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Undoubtedly, there has been an increase in diseases, and the cost of healthcare in Kenya has also dramatically increased. This has made getting a medical insurance cover a necessity. When seeking medical coverage in Kenya, you will encounter a variety of options from different insurance companies and brokers.

From the available medical plans you are presented with, how do you choose the best medical cover that will suit your needs? In this article we shall explore these 6 tips that can guide you through choosing the best medical cover that will offer sufficient coverage for your healthcare needs.

Types of Health Insurance in Kenya

There are different types of health insurance plans each catering to different needs and preferences. Technically, these types of health insurance plans can be divided into the following:

Choosing the Right Medical Schemes in Kenya

Now that we understand the different types of health insurance plans, let us dive into these 6 tips that will help you make the right choice when choosing a medical cover.

#1 Choose the Right Insurance Company

With a myriad of options when it comes to insurance companies in Kenya, this is the first important decision you have to make when choosing your insurance cover. A good place to start is finding out what existing customers say about these insurance companies.

You can quickly pick out questionable insurance companies from online reviews. With the seriousness of health matters, you want to avoid insurance companies that may frustrate you at your time of need. Try asking among your circles the insurance covers that they use and how their experience has been.

Other factors to consider when identifying the right insurance companies to deal with include:

#2 What Benefits do the Plans Cover

You will most likely find that all the insurance plans that you get from different providers offer some basic benefits. You need to look out for additional benefits that distinguish one insurance plan from the next.

You will need to assess what is most important to you at the moment and in the near future. Look out for the medical schemes that offer this cover. For instance, if you are starting out a family and you are looking to have kids, choose an insurance plan that offers maternity cover. This may not be important for an individual who may not be looking to start a family.

There are additional features that may also add value to the cover and may be important to you. Such feature may include; annual medical checkups, wellness and nutrition, no claim bonus etc.

#3 How Much Does It Cost?

With the current financial constraints, this is probably first on the list when choosing a medical scheme. With anything that we purchase, we always want to have value for money. Health insurance premiums come with different pricing from different providers.

Therefore, at this point, it is important that you compare the premiums from the different insurance companies. While, comparing, take into account the different features each insurance plan offers. Make sure that you consider the plan with the features you care about even if these would raise the premiums costs.

At this point, you can dismiss the insurance premiums that seem exaggerated.

#4 What Co-Pay Clauses are in the Policies?

There are different reasons that insurance companies include copayment in their policies. This basically means that you may have to part with some amount of money every time you make a claim. Some would have this as a constant figure, say Ksh 500 or it may be a percentage of the total claim say 5%.

It is important that you choose an insurance plan that does not have copayment as this may inconvenience you. However, in other instances, you may not be able to completely avoid copay. For instance, the occasion that the individual may be above a particular age or for particular illnesses or treatments.

In such scenarios, it will be in your best interest to opt for the insurance plan with the list co-pay.

#5 What are the Waiting Periods?

The waiting period refers to the duration of time one must wait after enrolling in a health insurance plan before certain benefits become available. This waiting period is typically established by the insurance provider and outlined in the policy terms.

Waiting periods are basically a risk management strategy. The reasoning behind this is to prevent individuals taking up insurance covers because of pre-existing conditions or big medical procedures.

There is the initial waiting period that begins when you first enroll restricting particular services or conditions. There can also be a pre-existing condition waiting period imposed specifically for pre-existing conditions.

It is therefore important that you review the policy and take note of these waiting periods. These waiting periods may vary significantly from one policy to another. Consider the policies with reasonable waiting periods that you are comfortable with.

#6 What are the Coverage Limits?

This is another very important aspect when it comes to choosing the right health insurance coverage in Kenya. The insurance plans often have limits for different aspects. The most important limits include:

The limits vary from one policy to another and this directly affects the premiums. It is important that you work out a ballpark figure on the amount that you may need each year that will fully cover you. For instance, you may be taking up a healthcare plan for your family and you could be averaging Ksh 200,000 in expenses each year. You will therefore need a plan that would adequately cover this cost.

There are also other sub-limits that you need to take into account when choosing the medical scheme. These are normally overlooked but are equally important and may save you some out-of-pocket cash when you least expected. These may include; room charges, ICU room charges, home treatment etc.

Choosing the Right Healthcare Plan in Kenya

The Bottom Line

Choosing the right medical insurance cover in Kenya is an important decision that can greatly impact your finances and access to quality healthcare. These simple tips we have outlined can help you navigate the complexities of insurance in Kenya and help you make a more informed decision.

Remember to;

Additionally, seek advice from insurance consultants or consult with trusted peers to gain insights and recommendations.

Ensure that you prioritize comprehensive coverage, affordability, and reliability. This will empower you to safeguard your health and well-being, ensuring peace of mind for you and your loved ones in the face of medical uncertainties.