Demystifying Private Medical Insurance (PMI) in Kenya

When you or your loved one is sick and you would like immediate access to the highest quality of medical care in Kenya, a private medical insurance plan can do you great good. With a PMI policy, you will have

:

i.       Access to hundreds of private hospitals in Kenya

ii.      Get medical advice and treatment by a leading specialist in Kenya

iii.    Arrange your appointments at the most convenient time.

iv.     Recover in a private en-suite hospital room with the best amenities.

v.      Benefit from groundbreaking new drugs and treatments.

Having a private medical insurance plan also means reduced waiting time on the NHIF queues. PMI providers in Kenya allow their customers to call directly or to be served conveniently as soon as they need medical attention. So you need a private medical insurance plan to enable you get private treatment promptly.

(a)    Is private medical insurance too expensive?

By design, medical insurance has traditionally been considered a luxury product. Because of that, it is often perceived as a very expensive product. In reality however, most health insurance policies in Kenya are quite affordable. Kenyan insurers have had to adapt to increased competition and changing market trends, resulting in tailor-made policies that suit as many budgets as possible.

For example, most Kenyan private medical insurers offer:

i.       Basic policy: Coverage for inpatient treatment (staying overnight in hospital), though may not cover outpatient treatment (when no overnight stay is necessary).

ii.      Mid-range policy: Coverage for inpatient and day patient treatment, plus some selected outpatient treatments.

iii.    Comprehensive policy: Coverage for a broad range of treatments, including dental, psychiatric, physiotherapy, hospital expenses and home nursing.

Many Kenyan private medical insurers will also allow you to build your own unique cover so you only pay for what you really need.

(b)    Is there private medical insurance for pre-existing conditions?

Any health problem that you have suffered its symptoms or sought medical advice on before you take your medical insurance policy will be considered pre-existing by a Kenyan insurer. Such a condition will not be covered straight away. Nevertheless, you will be able to gain cover for the condition in the future if you opt for a moratorium policy. Moratorium policies initially exclude all health conditions you have suffered in the last 5 years, but allow you to gain cover if you go 2 continuous years without any medical advice, symptoms and treatments for the same conditions. Still, conditions with a complex medical history are often not eligible, and conditions requiring ongoing treatment may never be covered as Kenyan insurers do not usually cover chronic conditions.

(c)    Is emergency treatment covered by PMI?

Since most private clinics in Kenya do not have accident and emergency sections, you may need to first go for emergency treatment in a local public hospital where your private medical insurance policy may not be applicable. However, as soon as you are stabilized, your medical insurance policy will cover the costs of your continued private medical care.

(d)   How do I buy private medical insurance in Kenya?

Kenyan health insurers offer different types of medical insurance policies. As such, you will need to decide which type of policy meets your needs and budget before making a purchase. When buying medical insurance in Kenya, you should:

i.       Shop around thoroughly.

ii.      Carefully read policy details to understand what is covered.

iii.    Be very honest about your current health status. This is mandatory and failure to “disclose all material facts” of your health may lead to policy cancellation or refusal by insurer to pay you out.

iv.     Inform your insurer of any change of circumstance that may affect your medical cover.

(e)    What rules should I follow when buying private medical insurance?

i.       Consider whether you can afford the premiums. Remember, premium costs may be increased by factors such as age, smoking, and medical history.

ii.      Consider whether there are any medical costs that are not covered by the policy.

iii.    Check if there is a limit on the amount the policy can pay out.

iv.     Check whether there is a waiting period/qualifying period before you are allowed to make claims on the policy.

v.      Consider other coverage you may have such as a workplace health insurance scheme or your partner’s workplace insurance scheme.

vi.     Know whether the policy requires you to pay for treatment up-front before claiming the cost back from the insurer. If so, think about whether you can afford to do this.

Well, as you can see, all the fears about private medical insurance are unwarranted and may lock you out of immediate, high quality medical care unnecessarily. Rise above the fears and shop around for your ideal medical insurance plan. Good luck.