5 Affordable health insurance covers Kenya

June 12, 2022 HEALTH INSURANCE IN KENYA, UNCATEGORIZED

As an insurance agency, we are asked two major questions when it comes to health insurance covers Kenya in Kenya” How much does medical insurance cost in Kenya?” and “Which is the cheapest medical cover in Kenya?” As an insurance agency, we get asked this question a lot. The affordability of health insurance definitely varies from one person to another and it requires understanding what the coverage entails.

If you find yourself asking about healthcare affordability, we are here to help you understand affordable health insurance covers in Kenya. When looking at healthcare in Kenya, we shall look at Kenya’s national insurance options as well as private health insurance covers in Kenya.

National Health Insurance Fund (NHIF)

The National Health Insurance Fund commonly known as NHIF is the most affordable health insurance plan in Kenya with contributions ranging from KES 500 to 1700. The contributions are based on your income as well as the nature of employment one is engaged in.

For self-employed individuals, they are automatically enrolled in the NHIF Supa cover. This will cover them, their spouses, and their children. They are responsible for remitting their contributions to NHIF. As for NHIF members that are employed, their employers are responsible for their submission of NHIF fees, and the contribution is based on an income scale.

What does NHIF cover in Kenya?

NHIF offers the services below:

Outpatient service

1. Consultation services
2. Labs
3. Daycare procedures and surgeries
4. Drugs & prescriptions
5. Health education
6. Drug and substance abuse
7. Rehabilitation and physiotherapy services

It is important to note that NHIF Supa Cover does not cover dental and optical services without preauthorization. This means that you will need to seek approval first from them before you can enjoy the benefits.

Inpatient services

1. Consultations
2. Accommodation
3. Nursing care
4. Laboratory tests
5. Radiology examinations
6. Physician’s fees
7. Surgeries and operating theater charges
8. Prescribed medications
9. Dressings and Maternity

You can read more on the other services provided by NHIF here.

Affordable Private Health Insurance Covers Kenya

Now that we have a basic understanding of NHIF, we shall discuss what other options we have for affordable health insurance covers Kenya has to offer. By no means, this list will not be exhaustive and we welcome your experience with the current.

What is covered in a health insurance policy?

So, what is covered in health insurance covers Kenya has to offer? We had discussed the components of private medical insurance in Kenya in an earlier article. You can have a refresher read here. However, the main areas of coverage for medical insurance include:

1. Inpatient services
2. Outpatient services
3. Maternity services
4. Dental and optical plan

Health insurance companies in Kenya

Before we go further, we shall need to understand who are the major health insurance companies in Kenya and the best medical insurance companies in Kenya 2024. The list below gives us a list of health insurance covers Kenya providers in no particular order or preference.

1. Jubilee Insurance*
2. UAP-Old Mutual Insurance is now Old Mutual Insurance
3. Heritage Insurance*
4. GA Insurance
5. Madison Insurance
6. AAR
7. Kenyan Alliance
8. APA Insurance
9. MUA Insurance
10. Resolution Insurance is now under receivership

* to mean they provide medical insurance for corporates only for both local and international health insurance covers.

**to mean they provide international medical insurance for both individuals and corporates and they have a local office presence.

So, what are affordable private health insurance covers in Kenya? To make this make sense we shall assume the average family size in Kenya to be 4 members based on 2019 statistics. Other important things to note are as below:

* Family options available

**Individuals only

***Family and individual options are available but for SMEs only

Madison Insurance

Madison recently revised their medical insurance cover to include new benefits packages. However, in the spirit of keeping affordability in mind for health insurance covers Kenya has available, we shall only look at two of the new benefits:

Madison Betterlife Budget*

This package provides options for 1 family member and above. The package is one of the most comprehensive plans with basic inpatient and outpatient cover. One can add a maternity benefit at a cost of up to KES 75,000. The outpatient cover has an inclusive dental and optical plan of up to 15,000 each per family which forms part of outpatient.

The cover also offers one of the biggest inpatient limits of up to 1.5M a family. Making it one of the highest in the market, especially for individuals and families.

1. Inpatient cover limits vary from 500K-1.5M (per person and family options available)
2. outpatient limit varies from 50K to 100K per person
3. Maternity between 30K-75K
4. Dental and optical cover covered within the outpatient of between 5K-15K
5. Premiums are based on the age of the person

Madison Budget Health Insurance	Cost
M (One Person Above 18 years)	Ksh. 16,923
A Family of 4	Ksh. 67,692

Britam’s Bima Ya Mwanainchi

Britam provides another affordable health insurance cover in Kenya and it’s called Bima ya Mwanainchi. This particular health insurance covers:

1. Inpatient cover of between 75K-500K
2. Outpatient of between 30K-75K
3. Maternity within the inpatient cover of between 20K-30k
4. Dental and optical cover within the outpatient cover of between 3K-7K
5. Chronic/pre-existing/congenital conditions are covered to a sublimit within both inpatient and outpatient

