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How to Find the Best Medical Insurance in Kenya?

Health Insurance
Medical Insurance in Nairobi

Medical Insurance in Nairobi

How often have you received a WhatsApp group invitation to contribute towards medical bill payment for a friend or relative? Unfortunately, this is the sad reality in Kenya. Only 20% of Kenyans have an active medical insurance policy of which 19% are under National Health Insurance Fund (NHIF) and only 1% of Kenyans are covered by private medical insurance covers. The last two years when Covid-19 pandemic was at the pick should remind us that the world is unpredictable. The best way to protect yourself and your loved ones is by having the right healthcare insurance policy. If you are yet to take control of your health since you can’t find the right medical insurance policy, this article is for you. We will discuss the steps you should follow to find the best health insurance policy and the best health insurance companies in Kenya. 

Find Out Whether Your Employer Provides Medical Cover 

If you are employed, it’s important to find out whether your employer offers you medical cover, if it extends to your dependants and the limits of benefits. You won’t have to apply for private health insurance if your employer provides medical cover unless you prefer to have your own enhanced medical insurance. It’s very okay to have more than one medical insurance cover. 

It’s important to note that the private medical cover pays for costs that are net of National Hospital Insurance Fund, NHIF, thus it’s important to have NHIF as the basic medical cover.

The National Health Insurance Fund was established in 1966 to cater for the changing needs of the Kenyan population. The fund covers both employed and self-employed individuals. NHIF is an excellent option for those who can’t afford private medical cover which is more expensive. 

NHIF offers various cover limits, including: 

  • Maternity cover 
  • Oncology package
  • Outpatient cover
  • Inpatient cover
  • Renal dialysis
  • Kidney transplant
  • Radiology package
  • Rehabilitation
  • Drug and substance abuse package
  • Foreign treatment package
  • Chronic disease
  • Specialized lab tests like MRI, CT Scan and more

Let’s discuss below how you can find the ideal health insurance plan. 

Think About Your Health Insurance Needs 

Health insurance needs vary from one person to another. That’s why you should always take the time to think about your individual needs. For instance, you might have to look for the best health insurance for senior citizens if you are shopping around for the right insurance for your parents or if you are a retiree. You could also be in the market searching for insurance that covers, maternity, pre-existing and chronic conditions, or perhaps you are searching for affordable health insurance plans for your family. You might also need health insurance to cover specialized treatments, such as fertility treatments. 

Regardless of your goals, taking the time to consider your needs will make it easy for you to find the ideal medical insurance plan. 

Check the Benefits Offered

Now that you have identified your health insurance needs, it’s time to pick a health insurance plan that offers the benefits you need. Unfortunately, many health insurance policyholders don’t take their time to understand the benefits offered. This can be detrimental since you only qualify for the covered treatments. So, ask the health insurance company you are considering to send a summary of benefits for you to confirm. 

Why a Private medical cover

Private Medical Insurance covers you for inpatient hospitalization (admission) from limits as low as Kshs 300,000/- , Three hundred thousand to a limit of Kshs 10,000,000/-, Ten Million. Most Outpatient covers range from a limit of Kes 35,000 to Kes 300,000/-.

Private Medical Insurance covers you for benefits such as;

  • Consultation fees
  • Specialty Fees
  • Prescribed drugs
  • Diagnosis including XRAYS, MRI’s, CT Scans, Laboratory tests, ultrasounds
  • Pre-existing and Chronic conditions
  • Congenital conditions
  • Maternity Costs
  • Prescribed Physiotherapy, Chemotherapy 
  • Hospitalization due to an accident including dental and optical following an accident
  • Children vaccinations
  • In-patient ophthalmologic surgery.
  • Bed Charges including accommodation net of NHIF
  • Oversea referrals 
  • Emergency rescue services
  • Outpatient services if purchased
  • General Health Check-ups


Look at the Plan’s Hospital Network 

Another vital step you have to take before choosing a health insurance provider is the hospital network. All insurance companies partner with hospitals, doctors and health clinics to provide the health insurance services you qualify to receive. It’s advisable to work with an insurance provider with an extensive network of doctors and clinics. This way, you can be sure that you and your loved ones will get quality healthcare anytime, anywhere. While on it, find out if the plan you are choosing requires you to have a referral to see a specialist. 

Compare the Premiums 

You have to pay premiums upfront to qualify to receive the benefits under a medical cover. As a result, it’s only wise to compare the premiums before choosing your preferred medical insurance plan. Whether you are an individual, SME or a Corporate, choosing the best provider with the fairest premium and preferred benefits is not a walk in the park, that’s why it’s best to work with an experienced and trusted intermediary.

Work With a trusted Insurance Agent 

Buying medical insurance can seem like an easy task. However, you have to understand the different options in the market to find the best plan for you. When buying health insurance, some of the terms you are likely to encounter include copay, sub-limits, premium, exclusions, and more. Beyond that, you have to compare countless policies to find the right one for you. Instead of putting yourself through all that, let the experienced health insurance advisor at Earnest Financial and Insurance Consultants help you find the best medical plan. Contact us today.


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