Family Medical Cover

SHA (the Social Health Authority) gives you a valuable basic layer of cover, but its limits and hospital options are narrower. Private medical insurance sits on top of SHA, giving access to a wider choice of private hospitals, higher limits, specialists and faster service. Many families use both.

Usually, yes. Conditions such as hypertension, diabetes or asthma are normally covered after a waiting period, often 12 months, and some insurers apply a lower limit for them at first. You must declare existing conditions when applying, because an undeclared condition can lead to a claim being declined.

Premiums depend mainly on the age of each person covered, the inpatient and outpatient limits you choose, extra benefits such as maternity, dental and optical, the number of dependants, and the insurer's hospital network. Wysline compares several insurers so you can see how the same cover is priced across the market.

Yes. Parents are often better covered on a dedicated plan for older adults, which you can pay for on their behalf. See our Senior Medical Cover page; note that applicants above 60 usually need a medical examination before cover starts.

At a panel hospital, the hospital bills the insurer directly, so you only show your medical card and pay any co-payment. With reimbursement, you pay the bill yourself and then claim the money back from the insurer with your receipts and medical report. Direct billing is easier, so it is worth checking that your preferred hospitals are on the insurer's panel.

A co-payment is a small share of each bill, usually on outpatient visits, that you pay yourself, for example a fixed amount or a percentage per visit. Choosing a plan with co-payment lowers the premium. It suits people who rarely use outpatient care; frequent users are often better off paying a higher premium with no co-payment.

Maternity is usually an optional benefit you add to a family or individual plan. It normally has a waiting period, commonly around 12 months, before you can claim for a delivery, so it is best added well before you plan to start or grow your family.

Often, yes. Many insurers accept monthly, quarterly or half-yearly payments, and premium financing is available for larger policies. We will show you the payment options available with each insurer when we prepare your quote.

Most local plans cover treatment in Kenya only, with limited or no overseas benefit. If you travel often, live abroad or want access to hospitals outside Kenya, look at International Medical Insurance, or add travel insurance for specific trips.