The Best Medical Insurance Companies in Kenya

If you are torn between different medical insurance policies offered by various companies in Kenya, this article is for you.

You subscribe for a medical cover because you are in need of protection. You want the cover to take care of your medical expenses and those of your family members.

You obviously don’t want to make silly mistakes on matters concerning your health and the health of your family.

Why Health Insurance?

Some statistics for you. About 56% of Kenyans reading this article are car owners. 99.8% of these cars have valid insurance covers.

However, only 23.1% of this group is attached to a valid medical cover. And that’s a crisis right there! Your car is now covered and not your health.

Remember to check this article on the best car insurance policies available in Kenya.

We all agree that health is precious, but maintaining good health is a challenge in today’s time, especially, with the ever-increasing health costs in Kenya.

And is it necessary anyway? Well, with the many uncertainties surrounding our lives today, the chance to secure your life by seeking protection against health risks is real luck!

And so I would say, Health Insurance is a need. A basic need.

Basic Benefits of Health Insurance

The extent to which your medical expenses will be paid varies from one insurance company to another.

However, any health insurance policy should guarantee the following basic benefits:

1.  The cover should cater for your medical expenses across an easily accessible network of hospitals.

2. The cost of laboratory medical tests, doctor’s and specialist’s fees.

3. All the medical costs on maternity and newborn care should be catered for.

4. The cover should offer reimbursements for any amount you pay for medication outside the approved network of hospitals. Let’s say the cover should at least pay something in such cases.

5. The policy should cover you for treatment pre and post-hospitalization costs.

6. Accommodation for parent/guardian accompanying a child aged below 7 years or thereabout. And so much more.

Best Medical Insurance Policy

Choosing the most suitable health insurance policy that gives you peace of mind is real homework.

Making a final decision after figuring out the differences between the policies offered by the various insurance companies is such a task.

The bottom line: Before making a choice, take your time and weigh all the options, bearing in mind that subscribing to the wrong health insurance plan would cause you disappointment in future.

Below are some of the key questions to ask:

Which Health Facilities Most health care insurance companies require you to only use their network of health facilities and doctors.

A number of medical insurance providers in Kenya will accept liability for medical costs in any NHIF accredited facility.

This would be a better offer since NHIF has a wide network of accredited public and private medical facilities across the 47 Counties in Kenya.

You, therefore, need to check the list of the insurer’s network of health facilities before making the final decision about the insurance cover.

If you currently have a preferred health facility or a doctor who you would like to keep seeing, check to see if they are included in the health care plan you are considering.

The Premiums Premiums are the monthly payments you pay to the insurance company, whether or not you incur any medical expenses.

When shopping for a medical cover, you not only need to check on the premium amounts but also the mode of payment (monthly, quarterly, half-yearly or annually)

Remember that a default in the payment of premiums puts you at risk of losing your health coverage.

As you can see, there is a need to choose a mode of payment that is most adapted to your income schedules.

Waiting Periods In health insurance, there exists a specified period of time which must pass before some or all of your health care coverage can begin.

During this time frame, a claim is not admitted. You would have to foot all your medical bills.

Waiting periods are especially attached to pre-existing, chronic and major ailments (cancer and HIV/AIDS) among others.

The advantage of a waiting period is to the insurance company. It is essentially their ‘time to eat’. During this time, they are able to collect premiums with an assurance of zero claims.

This concept of waiting periods ideally protects insurance companies against opportunists who would take the health insurance policy after being diagnosed with a serious disease.

Waiting periods also apply to policies that have maternity benefits, normally 9 months to 2 months. What this means is that a health insurance policy taken after conceiving would not cater for the arising maternity costs.

Exclusions It is important to note that health insurance policies will not take care of medical expenses for all medical conditions.

I think this is the most crucial (yet most ignored) part by most medical policyholders in Kenya.

You would need to check what medical conditions are covered (fully or in part) and to find out if any of the conditions you is expected is not listed.

For instance, most medical insurance companies will not cater for expenses related to herbal treatment, food supplements and weight reduction or slimming services.

Plastic or cosmetic surgery, beauty therapy, and massage services are also an exclusion for most medical covers in Kenya.

#1. Jubilee Medical Insurance

Jubilee Medical Insurance

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Jubilee is undeniably one of the best medical insurance companies in Kenya, with health insurance policies customized for both individuals and corporates.

J-Cure is a choice for many Kenyans, partly because it takes care of pre-existing, chronic, psychiatric, congenital conditions and HIV/AIDS.

Jubilee Insurance has a number of options you can choose from, depending on your insurance needs and budget.

Anyone between the age of 1 month and 60 years is eligible for the JCure cover.

Senior members (above 50 years) are required to undergo a medical examination before the cover can be confirmed.

