2019 Best Insurer Award
Liaison House, State House Avenue
Available 24 hours, 7 days a week
(254) 703 071 000
Get Sorted
2019 Best Insurer Award

All you Need to know About Group Health Insurance

Health insurance is becoming increasingly important in Kenya, as the cost of medical care continues to rise. Without proper coverage, even a minor illness or injury can result in significant financial burden. This is where group health insurance comes in.

In Kenya, group health insurance plans are available for organizations such as companies and associations, providing coverage for their employees or members. Not only does group health insurance offer comprehensive coverage, it also comes with a range of advantages such as lower premiums, tax benefits, and reduced paperwork.

You are probably stuck trying to figure out how to go about getting medical cover for your employees. Or perhaps you invested in one that is not really working out for your organization. We get it, it can be very frustrating. Let us explore everything you need to know about group health insurance in Kenya, including its benefits, how it works, and how to choose the right plan for your business or organization.

What is Group Insurance?

In simple terms, group health insurance is a type of insurance coverage that provides medical benefits to employees and their families. It is also commonly known as "employee health benefits" or "employer-sponsored coverage".

The government through the IRA(Insurance Regulatory Authority) regulates group health insurance plans, which means that there are minimum requirements for coverage that must be included in any plan offered through an employer.

However, with many different types of group health plans available, each with their own set of costs and benefits, it is essential to understand the different options to make an informed decision.

Types of Group Health Insurance in Kenya

Based on their cost structure, the types of group health plans available in Kenya can be categorized as follows:

It is important to note that the cost of each plan varies depending on the specific features and benefits included. Additionally, the cost of a plan may also depend on factors such as the age and health status of the employees or members, the location of the organization, and the level of coverage offered.

Employers and organizations should work with insurance consultants in Kenya to carefully assess their needs and budget before selecting a group health plan.

Group Health Insurance in Kenya

How Group Health Insurance Works

In Kenya, group health insurance plans offer a range of benefits to both employers and employees. One of the primary benefits of group health insurance is that it can be more affordable than individual health insurance plans. This is because the risk is spread across a group of people, which allows for lower premiums.

Group health insurance plans also offer employers a way to attract and retain employees.

A comprehensive group health plan can be a valuable part of an employee benefits package, which can help to increase job satisfaction and employee loyalty.

For employees, group health insurance can provide access to healthcare services that may not be available or affordable otherwise. With a group health plan, employees can receive preventive care, diagnostic tests, and treatment for illnesses and injuries. Depending on the plan, coverage may also extend to dental and vision care.

Group health insurance plans are regulated by the Kenyan government majorly through the IRA. The Insurance Regulatory Authority is a government agency established under the Insurance Act (Amendment) 2006, CAP 487 of Kenya's laws. Its primary mandate is to regulate, supervise, and foster the development of the insurance industry in the country.

This means that insurance companies must meet certain minimum requirements for coverage. These requirements ensure that employees have access to essential healthcare services in Kenya, such as preventative care, emergency services, and prescription drugs.

The Benefits of Group Health Insurance in Kenya

There are some benefits with group health insurance for both the employer and the employee. Some of these advantages include:

There are many more benefits associated with group medical schemes. Employers can choose the appropriate group health insurance plan for their organization and employees by collaborating with trustworthy corporate insurance consultants in Kenya.

Key Features to Look for in a Group Healthcare Plan

When selecting a group healthcare plan for your organization, there are several key features to consider:

This will help you choose a group healthcare plan that meets the needs of your organization and employees while providing comprehensive coverage at an affordable cost.

What is a Waiting Period?

Health insurance plans in Kenya typically have waiting periods before certain benefits can be accessed. Waiting periods can vary depending on the plan, but they are designed to prevent people from enrolling in a plan just to receive expensive medical treatment and then dropping out.

Waiting periods may apply to certain medical procedures or treatments that are deemed to be high-cost or elective. For example, a plan may have a waiting period of six months before coverage for orthodontic treatment or a pre-existing medical condition can begin.

It's important for employers and employees to understand the waiting periods associated with their group health plan. This will help them to plan for out-of-pocket expenses and avoid unexpected costs.

Some group health plans may waive waiting periods for employees who are transitioning from a previous employer-sponsored plan or who have had continuous coverage for a certain period of time.

Employees who are new to a company or who missed the initial enrolment period for their employer-sponsored plan may also be subject to waiting periods. In this case, they may need to explore other healthcare coverage options until their group health coverage takes effect.

Get a Good Insurance Consultant

Getting a good health insurance consultant is very important. They have the expertise and knowledge to help you navigate the complex world of insurance policies and find the best plan for your needs. They can help you understand the coverage and benefits provided by each plan, as well as any exclusions or limitations.

A good insurance consultancy firm can also help you save time and money by comparing plans from multiple insurance providers and negotiating better rates on your behalf. Ultimately, having a good consultant can provide you with peace of mind and the confidence that you have the best possible coverage for yourself or your employees.