- By Admin Weru
Maternity Insurance Covers In Kenya
Having a baby is anexciting time but it can be overwhelming for expectant parents, and if youdon’t have health insurance in place, there are lots of things to think about. Anormal delivery can cost between KSH 30,000 and KSH 150,000 and a C-section cancost between KSH 100,000 and KSH 300,000. So, where do you start?
Health care in Kenyavaries greatly depending on where you are. In rural areas, health care is very basicand usually focussed on prevention and immunisation. The public health systemin Kenya works by escalating more serious issues up the system. The first pointof contact is a dispensary, which provides preventative medicine, basic healtheducation and out-patient treatmentfor illnesses such as uncomplicatedmalaria.
As an insuranceexpert, I get a lot of questions relating to maternity covers from concerned expectantmothers and fathers. To set the record straight, there is no retail, individualor family medical insurance scheme in Kenya that will cover an expecting motherwithout a mandatory waiting period. A pregnancy can never be classified as anaccident in the insurance world (although for many young couples, it oftencomes about in the most unplanned manner). Therefore, once a woman is alreadyexpecting, it beats the logic of insurance trying to purchase insurance for arisk, which has already occurred. Understandably, no insurer will accept tocollect an insurance premium of let’s say Kshs.15, 000 in return for amaternity insurance bill of Kshs. 120,000 in the next 8 or less months. Even inthe other parts of the world for example in the United Kingdom, leading medicalinsurers also have simular conditions and waiting periods for pregnancy e.gBUPA, AETNA, NOW HEALTH etc.
This begs thequestions, what should I do if I am already pregnant? What are my options? Whatadvice can you give me? This can be a source of worry and stress foryoung/first time mothers, trying to find the right information to make surethat they have a smooth pregnancy and safe delivery for themselves and theirchild.
NHIF– National Hospital Insurance Fund
National HospitalInsurance Fund (NHIF) is a government run medical insurance service, developedwith the eventual goal of offering universal healthcare for all Kenyans. Allcitizens in the formal and informal sectors in Kenya are required to be membersof the fund. The fund is the main source of medical insurance for Kenyans afterthe demise of the Linda Jamii medical cover in 2015. It is very important to bea paid up member of NHIF because of the comprehensive medical insurancebenefits this membership affords you as a member and declared spouse andchildren. It is advisable to pay an upfront lump sum amount for the membershipinstead of paying monthly, as the system may take some time to reflect thepayments, which may inconvenience you at the time of seeking treatment. TheNHIF monthly contributions are pocket friendly for all income brackets, you cantalk to the experts at imana insurance https://imana.co.ke/ to find out how much the premiums for yourmonthly income bracket will be.
Every Kenyan shouldconsider NHIF membership because it subsidizes cost of treatment especially forthose without a personal or corporate medical cover. The NHIF has recentlyexpanded its scope of coverage, range of benefits and medical provider panel.While it previously only covered the expenses for hospitalization of members atlisted medical providers and hospitals, the NHIF now takes care of costsassociated with outpatient services, the treatment of cancer and the cost ofdialysis, surgeries as announced in thenew NHIF benefits. This means you getaccess to comprehensive care i.e. walking in and out of any hospital undercategory A and B without paying a single cent as a negotiated amount is alreadyset between the hospital and NHIF. But note that it does not apply to surgicalcases in Hospitals under contract B where members do co-pay. Whether theseservices are really free is a subject of discussion in another forum. Whatexactly is covered by NHIF? I also don’t know.
I have my ownreservations about the effectiveness of the NHIF comprehensive benefit package.You can’t depend on it fully; it can let you down when you need it the most asfrom my most recent experiences. I recently visited one hospital in Westlandsin Nairobi. I have been using my https://apainsurance.org/ andhttps://imana.co.ke/cards on outpatient; this time I decidedto use NHIF since I contribute a good chunk of my monthly package to thisscheme. I was ushered to a separate waiting bay, billing section, consultationand pharmacy, which are deliberately set for universal/NHIF patients. I wastreated like an individual seeking free services. The doctor prescribed benzoylperoxide, which goes for at most Ksh. 800. According to the pharmacist at theNHIF section, this medication is not covered. I was instructed to either pay incash for the medication or go seek the services from a government hospital!
NHIFMaternity Benefit
Luckily for manyKenyans, the NHIF will cover maternity insurance even if the member joins thescheme when they are already expecting, this is unlike the retail medicalinsurance products we have in Kenya.