JCUre Medical Cover Benefits

Caters for all accredited medical specialists’ fees including surgical fees and theatre charges. Pays HDU and ICU costs, MRI/CT Scans, and PET Scans after authorization.

Reconstructive and dental surgery costs after an accident. Inpatient Physiotherapy sessions. Post hospitalization medication and Discharge take-home medication covered.

Gynecological treatment covered. Pre-existing, congenital and chronic conditions. Major ailments like HIV/ AIDS and Cancer treatment covered.

Organ Transplant and Psychiatric conditions. Inpatient non-accident-related eye treatment. Also takes care of funeral expenses.

JCure Medical Exclusions

All other sexually transmitted diseases apart from HIV/AIDS. Age and puberty-related conditions such as menopause.

Plastic or cosmetic surgery not covered, unless necessitated by an accident. Medical costs as a result of racing accidents. All types of beauty treatment or massage sessions excluded.

Injury to Jubilee policyholders participating in strikes or riots. Herbal treatment. Abortion or miscarriage. Contraceptive services and supplies, family planning, and fertility treatment. Weight reduction or slimming services not covered.

Medical Benefits Waiting Periods

Outpatient illnesses 3 weeks Inpatient admission 45 days Surgical cases 90 days

Maternity and CS One Year

Congenital Conditions One Year

Accident None

Cancer Treatment 2 Years

Removal of Fibroids, uterus, adenoids, tonsils, and repair of hernias 1 Year

Optical laser treatment 1 Year

#2. Madison Group Medical Insurance

Madison Alpha (the brand name for their medical cover) is a choice to many Kenyans.

This preference is partly due to Madison’s provided access to a reliable network of service providers across the country.

If you have pre-existing chronic, non-chronic, and HIV/AIDS-related illnesses, Madison will still get you covered.

Kenyans traveling overseas are covered for the first 45 days of travel for emergency treatment only.

Expectant mothers are covered for emergency cesarean sections. In case of death, Madison will provide a free last expense.

Madison Alpha Cover Benefits

Admission in any NHIF accredited hospital.  Accommodation for parent/ guardian accompanying a child below 8 years. Doctors; surgeons; and specialist’s fees fully paid. Laboratory investigations, X-rays, ultrasound, ECG, MRI scans catered for.

Prescribed drugs, dressings, surgical appliances, and nursing procedures covered.  ICU and HDU costs covered. Radiotherapy, chemotherapy, physiotherapy sessions covered.

Gynecological treatment included. Prescription drugs and dressings. Maternity expenses: maternity-related complications, pre and postnatal care, cesarean section.

Dental Benefits: Cost of fillings, Root canal,  X-rays, Tooth extractions including surgical extractions together with the anesthetic fee.

Optical Benefits: Eye testing, Expenses related to vision correction, supply and fitting of eyeglasses and frames. Prescription drugs and dressings. Immunizations and vaccinations for children (KEPI recommended)

Madison Alpha Medical Exclusions

Expenses incurred in relation to and or in connection with the ritual circumcision. Intentional self-injury, attempted suicide, domestic violence, deliberate exposure to exceptional danger and hazardous sports.

Infertility, Impotence or in the course of treatment to correct the cause of infertility, family planning, and hormonal replacement therapy. Cosmetic treatment. Beauty treatment or massage.

Naval, military and air force operations. Expenses incurred in connection with drunkenness, treatment of chronic alcoholism, intoxication, use of drugs not prescribed by a physician or drug addiction. Nutritional food supplements and weight management

Chiropractors, acupuncturists, and herbalists fee. Private vaccines except for KEPI recommended vaccines for children. Outpatient ambulance services. Laser eye surgery.

Medical Benefits Waiting Periods

Outpatient illnesses 3 weeks

Inpatient admission 45 days

Surgical cases 90 days

Maternity and CS One Year

Congenital Conditions One Year

Accident None

Cancer Treatment 2 Years

Removal of Fibroids, uterus, adenoids, tonsils, and repair of hernias 1 Year

Optical laser treatment 1 Year

#3. UAP/Old Mutual Medical Insurance

Afyaimara is the brand name used by UAP/Old Mutual for their health insurance policies.

Like most health insurance covers in Kenya, Afyaimara offers both inpatient and outpatient benefits and has flexible packages applicable to individuals, families, and SMEs.

The policy caters for among others maternity, optical, dental & chronic diseases.

If you are comfortable taking care of your outpatient medical expenses, you have the option of taking the inpatient cover only.

UAP/Old Mutual accepts installment premium payments and offers a volume discount for a package with over 10 principal members.

The policy has a lot of conveniences to offer, with road evacuation available for all cover limits

With Afya Imara, you are at liberty to seek treatment in Kenya, Uganda, Tanzania, Rwanda, South Sudan, and the much-coveted India.

