Health Insurance in Kenya: 5 Essential Factors to consider

Health insurance is not an investment but a way to protect your investments. It caters to the possibility of spending your hard-earned money on medical bills. If you have medical bills running to the thousands or million shillings, having insurance to cover the costs is essential.

There is no way to overstate how bad things are in the Kenyan health care system. The option is the overcrowded government hospitals with desperate people in need of medical treatment. Also, the staff shortages make services in these hospitals miserable.

The other option is the expensive private hospitals. Many people have become bankrupt due to huge medical bills as a result of being unable to afford the prestigious private hospitals.

A good insurance advisor can help us navigate the often complicated world of insurance. However, this article will explain the details in a simple understandable manner.

Types of Health Insurance companies

We have two types of insurance companies in Kenya.

National Hospital Insurance Fund (NHIF) is Kenya’s government-owned health insurance fund

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that provides affordable, accessible health care to Kenyans at subsidized prices of between Kes 250 to1500 per month per family. The majority of hospitals all over Kenya are NHIF accredited.

Due to a parliament ACT, all employers have to take up NHIF for all their staff, however, you can also opt to purchase it as an individual.

NHIF pays part of your medical expenses when you access health care, however

Private Health Insurance companies are licensed and regulated by the Insurance Regulatory Authority IRA. Insurance companies provide insurance services by pooling people’s money and using the pool money to pay for the few people who do incur medical expenses. It is a delicate balance to ensure the fund pooled together are available to pay for the people who claim.

The unique thing about the two types of insurance is that you will need to have both types of insurance cover. NHIF is a government-run insurance fund and Private insurance companies pay their bills less than what NHIF pays.

5 Features of Health insurance to consider:

When purchasing your health insurance, you must consider the extent of medical expenses the insurance will cover for you depending on your budget. An experienced insurance consultant will assist you to choose the package that suits you.

Below are the features that will determine the kind of insurance cover that suits your needs.

Inpatient: This is the major feature of health insurance. It caters to the medical expenses when you or your family is admitted to the hospital for treatment. Inpatient is usually the biggest cost you will want to protect yourself from because most hospitals will require you to pay a hefty deposit.

According to the Kenya practitioner and dentist board and depending on the hospital you are admitted to an ICU bed, the deposit requires between 200,000 to 650,000 before they can start treatment.

The price of inpatient insurance is determined by the limit you will get covered for. This ranges from 10 million per year to 200,000 per year. You can opt to only have an inpatient benefit if that is the only medical requirement you would want to be protected against.

Outpatient is an added feature to the inpatient benefits you take. Caters for medical expenses that you incur when you visit a medical facility or doctor for treatment and go back home to recover.

These visits are more common than inpatient visits. The average cost of a hospital visit from consultation, laboratory tests, and medication will cost you between Kes 2,000 to 10,000. An average family will visit the hospital at least 5 to 15 times a year depending on your family’s medical needs.

The price of the outpatient is also determined by the limits you choose to take. However, you would need to have already purchased inpatient benefits.

“It is health that is real wealth and not pieces of gold and silver.”- Mahatma Gandhi

Dental and Optical: These are features that are considered an auxiliary benefit. You add these features if you already have inpatient and outpatient. These cater for medical expenses that are related to dental treatment and the purchase of spectacles to assist with eye impairments.

Sub-limits are limits within the overall limit you purchase. For example, when you purchase an inpatient insurance limit of 5 million, you will have a sub-limit of 2.5M for certain conditions.

If you have a medical condition that you have had treatment for before you take up the insurance, then it will be considered a pre-existing condition. If you have a condition that you have to manage like Diabetes that requires daily medication, this will be considered a Chronic condition. These are some of the conditions that have sub-limits.

Waiting Periods: Insurance benefits have a period when you have to wait before you can access services. Maternity benefits, for instance, have a waiting period of 10 to 12 months. The purpose of this feature is to safeguard the insurance company from people buying insurance only when they actually have a medical expense.

If you take up insurance to cater for a scheduled procedure, then you must know if that procedure has a waiting period on it. your insurance agent will be able to assist you with this.


One of the major basic needs of humans is protection. We want protection from unforeseeable situations. One of these situations is ill health. Illness and accidents come when we are not expecting them. When we invest our money, there is no intention to lose it on unexpected expenses like medical bills, which can wipe out years of savings.

Insurance is a way to ensure you save guard your health and wealth, you are better safe than sorry. With a reliable insurance advisor who can guide you in the best options in the market.