Buying private health insurance in Kenya is almost similar
to buying any other type of insurance policy. In Kenya, private medical
insurance is available in a broad range of cover levels at varied premium
levels tailored to meet the needs of different consumers.
For instance, there
are options around the types of treatments covered, the cover level that apply
to those treatments, where such treatments are offered, and the contribution a
person is willing to make to the cost of treatment (the excess). Therefore,
before any Kenyan chooses a private medical insurance policy, he/she should
take time to understand the various options available in order to make an
informed choice.
When assessing your options, you should:
(a) Compare the
benefits offered by different Kenyan insurers.
(b) Compare any
cover limits or monetary amounts in every option.
(c) Consider your
unique health needs and requirements.
(d) Ask questions
about how each cover works.
Note: Whenever your employer purchases insurance on your
behalf, he/she will make these decisions for you.
Know the Policy Terms and Conditions
In order to ensure that you thoroughly understand what you
are covered for and all the limits that apply when you make a claim, you should
carefully read the policy terms and conditions. Make sure to contact the
insurer to ask questions about the cover. When speaking to your potential
insurer, you should find out the following:
i. Does the
policy have monetary limits? Make sure to get a cover that will take care of
the portion of treatment you want covered or the specific course of treatment
you want covered.
ii. How does the
excess on the policy work? Will it be applied per policy year or per claim?
iii. Is there a
cover for cancer? If there is, what treatments are covered and for which stages
of the disease does the cover apply?
iv. Does the insurer allow clients to enjoy any
discounts or extra benefits during policy renewal?
v. Is there a no
claims discount and what happens to my next premium after I make a claim?
Meaning of Private Insurance
It is also important for you not to confuse private medical
insurance with other forms of insurance such as income protection, critical
illness and health cash plans. By private medical insurance we mean that form
of insurance designed to cover the cost of private medical and surgical
treatment for “acute conditions” that begin soon after the policy begins.
Acute conditions are defined as diseases, illnesses or
injuries that are likely to respond quickly to treatments aimed at restoring
the patients’ state of health to where they were immediately before suffering
the diseases, illnesses or injuries, or which results in full recovery. Your
insurer should be able to explain to you the available coverage options for
acute conditions and state clearly whether there is coverage for long-term
conditions (also called chronic conditions).
Chronic Conditions are diseases, illnesses or injuries that
have one or more of the following attributes: need long-term monitoring, relief
of symptoms or control, require rehabilitation, continue indefinitely, have no
known cure, or are likely to recur after treatment.
Reasons to Buy Private Medical Insurance in Kenya
Private health insurance is designed to work alongside (not
to replace) all the services offered by the National Health Insurance Fund
(NHIF). In fact, individuals who purchase private medical insurance coverage
still retain the right to use NHIF.
The reasons to buy private medical insurance are:
i. To enjoy
timely access to medical care.
ii. To get
prompt referral to a medical consultant or specialist.
iii. To get quick
admission to hospital.
iv. To enjoy
treatment at a convenient place and time.
v. To get direct
care from experienced medical specialist.
vi. To enjoy
highly advanced treatment options in the best private clinics.
vii. To enjoy
amazing hospital accommodation, including the privacy of an en-suite room, home
amenities such as TV, and great comfort and cleanliness.
viii. PMI also pays
cash benefits to insured Kenyans who choose to get treated in public hospitals
instead of private ones.
How Does Private Medical Insurance Work?
While insurance policies are usually different, medical
treatment typically starts with a referral by a doctor for specialist
treatment. Before they begin private treatment, insured persons are required to
contact their insurers to confirm whether they are covered for the treatments
they seek. It is also important to keep in touch with the insurer throughout
the treatment period to ensure that every stage of treatment is covered.
Remember that there are treatments for certain illnesses, particularly
pre-existing conditions, which may not be covered by the policy.
How to Buy Private Medical Insurance in Kenya
In Kenya, private medical insurance is offered only by
insurers and may be purchased:
i. Directly
from the insurer
ii. Through an
independent advisor
iii. Through an
agent, such as retail outlet, bank or building society.
Medical insurance applications can be made:
i. Over the
phone
ii. By using the
internet
iii. By post
iv. Face-to-face
Methods of application for medical insurance vary according
to insurers. For instance, when you intend to make a purchase through the
internet, you should try searching for both “medical insurance in Kenya” and
“health insurance in Kenya” as the terms are used interchangeably. When buying
directly through an insurer or an agent tied to a particular insurer, you will
only be able to access information on policies offered by the specific insurer
or agent. Alternatively, you can
purchase your medical plan through an independent advisor who is capable of
offering policies from a broad range of Kenyan insurers. In fact, an independent advisor is able to
recommend the right medical cover after carefully assessing your needs.
Completing the Application Form
Whether you purchase your medical plan directly or
indirectly, you will be required to fill an application form, answering various
questions about your health. The application or any declaration you make to the
prospective insurer is very important as it informs the basis of your contract
with the Kenyan insurer. Therefore, you ought to answer the questions as
completely and accurately as possible, and to the best of your knowledge and
belief. If you don’t, your insurer may refuse to pay your claim or even cancel
your policy. Hence, when unsure whether something is important to the insurer,
you should disclose it. For example, you should disclose any pre-existing
health conditions during the application.
Kenyan private medical insurance companies deal with
applications for cover in two ways: full medical underwriting or moratorium
underwriting. All Kenyan private medical insurers offer the full medical
underwriting option, but only a few provide the moratorium underwriting option.
Full medical underwriting (medical history declaration) means you are requested
to provide details of your medical history as comprehensively and accurately as
possible. The insurance company may even write to your doctor for more
information, though insurers don’t do so in all cases. Make sure to provide all
the information requested by your insurer because if you don’t then your
insurer may refuse to pay your claims in future or cancel your policy.
In moratorium underwriting, the insurer does not ask you to
provide the details of your medical history. However, the insurer will not
cover any condition that you have been treated for, taken medication for, had
symptoms of, or asked advice on. That is, the insurer will not cover you for
any conditions that existed in the last few years, with 5 years being the usual
period. And while the conditions may eventually become eligible for cover
automatically, this will only occur when you have not shown the symptoms of,
received treatment for, taken medication, or got advice and tests for that
condition (or in relation to the condition) for a continuous period of 2 years
after the policy commenced. Your insurer will provide you with information on
how the moratorium system works.
After your application is approved, the insurer will tell
you when the cover starts. Usually, the insurer will send policy documents to
you as soon as the policy is set up. You will have at least 14 days from the
date of receiving the documents to decide whether the product offered is ideal
for you. This duration is called the “cooling-off period”. If you want to cancel your policy, you must
do so within the indicated period and inform the insurer that you intend to
cancel your cover. Such a timely cancellation will enable you to get a full
refund of any payments you have made unless you have made a claim.
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