Afya Imara comes with a number of comprehensive benefits, covering pre-existing conditions, chronic conditions, and HIV/Aids.

Accommodation costs for parent/guardian accompanying a child aged below 6 years are also taken care of.

Afya Imara Medical Cover Benefits

Standard private room in-patient accommodation. Accident and non-chronic in-patient specialists, theatre costs, ward and theatre medicines. Emergency ambulance services (in-country road/air ambulance).

High care and intensive care. Maternity (childbirth and post-delivery). Neonatal care (incubator, phototherapy, congenital conditions, prematurity). Psychiatric hospitalization.

Prosthesis. External medical appliances. Specialized Radiology. Hospitalization related to chronic conditions. Optical surgery. Dental surgery. Medicines to take home.

Cancer treatment (in- and out-patient). Organ transplants (in- and out-patient). Kidney dialysis (in- and out-patient). Out-patient maternity care (in addition to other day-to-day benefits)

Afya Imara Medical Insurance Exclusions

The amount recoverable from other insurances such as NHIF, GPA. Expenses where material information is withheld or misstated.

Expenses incurred in connection with active participation in riots, civil unrest, etc. Self-inflicted injury and attempted suicide.

Homeopathy, Chiropractic treatment, acupuncture, herbal medicine, and treatment. Medical Costs due to experimental treatment. Professional and hazardous sports activities.

Cosmetic surgery. Infertility. Alcoholism & conditions related to alcohol intoxication. Non KEPI vaccines.

Medical Benefits Waiting Periods

Pre-existing conditions and chronic conditions 1 Year

Cancer treatment including but not limited to oncology 1 Year

HIV / AIDS and related conditions 1 Year

In-patient non-accident related eye treatment, Maternity and CS 1 Year

Gynecological surgery 1 Year

Psychiatry and psychotherapy 1 Year

Congenital defects and genetic disorders 1 Year

Removal of Fibroids, uterus, adenoids, tonsils, and repair of hernias 1 Year

Illness claims 28 days

Non-accident surgical claims 60 days

#4. Heritage Medical Insurance

Heritage offers medical insurance 

Heritage Medical Cover Benefits

Inpatient expenses related to acute conditions or accidents covered. Pre-existing conditions and chronic conditions on full disclosure at the time of joining. Newly diagnosed chronic conditions after the inception of cover.

Cancer treatment including but not limited to oncology. HIV / AIDS and related conditions. Post-hospitalization treatment related to cause of pre-authorization.

Inpatient non-accident related eye treatments excluding surgery for refractive errors and laser treatment. Inpatient non-accident related dental surgery/treatment.

Gynecological treatment. Organ transplant after (cost of the donor or securing the organ is excluded). Diagnostic examinations. Prescription drugs and dressings. Immunizations and vaccinations for children (KEPI recommended).

Internal and external surgical implants, appliances, joint replacement, and prostheses (excluding dental fixtures). Psychiatry and psychotherapy.

Illness-related reconstructive/plastic surgery after three years waiting period and excludes cosmetic, obstetrics, and gynecology related. Congenital defects and genetic disorders + Funeral expenses per member

Heritage Medical Exclusions

The amount recoverable from other insurances such as NHIF, GPA. Expenses where material information is withheld or misstated.

Expenses incurred in connection with active participation in riots, civil unrest etc. Self-inflicted injury and attempted suicide.

Homeopathy, Chiropractic treatment, acupuncture, herbal medicine, and treatment. Medical Costs due to experimental treatment. Professional and hazardous sports activities.

Cosmetic surgery. Infertility. Alcoholism & conditions related to alcohol intoxication. Non KEPI vaccines

Medical Benefits Waiting Periods

Pre-existing conditions and chronic conditions 1 Year

Cancer treatment including but not limited to oncology 1 Year

HIV / AIDS and related conditions 1 Year

In-patient non-accident related eye treatment, Maternity and CS 1 Year

Gynecological surgery 1 Year

Psychiatry and psychotherapy 1 Year

Congenital defects and genetic disorders 1 Year

Removal of Fibroids, uterus, adenoids, tonsils, and repair of hernias 1 Year

Illness claims 28 days

Non-accident surgical claims 60 days

#5. Britam Medical Insurance

Britam also ranks as one of the very best medical insurance companies in Kenya.

Britam Milele is the brand name for the company’s most preferred medical cover by individuals and families.

To let you decide on the right policy that suits your needs, Britam Milele is custom-made with six plan variants available.

The maximum entry age is 70 years with no maximum exit age.

Applicants aged over 50 years are eligible subject to a satisfactory medical test from a Britam appointed provider at the applicant’s cost.

NHIF membership is a compulsory requirement for all Britam Milele Health insurance cover.

