than inflation in food, clothing and other items. This means that Kenyans must find ways of cushioning themselves from the rising rates of medical services. For example, the cost of open heart surgery is around Ksh 400,000 at Kenyatta National Hospital and between Ksh 800,000 and Ksh 1.2 million in private hospitals. For an individual who has not saved such a sum of money, making arrangements at the eleventh hour to fund open heart surgery may be extremely difficult.  And for elderly persons stricken frequently by different kinds of ailments, meeting the cost of medical care may be impossible.

One way of avoiding the heartache of last minute fundraising for medical emergencies is to take medical insurance. Medical insurance offers great flexibility in terms of the range of diseases/ailments covered. For example, some Kenyan insurance plans cover up to 30 critical illnesses and more than 80 surgical procedures. So in case of sickness, the insurance plan simply disburses payment towards the illness/surgery regardless of the actual amount of medical expenses. Besides, the policy continues even after the insured individual has benefited on selected illnesses. With a Kenyan medical insurance cover, you are guaranteed a more secure future both health-wise and money-wise.

Types of Medical Insurance in Kenya     

Kenyan insurance firms offer a variety of medical insurance plans. The medical health insurance may be procured for you and your family through your employer, a private insurer, or through the government (public health insurance). Each medical insurance plan is unique, but is primarily tailored for the costs of medical and surgical procedures. In some cases, you may be required to purchase additional insurance plans in order to cater for all your needs. The most common additional plans are prescription drugs, vision, dental, travel, disability and life.

Summary

A health insurance policy is a contract between a service provider (insurance company/government) and an individual or his/her spouse. Such a contract may be renewable (monthly/annually etc) or lifelong (in case of private insurance). The type and amount of medical and surgical costs to be covered by the Kenyan insurance provider are clearly specified in writing. When the insured person is sick or injured after taking an insurance plan, the costs are taken care of by the provider as agreed.