How to Discuss Coverage Options with Medical Insurers in Kenya?

Kenya has several medical insurance companies that are just waiting for you to begin your journey with them. While the many insurers in Kenya is good for you as the stiff competition keeps the premiums down, you need to know the basics of discussing coverage options and details with insurers in order to avoid running into problems.

Discussing your health

When you decide to buy private medical insurance, you must be ready to talk about your current health status as openly as possible with insurers. In fact, you must be ready to disclose anything which may affect your medical insurance cover, such as existing medical conditions, smoking etc. Honest disclosure applies even if the insurer does not ask a direct question about your health in the application form. Remember that failure to provide this information may be reason enough for the insurance company to refuse to cover the cost of your treatment. It is also important to inform your insurer about any changes in your circumstances that may affect your policy.

Discuss what is and what is not covered

Since you do not want to run into problems when you or your loved ones are sick and require urgent medical attention, make sure to discuss what is covered and what is not covered with your insurer. While Kenyan insurers usually provide details of what is covered and not covered in policy documents, discussing with insurers enable you to make the right decisions and to put your money on a policy that meets your needs. Ask all questions you may have and do not purchase a policy until you are satisfied that you are getting the right plan. Many Kenyan medical insurers do not cover pre-existing health conditions, costs of psychiatric treatment, incurable long-term (chronic) illnesses, fertility treatment, health expenses abroad, cosmetic surgery, unproven or experimental treatments, and the cost of treating children. Nevertheless, discussing with potential insurers will enable you to get a policy that covers all your needs.

What if you have a disability?

Kenyans with disability may have difficulties getting some types of medical coverage. While the Kenyan law is against insurers discriminating the disabled, insurers may often take into account your disability when deciding whether or not to approve your application and even adjust the terms. For disabled Kenyans, it is advisable to discuss your coverage options with an independent broker or an independent intermediary so you are directed to the most suitable policy.

When you have treatment

Before you are put under any treatment, make sure to check your medical policy and to contact your insurance company to seek their agreement on the place, cost and type of treatment. Most Kenyan insurers have claims departments that help customers to get quality treatments at the right price. So you need a confirmation from your insurer that they are happy with your treatment arrangements and that they will pay for it. It is also prudent to get an estimate of the treatment costs from the doctor/practitioner and send a copy to your insurer. Make sure to keep detailed records of all treatment expenses, including receipts and invoices.