How To Choose The Right Health Insurance Plan

Written by Wellington Ayugi

For the past three years, the Government of Kenya has been making progress in reforming the health sector in the country. The restructuring efforts and initiatives, such as the free maternal services, that have been undertaken, are all geared towards getting affordable health care accessible to all Kenyans.

What is Health Insurance?

This is a type of insurance coverage that protects against medical and surgical expenses incurred by an individual. The individual can either make payments directly to the insurance provider or cover the cost from their pocket and is reimbursed.

Categories of Health Insurance

There are two major categories of heath insurance:

  • Private health insurance: This is health insurance that is offered by private health insurance companies.
  • Public (government) health insurance: This is the government-sponsored health insurance that is available to all citizens of Kenya. It is offered by the National Hospital Insurance Fund or NHIF. NHIF registers all eligible members from both the formal and informal sector. For those in the formal sector, it is compulsory to be a member. For those in the informal sector and retirees, membership is open and voluntary.

Why Is It Important To Have Health Insurance?

Here are significant reasons why you should consider getting a health insurance policy for your family, yourself and other dependents:

  • Protection against accidents

Accidents occur and managing the injuries can be an expensive affair. A good health insurance policy can help cover your medical costs as you recuperate.

  • It is relatively affordable

The insurance providers have tailor-made their products suit the needs of anyone in the country.

  • It offers tax advantages

The Kenyan tax code guarantees the policyholder a 15% tax relief on the premiums paid annually.

Types of Medical Covers in Kenya

The health insurance industry in the country has various insurance plans targeting Kenyans from all walks of life. Here are the main types of health covers in the market:

  1. Inpatient plan: This refers to policies that cover expenses associated with hospitalization. In other words, the cover takes effect when the insurer is admitted to hospital. The cover is usually expensive due to covering the liabilities relating to accommodation expenses in the hospital, in addition to the direct treatment costs.
  2. Outpatient Plan: This is the most popular type of health insurance cover. The plan covers costs associated with visiting medical facilities accredited by the insurance provider. The patient receives treatment then exits the health facility. The plan is cheap as it does not include accommodation related costs.
  3. Maternity Plan: The plan meets the cost of hospitalization and includes delivery plus related complications that may arise from the pregnancy.

How To Choose The Right Health Insurance Plan

When it comes to selecting a private insurance plan, one can be bombarded with various packages that can be overwhelming. Just make sure that when you are making a decision you consider the following:

  1. Ensure the plan you select will cover for necessary and regular care, like seeing specialists and filling prescriptions.
  1. Compare and contrast various policy options from different insurance companies considering their related benefits carefully. 
  1. Carefully scrutinize the insurance companies list of pre-approved specialists and ensure your previous specialists are listed. 
  1. Depending on your medical history, determine whether you will  want an extensive health insurance cover with higher premiums, or increased out of pocket expenses but a lower premium.

Before you make a decision, make sure you carefully opt for a health insurance cover that is not only affordable but adequately caters for your needs. The trick is to do your homework and do not make the decision hurriedly. You can still decide to utilize the government sponsored NHIF plan.

With the NHIF plan, Kenya has made great strides in improving the quality of healthcare for its population. More Government policies are being formulated to make health services affordable.

Both the public or private health insurance plans have their own advantages and disadvantages. So whichever you opt for, just make sure you have an insurance policy. It is better to be safe than sorry!

Learn More:

  1. Taking a Closer Look at How NHIF Works in Kenya
  2. Top 10 medical insurance companies in Kenya

About the author

Wellington Ayugi
