Premiums

The amounts of the premiums go with the age of the principal beneficiary, the older one is the higher the amount to be paid, the younger the beneficiary the less the amount to be paid. For Government Health coverage, the process follows more scrutiny i.e. there is an assessment they call a “Means Test” which assesses your financial capacity, allowing SHA to determine your contribution amount this is meant to ensure equitable contributions based on individual circumstances, the higher your financial capacity the higher your premium and vis verse.

Family Cover

• Principal Beneficiary
• Spouse (if present)
• Child 1
• Child 2
• Individual Cover – Over the age of 18+
• Child’s Cover
• Seniors Cover 65+ depending on company

Consultation Process

Engaging with experienced insurance consultants can simplify the selection process. They will inquire about factors such as your date of birth, the type of cover you’re seeking (individual or family), the ages of family members, and any existing health conditions. This information helps tailor a plan that best suits your specific needs. While having a consultant makes it easier it is essential to also do your homework regarding this cover plan and what exactly they cover and the limits associated with the covers. Don’t end up in a situation where you think you are covered but when it boils down to the fine print, you aren’t really covered well enough. By understanding the various options available in Kenya, you can make informed decisions that ensure you and your loved ones are adequately protected.

International Insurers

International health insurers provide plans tailored for expatriates and globally mobile individuals not necessarily individual covers. However, if you are employed by an international company, you may be provided with an international health insurance plan, the coverage terms will depend on the insurer’s policies and your employer’s agreement with them.

Here’s what typically happens in such situations:

1. Eligibility & Coverage Scope

• Many international insurers like Cigna, Bupa, Aetna, Allianz, and GeoBlue provide global health insurance plans for employees working remotely or for multinational companies.
• If your employer has a corporate group policy, it may cover you regardless of your country of residence, including Kenya.
• Coverage often includes inpatient and outpatient services, emergency evacuation, routine checkups, and sometimes dental and vision care.

2. Local & International Medical Access

• Some policies allow you to seek treatment both within Kenya and internationally, depending on the coverage tier.
• Many international insurers partner with hospitals in Kenya (like Aga Khan, Nairobi Hospital, and Gertrude’s for paediatric care) to offer direct billing.
• If you need treatment abroad, they may require pre-authorization unless it’s an emergency.

3. Underwriting & Policy Requirements

• Your employer typically handles policy enrolment, but you might need to declare pre-existing conditions.
• Some policies have waiting periods for non-emergency treatments.
• If you leave the company, your coverage may lapse unless there’s an option to convert to an individual plan.

4. Compliance with Kenyan Regulations

• Even with international insurance, some employers may still require you to have SHA formerly NHIF coverage, as it is a mandatory healthcare contribution in Kenya.
• It’s advisable to check if the Insurance Regulatory Authority (IRA) of Kenya recognizes the insurer, as this may affect claims and local hospital acceptance.

Comparison of Corporate, Private, and SME Insurance Covers in Kenya

Health insurance in Kenya is offered under different categories based on the type of policyholder. The three common types are Corporate Insurance Covers (for large companies like Safaricom), Private Insurance Covers (for individuals or families), and SME Insurance Covers (for small and medium-sized businesses). Here’s how they compare:

1. Corporate Insurance Covers

These are group health insurance policies provided by large corporations for their employees and, in some cases, their dependents.

These policies are usually Fully or partially paid for by the employer, they Cover employees and sometimes their spouses & children and they have Comprehensive benefits, including:

• Inpatient & Outpatient cover
• Dental & Optical cover
• Maternity cover
• Chronic & pre-existing conditions cover
• Emergency evacuation & overseas treatment (for some employees)
• Direct billing at selects hospitals (cashless access)
• Access to executive or private hospitals, depending on the company policy
• No waiting periods for employees since it’s a group policy
• Premiums are negotiated at lower rates due to economies of scale

Example:

• Safaricom Employee Cover is underwritten by major insurers like Jubilee or Minet and provides comprehensive coverage, including mental health and wellness benefits.

Best For:

• Large companies with many employees (e.g., banks, telecoms, multinationals)
• Employers looking to attract & retain top talent with health benefits

2. Private Insurance Covers (For Individuals & Families)

These are personal health insurance policies purchased by individuals or families.

Features:

• Flexible; You choose what to include based on your needs
• Covers inpatient, outpatient, maternity, dental, optical, and wellness programs
• Premiums are higher compared to corporate policies because it’s not subsidized
• Can be tailored to include International cover & high-end hospitals
• Has waiting periods for maternity, chronic conditions, and pre-existing illnesses
• Policyholder pays full premiums (unlike corporate insurance, which is employer-funded)
• Includes a wider range of hospitals, but some policies may require co-payments

Example:

• Jubilee, AAR, Britam, or APA Individual Health Covers
• Cigna or Bupa for international cover

Best For:

• Self-employed individuals, freelancers, business owners
• Families looking for independent coverage outside employer benefits
• Those not covered under a corporate plan

3. SME Insurance Covers (For Small & Medium Businesses)

These are designed for small & medium enterprises (SMEs) to offer health insurance for their employees at affordable group rates.

Features:

• More affordable than corporate insurance, but not as comprehensive
• Covers employees and their dependents (spouse & kids)
• Includes inpatient, outpatient, maternity, dental, and optical
• Some plans include last-expense (funeral) benefits
• Flexible pricing based on the number of employees (usually 5-100 employees)
• Employees get better rates than private insurance, but coverage is not as extensive as large corporate plans
• Has direct hospital access, but may be limited to specific providers

Example:

• Britam SME Cover, AAR SME Health Cover, Jubilee SME Insurance, NHIF SUPA Cover

Best For:

• Small & medium-sized businesses looking to provide employee benefits
• Companies with limited budgets but want to offer basic medical coverage

Feature	Corporate Insurance (e.g., Safaricom)	Private Insurance (Individuals/Families)	SME Insurance (Small Businesses)
Who Pays?	Employer	Individual	Employer
Coverage	Comprehensive	Flexible (based on budget)	Moderate
Beneficiaries	Employees & Dependents	Policyholder & Dependents	Employees & Dependents
Hospitals Covered	Executive & Private Hospitals	Selected hospitals based on plan	Limited network hospitals
Waiting Periods	None	Yes (Maternity, Chronic, Pre-existing)	Yes (depends on insurer)
Premiums	Lower (Bulk Discounts)	Higher (Self-funded)	Moderate (Affordable for SMEs)
Customizable?	Limited	Highly Customizable	Some flexibility

 

Final Thoughts

• Corporate health insurance is the most comprehensive and cost-effective for employees because employers cover most of the costs, there is no waiting period on ones cover and some do not have a set limit, they may cover all costs.
• Private insurance gives flexibility but is expensive.
• SME insurance offers affordable options for small businesses but may have limited benefits.

Stay in control of your healthcare costs!

Download the Fedhatrac App Now to manage your health insurance with ease!

https://play.google.com/store/apps/details?id=com.fedha.fedhatrac

Stay tuned for Step 3: Life Insurance & Financial Security, where we’ll explore how life insurance protects your loved ones and builds long-term financial stability.