Old Mutual Afyaimara County*

The other product in the list of available health insurance covers Kenya has is the plan from UAP-Old Mutual called Afyaimara County. This particular plan has also undergone some major changes in recent years. The plan has

1. Inpatient covers between 100K-1M
2. Outpatient covers of between 25K-50K.
3. Maternity within inpatient of between 30K-50K.
4. Dental and optical are covered within outpatient for the 50K limit outpatient only and up to 10K

Premium contribution rates of this particular product are based on age brackets of 10 years, meaning that the product is cheaper in your 20s, and price increases as your age increases irrespective of good medical history. A Family of 4 the oldest between the ages of 18-29 years, will pay approximately Kes. 70,000 for an inpatient of 100K and outpatient of 25K per person. With the same factors taken into consideration, the family of 4 will pay approximately 113K for an inpatient of 1M and 25K outpatient per person.

Old Mutual Affordable Health Insurance Afya Imara County	Cost
Family of 1	Ksh. 30,000
Up to a Family of 4	Ksh. 113,000

The maximum age for admission into the cover is 65 years. Dental and optical overs are only available under outpatient up to a limit of 10K each. Maternity insurance is in built into the inpatient cover.

APA Afya Nafuu*

Afya Nafuu provided by APA is one of the many health insurance covers Kenya has to offer that is available in the market. It has options for:

1. Inpatient of between 100K-1M per person
2. Outpatient of between 30K-100K per person.
3. It also has maternity cover between 50K-100K.
4. No Outpatient dental or optical cover
5. The premium contribution rates are based on the age bracket and consequently, the premium increases when your age increases.

A family of 4 will pay approximately KES 130K a year for a limit of 1M inpatient family shared and 100K outpatient per person. The maximum age for admission into the cover is 75 years. No dental and optical cover is provided.

APA Affordable Health Insurance Afya Nafuu	Cost
Family of 1	Ksh. 37,207
Up to a Family of 4	Ksh. 129,856

Jubilee Micro Health Cover

Jubilee Insurance provides 2 unique affordable health insurance covers as below:

J-Care Cover Bora*

This is purely an inpatient health insurance cover only and one of the most affordable medical insurance covers in Kenya. Cover Bora provides very unique inpatient benefits such as:

1. High levels of coverage for pre-existing conditions.
2. Maternity for both normal and CS births up to a specified limit.
3. Covers for pre-terms and congenital births up to a specified limit

The health insurance inpatient covers are between 250K – 500K.

This affordable cover bora costs start:

Jubilee Affordable Medical Insurance Cover Bora	Cost
Family of 1	Ksh. 6,200
Up to a Family of 4	Ksh. 12,600

J-Care Johari*

Jubilee Health Insurance also provides another all-in-one affordable medical insurance cover by the name Johari.

The particular health insurance cover provides for:

1. Inpatient cover of between 200K-400K
2. Outpatient cover of between 40K -50K
3. Maternity insurance of between 40K-50K
4. No outpatient dental and optical cover
5. It also covers long-acting family planning up to 2,500 within the outpatient

Jubilee Affordable Medical Insurance Johari	Cost
Family of 1	Ksh. 25,564
Up to a Family of 4	Ksh. 56,121

Jubilee Health Micro SME***

This is one of the health insurance covers Kenya has to offer and is available for SMEs, registered groups, and organizations with at least 10 principal members and above. Jubilee insurance medical cover rates for this micro health cover are based on benefits with a uniform age of between 18 years and 60 years. The benefits range from

1. Inpatient cover of between 100K-500K,
2. Outpatient cover of between 40K -60K,
3. Outpatient Dental and optical cover of between 5K-10K.
4. Maternity insurance is built into the inpatient cover of between 30K-75K

The premium contribution rates of a family of 4 for an inpatient of 500K and outpatient of 60K is approximately 73K.

GA SME Economy Plan***

This is one of the health insurance covers Kenya has to offer provided by GA targets SMEs from 3 members to -9 members. They provide relatively higher levels of cover with

1. Inpatient ranging from 300K-5M
2. Outpatient as from 50K-200K.,
3. Dental and optical of between 10K-30K, and
4. Maternity of between 75K-150K a family.

Premium contribution rates of a family of 4 for an inpatient of 2M and outpatient of 100K is approximately 122K a year. This excludes maternity, dental and optical insurance cover. It admits members between 18 years and 59 years.

Which health insurance covers Kenya has to offer is best ?

When it comes to the best medical insurance covers in Kenya, it is really a very difficult question as it is based on so many things which include but are not limited to your current health conditions, and budget requirements among others. You can read more on the same here:

New benefit packages in health insurance covers in Kenya are being updated and provided to ensure that they reflect the changes in terms of demand for better services, and competition from international health insurance providers as well as local companies.

At the end of the day, don’t forget to do a cost-benefit analysis for all the health insurance covers Kenya has to offer. This is because, cheap/affordable doesn’t always mean the best, sometimes cheap can be expensive. If you would like to talk to some to help you do a cost-benefit analysis for the above covers?