With so many health insurance providers in Kenya, choosing the right medical cover can be overwhelming. This guide will walk you through six key tips to help you pick a plan that balances affordability, coverage, and reliability.
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:
- The network of hospitals under their insurance plans.
- The types of plans they offer and what they are best known for.
- How much they charge as compared to other players in the market.
- Comparing their claim settlement ratio and ease of processing claims on the IRA website check here
- Assessing costs relative to other providers.
With health matters, reliability matters. Always choose a provider with a solid track record.
2. Understand What Benefits 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;
3. Compare Costs and Premiums
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.
cheaper isn’t always better. Prioritize value over price by choosing plans that offer the features you need most, even if premiums are slightly higher.
4. Check Co-Pay Clauses
Some insurance policies require a co-payment, meaning you pay a fixed amount or a percentage of the bill when making a claim. Example:
- Fixed amount, e.g., Ksh 500 or ksh 2000 (depends with whether it is a tier 1 or tier 2 hospital) per hospital visit.
- Percentage-based, e.g., 5% of the total bill.
Ideally, choose plans without co-payments. But if unavoidable, go for the lowest possible co-pay rate.
5. Understand 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.
Always review the policy carefully and choose a plan with reasonable waiting periods that match your needs.
6. Check the Coverage Limits
Coverage limits define how much your insurer will pay for different services, including:
- Inpatient & Outpatient treatment
- Dental procedures
- Optical benefits
- ICU, room charges, and home treatment
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.
7. Choosing the Right Healthcare Plan in Kenya
The right health insurance plan protects your finances and ensures access to quality healthcare when you need it most. Keep these tips in mind:
- Select the right insurance company
- Review the benefits a policy covers
- Compare premiums from different providers
- Take note of copayment
- Consider comfortable waiting periods
- Take note of the cover limits and sub-limits
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.
For personalized guidance, LAREN Insurance Agency can help you compare plans, choose the best medical cover, and secure your health future.Need Help Choosing the Best Medical Cover?
Talk to our experts at Laren Insurance Agency and secure the right plan for you and your family.
Contact Us Today What factors should I consider when choosing a medical cover in Kenya? You should evaluate the coverage benefits, hospital networks, waiting periods, exclusions, premiums, and claim settlement processes to ensure you choose a plan that fits your medical and financial needs. 2. Are outpatient services included in all medical insurance plans? No, not all plans cover outpatient services. Some provide inpatient cover only, while others offer combined packages. Always confirm what’s included before signing up. 3. Can I use private hospitals with my medical cover? It depends on your insurer and plan. Higher-tier plans often give access to private hospitals, while basic covers may restrict you to specific partner facilities. 4. How do I know if my preferred hospital accepts my medical cover? Before signing up, request the insurer’s hospital network list or consult your insurance agent. At Laren Insurance Agency, we help you find plans that cover your preferred hospitals. 5. Does having SHIF mean I don’t need private medical insurance? No, SHIF offers basic coverage, but private health insurance provides additional benefits like faster hospital admissions, higher claim limits, and access to specialized care. 6. Can I get customized medical insurance for my family? Yes, many insurers offer family packages that can be tailored based on your budget, dependents, and healthcare needs. We at Laren Insurance Agency specialize in finding the best-fit solutions for families.