Top 4 Types of Medical Insurance Plans in Kenya

Whether you are a Kenyan looking for an individual and family or a business and group medical insurance plan, there are many different options that are available in the market. Some of the plans are tailored to offer you as many choices as possible when it comes to hospitals and doctors, while others are crafted to keep the costs in check by restricting you to a particular group of “preferred” hospitals and doctors
. Nevertheless, the best Kenyan medical insurance plan for you will depend on how much protection and convenience you desire, and how much money you are willing to spend.

Below is a look at 4 of the most popular medical insurance plans in Kenya:

1.       Preferred Provider Organization (PPO) Plans

Preferred provider organization plans are the most popular option in the individual and family market. A person covered under a PPO plan is required to get his/her medical and surgical care from hospitals and doctors listed in the insurance company’s list of preferred provider in order for medical claims to be paid at the highest level. It is the responsibility of the ensured Kenyan under this plan to visit health care providers that participate in the PPO. If you get medical/surgical services from a clinic/doctor that is not in the insurance company’s list (out-of-network provider), your claims may not be covered or payments may be made at a lower level.

PPO plans are perfect for you if:

(a)     Your favorite doctor is already a member of the insurance company’s list of providers.

(b)     You desire the freedom to direct your own medical care but do not mind working with a list of preferred providers.

2.      Health Maintenance Organization (HMO) Plans

Health maintenance organization (HMO) plans offer a broad range of medical care services through a network of providers that are exclusively contacted with the HMO or who agree to offer health care services to the members of HMO. Members of HMO plans are usually required to choose their primary care physicians (PCPs) who provide them with most of their medical care needs and refer them to HMO specialists when necessary. Obtaining health care services outside the HMO are typically not covered, though emergencies are often exempted (covered).

HMO plans are ideal for you if:

(a)     You are ready to obey the rules and coordinate your medical care through a particular primary care physician.

(b)     You value preventive care services such as checkups, immunizations and similar services.

3.      Health Savings Accounts (HSA) Eligible Plans

HSA-eligible plans are PPO plans with higher deductibles, tailored for use with Health Savings Accounts (HSAs). An HSA is a special bank account (savings account) that allows participants to save money that is to be used for medical expenses in the future. The money in an HSA rolls over each year and can also acquire interest. By pairing the right high-deductible health plan with their HSAs, Kenyans can save money for health care and protect their health.

HSA-eligible plan is right for you if:

(a)     You would like to pay for medical care expenses with a saving account.

(b)     You are relatively young and healthy, rarely visiting the doctor.

(c)     Desire a cheaper monthly premium even if it means exposure to a higher deductible during an unexpected illness or injury.

4.      Indemnity

Indemnity plans allow Kenyan subscribers to take control of their own medical care and visit any hospital or doctor they like. When the insured person has been treated, the insurance company pays a specific portion of the total cost. Often, insured persons under indemnity are required to pay for some of the expenses up-front and then make an application to the insurance company for reimbursement. Since these plans offer a lot of freedom to policy holders, they are sometimes more expensive than other types of medical insurance plans.

Indemnity plan is suitable for you if:

(a)     You want maximum freedom in choosing hospitals and doctors.

(b)     You don’t mind the tasks of billing and reimbursement of your claims yourself.

Conclusion:

Whatever plan you choose, remember that the best Kenyan medical insurance plan for you will depend on how much protection and convenience you desire, and how much money you are willing to spend.