Maternity Insurance In Kenya: The Ultimate Top 3 Considerations

March 2, 2021 HEALTH INSURANCE IN KENYA

Maternity insurance in Kenya is offered as a benefit or a rider after purchasing the most compulsory inpatient cover. Imagine being a couple planning to have a child in a year or two? Or a single person planning on having a child? Or ever having been a parent before and never had medical insurance before? What if the cost of maternity health care gave you some anxiety the first time and you do not want to ever worry about it ever again?

Health Insurance is one of the most beneficial insurance options you can take up for yourself or your family. Much as it is a bit pricy it’s key in order to get the best advice and services in case anything happens. Remember to get the best deal you need to be willing to share your health and life with your agent to be able to get the best deal possible.

One of the benefits offered in medical insurance is the maternity benefit. This benefit is one of the most controversial covers since it has several limitations and conditions attached to it as discussed in this article.

We shall look at the cover in the following criteria:

1. Maternity insurance waiting period and what it means
2. What maternity insurance in Kenya covers
3. What is not covered under maternity insurance in Kenya
4. Maternity insurance in Kenya planning tips

Just like all other benefits under medical insurance, maternity coverage has a waiting period attached to it. This means that there is a period upon which once you take the cover, you cannot be able to claim under it or use it.

Maternity Insurance in Kenya Waiting Periods

This period varies from company to company but the maximum currently available with most insurance companies in Kenya is 12 months. However, the range is usually between 10-12 months. Companies like Madison and GA insurance so far have the least with 10 months waiting period.

This calls for planning from the individuals concerned when it comes to this benefit as one is not entitled to automatic coverage with the insurance companies even if they are on renewal terms. For example, if you are renewing the cover this year and you add the maternity benefit to your cover, you will still have to serve the maternity insurance waiting period under your cover.

Is there any maternity insurance in Kenya without a waiting period?

This has 4 answers depending on who is taking cover.

1. If it is an individual cover, the discussed maternity insurance waiting periods apply between 10 months-12 months based on the company.
2. If you are an individual moving from one insurance company to another, and you were enjoying the maternity insurance benefit, then you can discuss the option of waiver of waiting period for this cover.
3. SMEs and Corporates, they can negotiate for a waiver of the waiting period if it is the first time they are taking cover. They may be subject to an additional premium for this waiver.
4. SMEs and corporates moving from one insurance company and enjoying such benefits, then the waiting periods are automatically waived.

What is covered under Maternity Insurance in Kenya

Maternity insurance in Kenya covers several things as discussed below.

1. Consultation fees prior to delivery: This caters to costs related to seeing your doctor in regard to the prenatal visits
2. Standard Prenatal testing
3. This includes the usual testing that needs to ensure the safety of the mother and child
4. Obestritian Scans
5. Post natal consultations
6. Normal deliveries
7. C-Sections: whether elective or emergency.
8. Complications arise as a result of medical emergencies such as miscarriages.
9. Some companies will categorically state that any expenses towards medical termination of pregnancies will be accommodated.

What is not covered in Maternity insurance in Kenya

Just like all other insurance, maternity insurance in Kenya is subject to a few things that are not covered. The major ones include:

1. Any maternity-related expenses before the end of the waiting period.
2. Any family planning, infertility/impotence-related treatment**
3. Any maternity-related costs that can be covered by NHIF such as bed limit payable.
4. Any limits above the amount of maternity purchased.
5. Premature births unless expressly stated.

Does medical insurance in Kenya cover for IVF treatment?**

Currently, only APA insurance covers IVF treatment within its maternity insurance coverage. It covers between 50,000-75,0000 Ksh subject to the maternity amount applied for and it must be bought together with an inpatient cover.

Does Maternity insurance in Kenya cover family planning?

Maternity Insurance does not cover family planning but the following companies cover family planning within their outpatient covers:

1. Heritage insurance 2,500
2. Jubilee Health 2,500
3. APA Insurance up to 10,000

Can I apply for maternity insurance in Kenya if already pregnant?

Insurance companies in Kenya do not offer maternity insurance in Kenya if you are already expectant/pregnant. However, you can apply for normal health insurance plans and you will be covered by costs related to acute illnesses and accidents. However, costs related to pre-natal and birthing costs will not be catered to.

To qualify for maternity cover without waiting period in Kenya you will need to consider an SME Insurance cover or a corporate cover.

You can compare the various medical insurance benefits that have the health insurance benefits included by clicking on the link below.

Maternity Insurance Planning Tips

Are you planning on having a baby? Are you planning on taking maternity health insurance in Kenya? What do you need firsthand before taking up the medical insurance plan? We created a checklist on what you need to know, do and plan before you consider taking up a maternity health insurance package.

