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6 Factors Affecting Health Insurance Cost in Kenya


Health Insurance Rates in Kenya

Health Insurance Kenya cover cost is one of those key factors that you will be considering if you are interested in getting medical insurance. A cost-benefit analysis is important when it comes to determining the ideal medical insurance plan for yourself, your family, your parents, and even your employees.

So what are some of the factors that influence the cost of medical insurance in Kenya?

Age as a health insurance Kenya cover cost factor

When you begin a conversation with any insurance company, agent, or broker, the first question they will likely ask is your age and that of your family members, as well as a schedule of your employees to determine the premiums applicably.

The individual and family health insurance Kenya covered as well as the ex-pat individual medical insurance plans we have available in Kenya consider each age separately. This means the older the oldest member of that family is the more premium they pay and consequently the higher the cost of medical insurance.

For SMEs and Corporates, there are certain principles that might apply because of the volumes or the number of lives they bring into the cover. So what are some of the principles that insurance companies use in the simplest terms possible?

  1. Average age: By average age here, it means that category may be say 18-65 years. This means that every person pays the same premium irrespective of the age profile of your employees. This might be an advantage for a company with an older employee demographic as the cost is evenly distributed across the employees. It is easy to calculate cost implications when onboarding new employees as the rate is unlikely to be affected by age.
  2. Average age brackets: By average age bracket, here the insurance company takes the total sum of the principal member’s age, divide by the total number of employees, then the premiums are calculated based on an age bracket pricing model. For example, if the average age is between 18-30, 31-40, etc, the lower the average age bracket the lower the premium. This means if the population of your employees is in the higher age bracket, you will pay more in premiums
  3. Individual age: These use the individual age per employee. Meaning the cost of health insurance Kenya takes into consideration individual age per employee.

Family size

Health insurance cost determinants

When it comes to health insurance Kenya cover costs, the size of a family plays a critical role in how much premiums are payable. For example, a single person below 30 years will pay lower premiums compared to a couple who in turn pay lower premiums for a couple with children.

The higher the number of family members, the higher the premiums. Due to this, you might find some employers restricting medical cover to perhaps only 6 family members.

Insurance companies also in turn restrict some benefits to a specific number of family members because the cost-benefit analysis of those benefits does not make sense for larger family sizes to have them.

Medical history

Finding health insurance Kenya can be quite a difficult journey for people with certain pre-existing conditions, chronic conditions as well as congenital conditions meaning that you and your insurance agent need to take extra time to explore the various plans offered. This is is because the way the insurance companies offer insurance is based on what is called a risk profile.

The higher your risk profile the more they are likely to decline you as a client. If the company decides to take you onboard you might be subject to what we call premium loading and you pay more in premiums. Therefore it is important for you to understand your risk profile based on your family medical history so that you can take cover before your risk profile increases.

Depending on your income and if it allows, we can also advise that you set up a medical fund to help take care of huge bills that can come with certain health concerns and risks.

Health Insurance in Kenya

Hospital selection

The health insurance marketplace is composed of several players:

  1. Health insurance company
  2. Insurance agent or broker
  3. You
  4. Provider panel and specialist providers

What this means for you is that if you are working on a tight budget, you might need to consider a budget plan which will restrict you to specific hospitals. In Kenya, these budget plans mean high-cost hospitals also called tier 1 hospitals. NHIF has also classified those into either comprehensive or non-comprehensive hospitals. You can read more on that here.

If you are looking at an open hospital panel, you will need to understand that that means higher premiums and if that is an investment you are willing to make. At the end of the day, the choice of cover boils down to budget allocation as well.

Copayments and deductibles

When it comes to your choice of cover as an individual, family, or business, do you wish to contribute part contribute towards medical expenses in exchange for a premium discount? We shall look at this in two ways, retail health insurance comprising of the individuals and family and what options businesses have when it comes to this.

What is a copayment?

Copayment is where in exchange for a premium discount, a prospective client can opt to pay a certain amount towards each and every outpatient claim. For example, in tier-one hospitals, you might come across something like KES 1000 for all outpatient claims towards consultation fees.

For individual health insurance Kenya has to offer, local insurance companies do not give private individuals the option to opt out of this kind of arrangement. We have a premier plan with Madison Insurance which has been able to give the option to have a cover option with no copayment to individuals and families.

Businesses and corporates have the flexibility of determining whether or not they want a copayment and if so the level of it they want. Whatever option they choose, with a slight difference in premiums payable.

What is a deductible?

A deductible, on the other hand, is the amount for each and every claim that you pay a certain predetermined amount at cover inception. It can either be a percentage of the claim amount or a fixed amount.

In this case, some companies will be specific on inpatient cases or outpatient cases, or all of them depending on the agreement made between you and your insurer.

Local and international/ex-pat covers offer this at both individual and business cover options and it has an impact on how much you pay for health insurance Kenya has to offer .

Choice of insurance benefits

One of our articles discussed in detail the medical insurance components and benefits. The core benefit that medical insurance provides is the inpatient cover and you will realize it is the most affordable health insurance benefit of all.

Benefits such as outpatient, maternity, dental, and vision vary based on the individual needs and company and company need as well. Therefore, your budgetary allocation towards medical insurance will highly influence what other add-on benefits you will get.

As your budgetary allocation increases, at the point of renewal, you will be given an option to increase coverage or even add other benefits you need but subject to the terms and conditions of such extension of cover.

Which health insurance Kenya has to offer is best?

Finding health insurance does not have to be a difficult task and the most difficult question to answer is this, which one is the best? Some of the reasons include:

  1. Health condition and consideration at the time of choosing a cover.
  2. Insurance companies’ ability to pay claims
  3. Budget allocations toward your insurance plan
  4. Personal preferences and biases
  5. You preferred doctor and their experiences with the respective insurer preference.
  6. Family and peer influence etc

However, some of these can be handled by embracing an open mind towards engaging an experienced and professional agent, understanding the terms and conditions of the cover you would like to take, and understanding technical term definitions. We have discussed some of these terms in an earlier article. You can read more here.

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