Undoubtedly, there has been an increase in diseases, and the
cost of healthcare
in Kenya has also dramatically increased. This has made getting a
medical insurance cover a necessity. When seeking medical coverage in Kenya,
you will encounter a variety of options from different insurance companies and
brokers.
From the available medical plans you are presented with, how
do you choose the best medical cover that will suit your needs? In this article
we shall explore these 6 tips that can guide you through choosing the best
medical cover that will offer sufficient coverage for your healthcare needs.
Types of Health Insurance in Kenya
There are different types of health insurance plans each
catering to different needs and preferences. Technically, these types of health
insurance plans can be divided into the following:
- HMO
(Health Maintenance Organization): You get to choose a primary
care physician (PCP) who manages your healthcare needs and refers you to
specialists within the network.
- PPO
(Preferred Provider Organization): Gives you a wide network of
healthcare providers, allowing you to see specialists without a referral.
Premiums are relatively higher but you get the freedom to choose your
preferred hospital or doctor.
- EPO
(Exclusive Provider Organization): You don’t require a referral
to see specialists, but you must stick to the network for coverage, except
in emergencies.
- HDHP
with HSA (High Deductible Health Plan with Health Savings Account): HDHPs
have lower premiums and higher deductibles, accompanied by an HSA to save
for medical expenses tax-free. A greatchoice for those who don’t expect
frequent medical visits.
- POS (Point of Service): With a POS plan, you designate a primary care physician. In the event that you want to visit providers out of this network, you will be required to foot the additional costs involved.
Now that we understand the different types of health
insurance plans, let us dive into these 6 tips that will help you make the
right choice when choosing a medical cover.
#1 Choose the Right Insurance Company
With a myriad of options when it comes to insurance companies in Kenya,
this is the first important decision you have to make when choosing your
insurance cover. A good place to start is finding out what existing customers
say about these insurance companies.
You can quickly pick out questionable insurance companies
from online reviews. With the seriousness of health matters, you want to avoid
insurance companies that may frustrate you at your time of need. Try asking
among your circles the insurance covers that they use and how their experience
has been.
Other factors to consider when identifying the right insurance
companies to deal with include:
- The
network of hospitals under their insurance plans.
- The
types of plans they offer and what they are best known for.
- How
easy is the claims process and what their claim settlement ratio is.
- How
much they charge as compared to other players in the market.
#2 What Benefits do the Plans Cover
You will most likely find that all the insurance plans that
you get from different providers offer some basic benefits. You need to look
out for additional benefits that distinguish one insurance plan from the next.
You will need to assess what is most important to you at the
moment and in the near future. Look out for the medical schemes that offer this
cover. For instance, if you are starting out a family and you are looking to
have kids, choose an insurance plan that offers maternity cover. This may not be
important for an individual who may not be looking to start a family.
There are additional features that may also add value to the
cover and may be important to you. Such feature may include; annual medical
checkups, wellness and nutrition, no claim bonus etc.
#3 How Much Does It Cost?
With the current financial constraints, this is probably
first on the list when choosing a medical scheme. With anything that we
purchase, we always want to have value for money. Health insurance premiums
come with different pricing from different providers.
Therefore, at this point, it is important that you compare
the premiums from the different insurance companies. While, comparing, take
into account the different features each insurance plan offers. Make sure that
you consider the plan with the features you care about even if these would
raise the premiums costs.
At this point, you can dismiss the insurance premiums that
seem exaggerated.
#4 What Co-Pay Clauses are in the Policies?
There are different reasons that insurance companies include
copayment in their policies. This basically means that you may have to part
with some amount of money every time you make a claim. Some would have this as
a constant figure, say Ksh 500 or it may be a percentage of the total claim say
5%.
It is important that you choose an insurance plan that does
not have copayment as this may inconvenience you. However, in other instances,
you may not be able to completely avoid copay. For instance, the occasion that
the individual may be above a particular age or for particular illnesses or
treatments.
In such scenarios, it will be in your best interest to opt
for the insurance plan with the list co-pay.
#5 What are the Waiting Periods?
The waiting period refers to the duration of time one must
wait after enrolling in a health insurance plan before certain benefits become
available. This waiting period is typically established by the insurance
provider and outlined in the policy terms.
Waiting periods are basically a risk management strategy.
The reasoning behind this is to prevent individuals taking up insurance covers
because of pre-existing conditions or big medical procedures.
There is the initial waiting period that begins when you first
enroll restricting particular services or conditions. There can also be a
pre-existing condition waiting period imposed specifically for pre-existing
conditions.
It is therefore important that you review the policy and
take note of these waiting periods. These waiting periods may vary
significantly from one policy to another. Consider the policies with reasonable
waiting periods that you are comfortable with.
#6 What are the Coverage Limits?
This is another very important aspect when it comes to
choosing the right health insurance coverage in Kenya. The insurance plans
often have limits for different aspects. The most important limits include:
- Inpatient
Coverage
- Outpatient
Coverage
- Dental
- Optical
The limits vary from one policy to another and this directly
affects the premiums. It is important that you work out a ballpark figure on
the amount that you may need each year that will fully cover you. For instance,
you may be taking up a healthcare plan for your family and you could be
averaging Ksh 200,000 in expenses each year. You will therefore need a plan
that would adequately cover this cost.
There are also other sub-limits that you need to take into account when choosing the medical scheme. These are normally overlooked but are equally important and may save you some out-of-pocket cash when you least expected. These may include; room charges, ICU room charges, home treatment etc.
The Bottom Line
Choosing the right medical insurance cover in Kenya is an
important decision that can greatly impact your finances and access to quality
healthcare. These simple tips we have outlined can help you navigate the
complexities of insurance in Kenya and help you make a more informed decision.
Remember to;
- Select
the right insurance company
- Review
the benefits a policy covers
- Compare
premiums from different providers
- Take
note of copayment
- Consider
comfortable waiting periods
- Take
note of the cover limits and sub-limits
Additionally, seek advice from insurance consultants or
consult with trusted peers to gain insights and recommendations.
Ensure that you prioritize comprehensive coverage, affordability, and reliability. This will empower you to safeguard your health and well-being, ensuring peace of mind for you and your loved ones in the face of medical uncertainties.