Private medical insurance (PMI) is a supplement to what is
available on the National Health Insurance Fund (NHIF). PMI is designed to
ensure that you will not have to worry about NHIF waiting lists or pay for the
cost of treatment when you have a medical problem in future.
Private medical
plans ensure that your health problem is diagnosed and treated quickly. You are
offered a prompt referral to a specialist and gain quick admission to a private
hospital at a time and place that is convenient for you. Once covered, you will
typically have to make your choice of private hospital from an agreed list
provided by the insurer.
Types of Private Medical Insurance in Kenya
There are 2 types of private health insurance, namely,
hospital policies cover and general treatment cover. Hospital policies cover is
tailored for in-hospital treatment and related costs such as accommodation and
theatre fees. It is divided into top private hospital cover, medium private
hospital cover, basic private hospital cover and public hospital cover. General
treatment cover provides benefits for non-medical health services such as
dental optical and physiotherapy services. General treatment policies are often
offered separately or combined with hospital cover, and are categorized as
comprehensive cover, medium cover, and basic cover.
What Is Covered By Private Medical Insurance In Kenya?
The cover you get from a private Kenyan medical insurance
company depends on the policy you purchase. Basic private medical insurance
policies usually include costs of most in-patient treatments (testing and
surgery) and day-care surgery. However, some policies extend to outpatient
treatments (like visits to specialists and consultants) and will pay you a small
amount for every night you spend in an NHIF hospital.
What Is Not Covered By Private Medical Insurance In Kenya?
Your private medical insurance will not usually cover
private treatment for:
(a) Pre-existing
medical conditions
(b) Normal pregnancy
and childbirth costs
(c) Organ
transplants
(d) Chronic
illnesses like diabetes, epilepsy, HIV/AIDS-related illnesses, hypertension and
related illnesses
(e) Cosmetic
surgery to boost your appearance
(f) Injuries
related to dangerous sports or caused by war or war-like hostilities.
N/B: You may buy a policy that includes mental health,
sports injuries and depression, but these are not always covered.
Why Purchase a Private Medical Plan?
The reasons for buying a private medical cover include:
a. Quick
diagnosis: When sick and has been referred to a specialist, a private medical
cover allows you to arrange a specialist appointment within a few days; no need
to worry about the cost of diagnosis.
b. Prompt
treatment: When you need further tests or a complex operation, a private
medical cover allows you to arrange for this at a time and in a hospital that
is convenient for you.
c. Access to
top-notch facilities: Most private hospitals allow access to up-to-date
technology and offer patients a private en-suite room, choice of food from a
menu, TV and other amenities.
Do You Need a Private Health Insurance Policy?
A private medical insurance plan is very much a personal
choice. Since you can get treatment through the NHIF plan, choosing to buy a
private medical cover depends primarily on your judgment. Nevertheless, you
will really need a private medical cover when:
a. You prefer
not to wait for NHIF treatment.
b. You don’t want
to use the NHIF and prefer to have your treatments in a private hospital.
c. You desire to
be covered for drugs and treatment that you can’t get through the NHIF plan,
such as specialist surgery for sports-related injuries (ensure the treatment is
included in your private medical policy).
Who Does Not Need Private Medical Insurance?
You don’t need private medical insurance if:
a. You are happy
to depend on the NHIF plan.
b. You already
have adequate medical insurance through your employee benefits package.
c. You can pay
for individual treatments from your savings.
d. You have
debts to repay and have no savings; you ought to prioritize debt repayment over
private medical cover.
e. You only have
little cash for basic insurance, such as home, car and life insurance (if you
have dependants).
Pros and Cons of Private Medical Insurance in Kenya
Pros:
a. You can be
referred to experts or specialists working privately in order to get the best
treatment.
b. You can use
your cover to accelerate the diagnosis process, getting the scans and tests you
want very quickly.
c. You enjoy
reduced waiting time. Not much time spent waiting for treatment as occurs with
the NHIF plan.
d. You have the
freedom to choose the doctor or hospital that suits your time and place.
e. You enjoy the
comforts of a private hospital room; not staying in an open ward.
f. Specialist
treatments and drugs may be available
g. Quick access
to physiotherapy sessions.
Cons:
a. It is
expensive
b. Chronic
illnesses such as diabetes and cancers are not ordinarily covered.
c. You may not
have local treatment options, particularly if the approved list of consultants
and hospitals are not in your locality.
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