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Corporate Medical Schemes in Kenya

January 16, 2024

A Medical Insurance Scheme is an arrangement where the risk of sickness and/or injury is spread over a group of individuals. In Kenya, the most common types of medical schemes are inpatient, outpatient, major medical, and critical care plans.

  • Inpatient/hospitalization cover pays for all expenses relating to hospitalization in a private hospital, which is important for individuals who need access to quality medical care.
  • Outpatient cover pays for all medical expenses incurred outside the confines of a hospital, including doctor’s fees, specialist consultations, diagnostic tests, and other treatment prescribed by your doctor. This is especially important for those who need frequent medical attention but do not need to be hospitalized.
  • Major medical and critical care plans pay for all expenses arising from serious illnesses or injuries such as heart attacks and cancer, where immediate treatment may be necessary for survival or recovery. This type of coverage is crucial for individuals who need access to expensive medical treatments that may be necessary for their recovery. Critical care plans in Kenya are not very common and are mostly purchased by expats.

Businesses and institutions use corporate medical schemes to the advantage of their employees and the business. With the rising cost of healthcare in Kenya, having a medical insurance plan gives employees the peace of mind. This boosts efficiency and productivity when employees know that they are protected from unexpected medical expenses.

Corporate vs Individual Medical Schemes in Kenya

Individual medical schemes are designed for individuals and families who want to access healthcare services privately. Corporate medical schemes, on the other hand, are designed for businesses and organizations that want to provide healthcare coverage for their employees.

Corporate Healthcare Insurance in Kenya

The main difference between individual and corporate medical schemes is the group size. Individual medical schemes are designed to cover only one person or a family, while corporate medical schemes cover a group of people, usually employees of a business or organization. This group coverage can often lead to lower costs per individual, as the risk of medical expenses is spread over a larger group.

Understanding the Types of Corporate Medical Schemes

As a business owner, you will want to make sure that your employees are protected from any risks that may come their way. One way of doing this is by purchasing medical insurance for them. Below are the different types of corporate medical schemes in Kenya that you can choose from;

  1. Insured Medical Scheme – With an insured medical scheme, the employer pays a premium to an insurance company, who then provides healthcare benefits to the employees. The insurance company takes on the financial risk of providing these benefits, which can include hospitalization, surgery, and other medical services. This type of scheme can be a good option for companies who want a predictable monthly cost for healthcare coverage.
  2. Self-funded Medical Scheme – A self-funded medical scheme is one in which the employer takes on the financial risk of providing healthcare benefits to employees. The company sets aside a fund to pay for medical expenses, which can include hospitalization, surgery, and other medical services. This type of scheme can be more flexible than an insured scheme, as the employer has more control over the design and cost of the benefits. However, it also requires careful financial management to ensure that there are sufficient funds to cover healthcare expenses.
  3. Hybrid Medical Scheme – A hybrid medical scheme combines elements of both an insured scheme and a self-funded scheme. The employer pays a premium to an insurance company, but also sets aside a fund to pay for medical expenses. This type of scheme can offer the benefits of both types of schemes, including predictable monthly costs and greater flexibility in benefit design.

An insurance consultancy firm can work with companies to determine which type of medical scheme is best for their needs, taking into account factors such as company size, budget, and employee healthcare needs. By offering customized solutions, the firm can help companies provide their employees with the best possible healthcare coverage.

If you Care for your Employees, Cover them!

A common saying in Kenya and indeed around the world is that, “You are just one medical bill away from poverty”.

Insurance Cover for your Employees

Medical insurance in Kenya is a must when it comes to protecting your employees. With the right corporate medical scheme, you can enjoy the peace of mind that comes with knowing that they will be well taken care of if they fall ill or get injured.

Medical insurance in general helps you save money in case of an emergency and ensures that you don’t have to spend all your savings on medical bills.

The importance of getting the right medical scheme cannot be overstated as there are numerous schemes on offer today but not all are suitable for everyone’s needs and preferences. You need to engage an experienced insurance consultant in Kenya to help you identify the best medical schemes for your business or organization.

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