Private Health Insurance
Health insurance in Kenya provides financial protection against medical expenses incurred due to illness, accidents, or hospitalization. Private health insurance policies vary based on coverage, benefits, and premiums.
Types of private health insurance plans
Private health insurance offers more benefits, flexibility, and wider hospital choices than NHIF. It is ideal for individuals and families seeking better healthcare services.
- Individual & Family Medical Cover – Covers hospitalization, outpatient services, maternity, and dental/optical care.
- Corporate & Group Medical Cover– Provided by employers to employees and their families.Junior medical cover- Designed for children under the age of 18 whose parents do not want to be included in the cover.
- Senior Citizen Medical Cover – Designed for individuals aged 55 years and above.
- International Medical Cover – Offers coverage for treatment both locally and internationally.
- Junior medical cover - Designed for children under the age of 18 whose parents do not want to be included in the cover.
Coverage and benefits
The benefits offered include:
- Inpatient cover– Covers hospital accommodation, surgery, ICU, and specialist treatment.
- Outpatient cover– Covers consultations, diagnostic tests, medication, and therapies.
- Maternity cover– Prenatal, delivery, and postnatal care.
- Dental & Optical Cover– Covers dental procedures, glasses, and eye check-ups.
- Chronic Illness & Pre-existing Conditions– Some insurers provide partial or full coverage for diabetes, hypertension, etc
- International Treatment– Covers medical expenses in hospitals outside Kenya.
- Emergency Evacuation & Air Ambulance– Coverage for medical evacuation in case of emergencies.
Exclusions in private insurance include but not limited to:
- Pre-existing conditions may require a waiting period.
- Cosmetic and elective surgeries are not covered.
- Self-inflicted injuries, drug-related illnesses, and experimental treatments are excluded.
How to Choose the Best Cover
Consider the following factors when choosing a cover:
- Choose a plan based on your medical history, pre-existing conditions, and family needs.
- Compare Premiums & Benefits i.e balance between affordability and coverage.
- Check the Hospital Network. Ensure your preferred hospitals are covered.
- Look for Additional Benefits e.g Emergency care, maternity, dental, and optical add-ons.
- Read the Fine Prin. Understand policy exclusions and waiting periods.
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