What is health Insurance?

A health insurance policy is a legal contract between an insurance company and the owner of the policy which details various conditions under which the insurance company will be responsible for the costs of medical care of the policyholder which could be themselves, their family, or employees.

What is the cost of health insurance?

Cost varies with age and health cover needs. Insurance companies calculate the likelihood and costs of various medical treatments for which they will be liable and set an annual rate of premium to be paid by the policyholder termed as Premium.

What does health insurance cover?

The cost of receiving medical treatment, including scans and surgical procedures, when you are admitted to hospital as an In-patient, or a walk-in patient called out-patient. 

Sometimes it extends to cover for radiotherapy and chemotherapy to treat cancer, and access to a medical professional when needed. 

However, these benefits vary with the cover type purchased and the provider you choose. 

Each policy allows you to build a plan to suit you by including modules of different covers, there are many different providers with different options, and we know that you may need some help finding the policy to suit you, that is why we have made it simple. 

What is not covered by your health insurance?

Health insurance policies do not normally cover all medical expenses. That is why it is important to read and understand your policy contract. 

The non-covered expenses are defined by medical condition, type of treatment, or medical provider but most of them are well defined in the contract. 

For example, most health insurers do not cover elective cosmetic surgery, such as face lifts, tummy tucks, or obesity surgery, except in certain rare occasions. Policyholders remain 100% liable for any excluded treatment or expense. 

How can I save money and get the best health deals?

There are several ways to save on your health insurance quote. One of the most effective ways of finding a cheaper premium is to shop around and let us help you compare the best health insurance quotes.

Remember this when making a health claim?

Most health insurers issue clients with smart cards to use for each visit to a medical facility, however, to have the reassurance that your eligible claim will be paid for in full in case you pay cash at any medical facility, most insurers in Kenya will advise that you contact them before undergoing treatment to pre-authorize a claim.

What instances could a claim be denied or unpayable?

If you are receiving treatment for something you had before joining up for health insurance, or that has been identified as an endorsement or exclusion on your policy, in such a case you will have to fund the treatment yourself unless your policy contract specifically includes it. Always seek clarification from the insurer.

What are medical coverage limits/sub-limits?

Health insurance is restricted. Insurance companies usually limit the amount of liability they are exposed to by outlining the maximum amount for which they will pay medical costs for each medical treatment.

These limits usually vary from one insurer to another, and may be either lifetime, annual or both. Check with your insurer to confirm which sub-limits are outlined for your medical policy.

What is a co-payment?

Policyholders are usually required to pay a portion of the cost of each medical treatment covered or hospital visit made to reduce and manage claims. The co-pay varies depending on coverage and hospital facility, but most often it will be between Kshs. 500 and Kshs. 3000 depending on the facility.

What are medical exclusions?

Health insurance policies do not usually cover all medical expenses. The non-covered expenses or conditions are termed as exclusions which may be defined by medical condition, type of treatment, or medical provider and are mostly listed in the policy contract.

When is medical cost reimbursement applicable?

If you are receiving treatment for a new condition or visiting a medical facility or specialist outside of your insurer’s hospital panel list, you may be expected to pay all the costs subject to reimbursement after submitting the medical report and payment receipts to the insurer and provided the claim is within your cover scope. Not all insurers offer this, so confirm beforehand.

Can I still use the NHIF card with my private health insurance?

Your health insurance policy conveniently works alongside the NHIF, so you will still be entitled to free treatment at point-of-delivery for government hospitals, mission hospitals and at private medical facilities an NHIF bed rebate will be charged. As a government requirement, it is mandatory to have an NHIF cover for all tax-paying adults.

What should you know as a health insurance customer?

Our health insurance comparison service is provided by Bima Hakika Agency Limited, licensed and regulated by the Insurance Regulatory Authority (IRA) No. 97925. Office address: Mogotio Road, Royal Suites, Nairobi.

We understand that Health Insurance, despite being optional, can be the difference in having peace of mind or not and therefore plays an important part of our lives.

Role of Insurance Regulatory Authority (IRA)

The IRA is there to protect you, the regulatory body is designed to ensure that you as the consumer are cared for, and all products are sold appropriately.

 If you feel dissatisfied with the outcome of your complaint, there is the option to ask the IRA to consider your complaint. You can contact them on (254)- 0719047000 and find out whether your complaint is eligible. 

There are other questions you may want to know the answers to. In that case, please contact us to discuss your personal policy needs.