For maternity, normaldelivery NHIF covers up to Ksh.10, 000 and Caesarean Section patients will getup to Ksh. 30,000.
These maternity limitsare not sufficient even for category A hospitals leave alone category B. Forcategory C hospitals, the likes of Nairobi Hospital, Aga Khan, Ksh.10, 000 isnot even sufficient for a single day bed limit in a category C hospital. If youthought NHIF is sufficient, you should think again. An average normal deliverycost in Kenya is around Ksh.37, 500, for the same normal delivery in Category Chospital like Agha Khan, the advertised rates for this package start at aminimum of KSh. 99, 000.
In a nutshell, what amI saying? The NHIF maternity cover may be good news for an expectant mother butit is not sufficient even for normal delivery in a Category A hospital. Itleaves a large gap, which needs to be filled with either cash payment or aprivate medical insurance plan. Ideally, one should have an additional medicalplan to cushion these expenses. The joy of a newborn baby may be short livedwhen the hospital presents a very big medical bill for the maternity expenses.
Many Kenyans may notwant to register for privately funded health insurance plans because of theperceived high cost. When you buy a commercial medical insurance policy from alocal healthcare provider such as AAR Insurance, APA Insurance, JubileeInsurance RESOLUTION Insurance, UAP-OLD MUTUAL and other medical insuranceproviders in Kenya, your insurance is calculated net of the NHIF contributionto your hospitalization. Since membership in NHIF is mandatory for employedpersons, health insurance companies assume that everyone who buys additionalinsurance from them is actually buying ADDITIONAL insurance. The policybenefits are therefore calculated net of the amount NHIF should pay. If you donot keep your NHIF contributions current, you may have to foot an amountequivalent to what NHIF should pay, depending on the insurance company you arewith.
Maternity cover isusually included as an enhancement of a basic health insurance policy. It has awaiting period meaning the member cannot enjoy the benefits immediately theyare accepted on cover. The waiting period varies from 10 months up to 24 monthsfor some providers. Maternity insurance in Kenya usually meets the costs ofante, postnatal care, hospitalization, including delivery and any eventualitiessuch as congenital illnesses that may result from the pregnancy. Due to itsnature as an “assured risk”, the maternity cover in many ways is a customerretention element used by insurance companies.
Good health is such afoundational matter in life, without it, it becomes difficult to live and enjoylife, achieve any important life goals. Medical insurance plans in Kenya arevery affordable, there are a variety of economy packages with affordable premiumsof under KSh 10, 000 per adult. You do not need to take on a cover of limit KSh10 million, for most people, limits of KSh 1 million are more than sufficientto meet in patient medical bills. In addition, it is possible to enroll on oneof theaffordable https://imana.co.ke/plan for less than KSh 15, 000 perannum. One needs to look at their needs, budget, and benefits and comparequotesavailable in the market before finding the best compromise.
My advice to the younggeneration; as you constitute that wedding committee, don’t forget to put ahealth plan in mind since you are about to start a family. Medical andeducation are sure expenses in any family set up. Kids will bring joy, butplanning for them you must.
MiCoverBy Imana and Healthier Kenya Ltd
Unitas Insurance Agency Kenya {Now ImanaInsurance Agency Kenya Ltd} https://imana.co.ke/ in partnership with Healthier Kenya Ltd, Medical AdministratorsKenya Ltd and Medicross Ltd launched MiCover micro-health plan in April 2021 toaddress maternity concerns. This plan covers principal, spouse and 2 childrenat cost of Ksh.24,000 per year. This family of 4, share benefits as below;
1. In-Patient Ksh. 650,000
2. Out-Patient Ksh. 75,000
3. Maternity Ksh. 100,000
4. Optical Ksh. 10,000
5. Dental Ksh.10,000
This unique family micro-health plan has reducedmaternity waiting period from the 10 to 3 months. What does this mean?Expectant parents can now enjoy Ksh.100,000 maternity cover with waitingperiods of only 3 months. Adding MiCover to NHIF maternity benefit, means afamily can settle up to Ksh. 130,000 of hospital bills. MiCover maternitypackage has since benefited over 100 families in Kenya.
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By Raymond Momanyi
The writer is the Founderand CEO, Unitas Insurance Agency Kenya Ltd now IMANA. A leading onlineinsurance agency in Kenya https://imana.co.ke/
