Medical Insurance Options in Kenya

Selecting the right health insurance plan is very important not only because various providers charge differently, but also because the plans differ in terms of what coverage they offer and the flexibility.

But choosing the right health insurance plan is not easy because there are different options to compare, from Preferred Provider Organization and Health Savings Account to Indemnity plans. We have compiled an article to help you make the right choice when looking for medical insurance in Kenya.

1.Preferred Provider Organization

Also known as the PPO, it is a plan where the insured has to use a network of hospitals and doctors. The insured has more flexibility since he or she is free to use any doctor and hospital in the network and is not required to have a designated Primary Care physician. The insurance provider will make arrangements with the network of doctors and hospitals to provide health assistance and treatments to the plan members. This usually takes place for a negotiated or discounted rate.

For those looking for medical insurance in Kenya, before the coverage is active, you must pay a certain annual deductible. Higher out-of-pocket cost can result if services are provided out of the hospital and doctor network. You can use an online insurance calculator from many providers to determine the total cost, just the same way you use the KRA PAYE calculator.

2. Health Maintenance Organization

The provider of an HMO will require you to designate a primary care physician who can suggest treatment options or referrals, and you must seek treatment where the physician suggests, otherwise, you get charged more money.

The insured enjoys a wider range of preventative services but has lesser flexibility in regard to treatment hospital and doctor network. Some providers don’t require a deductible before enjoying coverage, an this is one of the best options for those looking for medical insurance in Kenya because it is associated with low deductibles and beneficiaries do not have to fill claim forms.

3.Health Savings Account

HSA is a tax-favored savings account that works with a HSA-compatible high deductible health plan.

With this plan, you pay a lesser monthly premium than you would with a lower-deductible plan

An HSA is a Health Savings Account. It is not actually a health plan. An HSA is a tax-favored savings account that is used in conjunction with an HSA-compatible high deductible health plan to pay for qualifying medical expenses. The contributions may be pre-tax up to a certain limit and unused funds in the account earn some interest. You use an insurance calculator the same way you use a KRA PAYE calculator to calculate the total cost of insurance and premiums.
4.Point of Service (POS)

Combining HMO and PPO features, the option requires you to get a primary care physician to refer you to specialized treatment where needful, but the services provided by the PCP are not subject to plans deductible. Again, you qualify for higher level of coverage if you get services of a PCP but may be charged deductible and get lower level of coverage if you do not use his or her service. Up-front payment and filing of reimbursement claim is required.

5.Exclusive Provider Organization (EPOs)

Members using the plan get medical help from a network of physicians and hospitals unless under emergency situations. They must pay a small co-payments and may require a deductible. A Primary Care Physician (PCP) refers them to the doctors or hospitals in the network.

6.Indemnity Health Insurance Plans

This is the most common type of medical insurance in Kenya. Basically, they are known as the Fee-for-Service plans because the percentage to be paid to the insured is pre-determined. You will pay deductibles out of your pockets or through coinsurance arrangements and then file a reimbursement claim for amount covered. Many providers have an online insurance calculator that can help you determine the amount of deductibles same way a KRA PAYE calculator is used.


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