Britam Medical Cover Benefits

Doctors, Physicians, Surgeons & Anesthetists Fees. Nursing Care, Drugs and Dressings. Surgical appliances and internal prosthesis. Theatre, ICU and HDU charges. MRI, CT Scans, Pathology and Diagnostic Tests whilst admitted.

Prescribed Physiotherapy whilst admitted. Daycare surgery under General Anesthesia. Home nursing care strictly on Britam’s approval caters for professional fees,( Max 60 days. Lodger fee for accompanying parent or guardian for children upto10 years age. Specialised Radiology.

Internal and external surgical implants, appliances, joint replacements and prostheses (excluding dental fixtures). Evacuation – Local Emergency Road/Air Ambulance charges must lead to an admission.

Overseas Treatment Cover that includes a wide array of hospitals in India.  Accidental & Non-accidental related Dental treatment. Accidental & Non-accidental related Optical treatment including laser treatment. Family Planning.

Pre-Existing, Chronic Ailments, HIV/AIDS. Cancer Treatment, Radiotherapy and Chemotherapy. Psychiatric Treatment. Congenital, Prematurity & Neonatal Conditions Cover.

Post hospitalization treatment for surgical and accident admissions. Maternity Cover + Last Expense Benefit

Britam Medical Exclusions

Self-referred or self-prescribed treatment. Infertility & Impotence. Intentional self-injury, chronic drunkenness, suicide or attempted suicide, hazardous pursuits (sports and hobbies).

Cosmetic and beauty treatment (unless necessitated by accidental injury). Experimental treatment or treatment subject to medical research. Weight management treatment and drugs.

Diagnostic equipment (glucometers, BP Machines) etc. Dental prosthesis, crowns, dentures, bridges and braces. Alternative medicine acupuncture, chiropractor, herbal medicine.

Expenses recoverable under any other insurance or source e.g. NHIF. Infertility. Nutritional supplements unless prescribed as part of medical treatment of specified conditions. Adult vaccinations and private (non-KEPI) vaccines for children.

Costs of donor and related cost transplant for an organ transplant. Costs of treatment for, or related to Menopause, andropause, aging, puberty, and pre-menstrual tension syndrome. Treatment of obesity or slimming preparation. Cost of hearing aids. Hormonal replacement therapy.

Illness, injury or disablement directly or indirectly caused by or contributed to by civil wars, riots, rebellion, revolution, insurrection or political activity.

Alcoholism & conditions related to alcohol intoxication.

All outpatient expenses including outpatient ambulance services.

Britam Medical Waiting Periods

Non-accidental surgery (Except surgeries relating to pre-existing, chronic and organ transplant) 10 Months

Gynecological surgery 10 Months

Disclosed pre-existing, chronic, and HIV/AIDS & related conditions 1 Year

Cancer Treatment 1 Year

Newly Diagnosed Chronic Conditions 1 Year

Maternity and maternity-related conditions. 1 Year

Congenital, prematurity, and newborn illness 1 Year

Organ transplant and related costs. 2 Years

Illness claims:  Non-accident surgical claims

6. Resolution Medical Cover

Resolution Medical Cover Benefits

Guaranteed membership for Life. A 24-hour medical emergency call center. Chronic conditions covered.

Maternity cover includes home deliveries and Lamaze classes. Ante-natal visits are covered from Outpatient benefit and not maternity limit, leaving the limit available for delivery bills.

New Babies born after 38 weeks of gestation to full term (and discharged from Hospital) can join immediately after birth. New Born Baby illness to cover babies born prematurely, illness after birth and before discharge.

Dental Illness is covered. Lodger fee for parent accompanying children up to 10 years of age.

Value Plans with a Worldwide Travel Cover Benefit.

Outpatient Benefits

Outpatient consultations and diagnostic examinations covered. Injections and procedures performed at a primary care level in a doctor’s consultation room fully covered.

Prescribed medicines, X-rays, laboratory, scans, and MRI taken care of.  Antenatal & Postnatal care, minor trauma treatment.

Well-baby check-ups inclusive of KEPI Immunization Programme.

HIV services such as adherence and nutritional counseling, follow-up every 3months, prevention of mother to child transmission (PMTCT),  ARV’s and Monitoring, treatment of opportunistic infections.

Resolution Medical Exclusions

Britam Medical Waiting Periods

Non-accidental surgery (Except surgeries relating to pre-existing, chronic and organ transplant) 10 Months

Gynecological surgery 10 Months

Disclosed pre-existing, chronic, and HIV/AIDS & related conditions 1 Year

Cancer Treatment 1 Year

Newly Diagnosed Chronic Conditions 1 Year

Maternity and maternity-related conditions. 1 Year

Congenital, prematurity, and newborn illness 1 Year

Organ transplant and related costs. 2 Years

Illness claims:  Non-accident surgical claims

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