4.1. Your Budget

How much are you willing to spend on insurance? That is an important consideration as you do not want to spend more on insurance premiums than necessary. If you do not know where to begin, why not get to compare medical insurance rates for free using our medical insurance premiums calculator?

4.2. Waiting Period

Unlike other classes of insurance, maternity insurance is usually subject to what is called a waiting period. A waiting period is a duration in which, though on the cover, that particular benefit cannot be used and therefore excluded. You can read more on the same in an article we had written about health insurance terms in Kenya here. You can also refer to the top of the article

Maternity insurance package waiting period range between 10-12 months subject to whether it is an individual cover or a corporate cover. For corporate medical insurance covers, they could have negotiated to have the waiting periods removed or not. Please feel free to engage with your HR or your insurance agent/broker for guidance.

What the waiting period implies is that you need to be on medical cover before you plan to conceive for at least 9 -12 months based on the waiting period.

4.3. NHIF

Is your NHIF up to date? Every inpatient claim under your medical insurance is subject to an NHIF bed rebate or NHIF net. What this means is that the cost of the hospital bed is paid out of your insurance once NHIF has paid its part. The rate that NHIF pays varies from hospital category i.e Category C(high-cost private hospitals) through Category C (Government hospitals) and as per the NHIF contract signed between the hospital and NHIF.

Ensuring that your NHIF is up to date means that the choice of the hospital you choose to go to will impact how much NHIF pays for, if not, then the difference is paid out of pocket/cash.

How much does NHIF cover maternity?

Apart from private medical insurance maternity insurance in Kenya, NHIF maternity insurance covers which cater delivery costs up to:

1. Normal delivery- Ksh. 10,000
2. Caesarian section -Ksh. 30,000

Does Linda Mama Cover C-sections?

Linda mama maternity cover is the free government maternity cover program that is administered by NHIF. The cover covers:

1. Four pre-natal clinics
2. Four post-natal clinics
3. Delivery costs for both normal and caesarian sections through all NHIF-accredited clinics nationwide. More specifically public hospital clinics. You need to be a registered member of the Linda Mama program. This program can only be accessed in NHIF-accredited hospitals that offer the Linda Mama maternity package.

4.4. Preferred Maternity Package

The amount of maternity cost depends on the package that you would like to go for. Most hospitals have pre-packaged maternity packages that you can choose to have. You can read more here to see which one is a good fit for you. Though these plans are estimates, you can decide on the hospital, and in conjunction with your OBGYN, you can pick the best one for you.

You will need to look at the cover in regards to limits provided for emergency CS, elective CS, and coverage for pre-maturity birth and any congenital conditions. All these will influence the cost of insurance as well as the maternity package you choose.

4.5. Talk to Your Doctor

It is important to talk to your talk to get the necessary advice regarding the insurance company you intend to work with. Get feedback on how they handle claims and pay them as well. It is important that you get to understand the rates that apply should your doctor not be on the hospital’s panel.

You will also need to plan in advance to get the pre-authorization for maternity to avoid the last-minute rush on the d-day. Talk to your agent and your insurer at least from month 7 to ensure this has been done and the terms are clear from set go.

4.6 Proper utilization of cover

Ensure that you have a clear understanding of how your pre and post-natal work under your plan. Check if they are utilized under your maternity limit or under your outpatient limit. This helps you keep the actual maternity cover limit within the package cost of your choice.

You can complement this by keeping a close eye on your bill while at the hospital to ensure that you do not go beyond the limit.

Best maternity insurance cover in Kenya

The best maternity coverage cover in Kenya needs to be one that considers all the above-discussed matters. Private medical insurance companies in Kenya include:

Kenya Insurance company medical insurance packages	Maternity Coverage limits available
AAR insurance medical cover packages	Ksh. 50,000-500,000
APA insurance medical cover packages	Ksh. 50,000-150,000
Britam insurance medical cover packages	Ksh. 80,000-300,000
GA insurance medical cover packages	Ksh. 50,000-500,000
Jubilee Insurance medical cover packages	Ksh. 50,000-200,000
Madison Insurance medical cover packages	Ksh. 30,000-200,000
Heritage Insurance medical cover packages	Ksh. 30,000-500,000
Old mutual insurance medical cover packages	Ksh. 50,000-200,000

What Next?

One needs to know that insurance is a contract that will only keep its end of the contract up to what they agreed, please take into account unexpected emergencies and plan accordingly.

In case you need to talk to us directly to help you decide which plan is the best one for you, reach us via Whatsapp or Call us, one of our agents will help you.