Kenyan medical insurance companies offer a wide range of
policies covering visits to health clinics, preventive care (like screening
tests, vaccines and checkups), hospital outpatient care, X-rays and imaging
tests, hospital stays, lab tests, prescription medicines,
medical equipment
(such as wheelchairs), diabetes supplies (like lancets, test strips and blood
sugar monitors), behavioral and mental health treatment, urgent and emergency
care, maternity care, and substance abuse treatment. Comprehensive medical
insurance plans may also cover physical therapy, rehabilitation services, home
health care, care in a skilled nursing facility, wellness programs,
chiropractic care, infertility treatment, and chiropractic care.
Each year, Kenyan medical insurers open up new enrollments
and change their existing plans to meet consumer needs. This means that even
individuals already enrolled into medical plans may have to review their plans
from time to time, update new information, re-enroll, or change their plans. So
how should a Kenyan consumer choose the right medical insurance company?
(a) Identify your
health needs
Before choosing an insurance company, make sure to consider
the benefits that working with the company will give you and your family. Some
of the benefits you may consider are:
i. Prescription
drugs
ii. Maternity
care and child birth
iii. Mental and
behavioral health services
iv. Physical
therapy
v. Inpatient and
outpatient surgery
vi. Seeing
out-of-network providers.
(b) Consider your
insurance budget
Your medical insurance budget is the portion of your income
you have allocated to paying monthly medical insurance premium. If you are
healthy and have a limited budget, consider a company offering a plan with
lower monthly premiums but higher deductibles and coinsurance or co-payment. On
the other hand, a company offering a plan with higher premiums may be suitable
for you if you have a chronic illness and need proper cover for your health
needs. Remember, your monthly premium payments will reduce significantly if you
are eligible for premium tax relief. Check if you are eligible for the relief
and enroll for it.
(c) Compare
different medical insurance plans
Since different companies offer different medical policies
with different benefits, you need to evaluate how the various plans on offer
meet your health needs. In fact, you should never re-enroll automatically in
your plan even when happy with the coverage as your needs or even the plan’s
coverage may have changed, including premium costs and participating hospitals
(doctors). When you evaluate medical insurance plans, consider:
i. Their monthly
premiums
ii. The
deductible you will have to pay before a plan can contribute towards your cost
of care.
iii. Copayments and
coinsurance for the benefits expected.
iv. The
prescription drugs formulary (list of drugs covered by a plan) and mail-order requirements.
v. Limits on the
benefits offered by a plan.
vi. Whether your
favorite hospital/doctor participates in a plan’s list of hospitals and
doctors.
(d) Ensure your
health care providers are in the insurer’s network
If there are specific health care facilities, medical
doctors or other health care providers that you want to see during the year,
you should check whether the insurer has them in their network of providers.
You can do this in two steps:
i. Confirm with
the plan: Check the list of medical providers in the plan you are considering,
and then ask the insurer to confirm whether the providers listed are currently
participating.
ii. Confirm with
your favorite provider: Even if the insurer confirms that your preferred doctor/hospital
is currently participating in the plan, make sure to call your favorite
doctor/hospital so they can confirm their participation.
Make sure to document everything for reference. You never
know when questions may arise in the future.
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