Is Health Insurance Mandatory In Kenya

health insurance Kenya

Health insurance is one of the best assets one can invest in. Healthcare costs across the globe are steadily rising; therefore, the financial impact of an unexpected illness can be devastating to many households without insurance. Making it worse is that, in many cases, people are left choosing between paying for a medical bill or other essential bills if they have limited funds. This is not a practical and safe way to live life.

Lifecare International is a certified insurance broker and we offer an exhaustive range of insurance products to ensure we can meet the diverse needs of all our clients, both business and personal.

We understand the difficulty in choosing the most suitable insurance plan for your needs, so we take the time to assess your situation. Then we match you with a plan that meets your budget, individual, and family requirements.

Is Health Insurance Mandatory In Kenya?

Health insurance is not mandatory in Kenya but is highly encouraged so Kenyans can confront all health issues or concerns without the fear of associated costs. Most employers offer their employees benefits and perks that include health insurance and add-ons, which are affordable. For Kenyans who are not employed or self-employed, there are many health care insurance options with a range of prices, making it more accessible for everyone despite their socioeconomic background.

Types of Health Insurance in Kenya

Kenyans have various options when it comes to picking out the most suitable type of insurance plan for their personal needs. Below is a list of the key health insurance policies available in the Kenyan market.

Inpatient Coverage

This policy covers costs associated with hospitalisation stays and care for the policyholder who must stay in the hospital for at least one night. It covers the cost of hospital stays, treatment while in the hospital, and liabilities associated with hospital care. In some cases, depending on the policy, the insurance company may require authorisation before the patient can access inpatient care. This is a measure taken to ensure the hospital stay is absolutely needed. The most common sections covered with inpatient cover are;

  • Bed use
  • Congenital
  • Post-hospitalization
  • Medical tests
  • Professional fees such as specialists

Outpatient Coverage

This policy is typically bundled with the inpatient coverage, as it covers costs associated with care following inpatient treatment at an accredited hospital or clinic. When the policyholder leaves the healthcare facility, the coverage covers all or most expenses related to outpatient facilities and other related medical costs. The policy costs tend to be cheaper than inpatient coverage as they do not include liability costs for a hospital stay. Under this coverage, the insured also can purchase additional coverage for optical and dental treatment. The most common sections covered with outpatient cover are;

  • Consultations
  • X-rays
  • Laboratories, scans & MRI
  • Diagnostic examination
  • Antenatal & postnatal care
  • Well-baby check-ups
  • Injections
  • Prescribed medications
  • Minor trauma treatment
  • HIV services
  • Adherence & nutritional counseling
  • Baby-friendly vaccines
  • Prevention of mother to child transmission (PMTCT)
  • ARV’s and monitoring
  • Opportunistic infections

Medium and High-Cost Coverage

Among the most common health insurance policies in Kenya is the medium and high-cost coverage, typically paid for through the employees’ workplace as a part of their perks and health benefits. Policies differ dependent on the company size. For example, a high-ranked employee is given high-cost coverage, whereas the middle and lower-ranking employees are given medium-cost coverage. Depending on the policy, employees can opt into added funeral cost benefits to prepare for the future, if needed.

Maternity Coverage

While maternity coverage is available for employees in the workplace, it is typically added on as an enhancement to a standard health insurance policy. It can be bought as an add-on to outpatient coverage. This coverage will cover the cost of all hospitalisation costs, including; delivery & labour, and any potential illnesses that may result from labour. The most common sections covered are;

  • Inpatient costs incurred for normal births
  • C-section birth
  • Home deliveries
  • Labour & post-labour wards
  • Professional costs
  • Pregnancy
  • Maternity-related hospitalisation
  • Lamaze classes if authorised
  • Other related ailments and complications

How Much Does Medical Insurance Cost In Kenya

Choosing health insurance for you and your family is not easy. An important factor that should always go into selecting the most suitable policy for health insurance in Kenya is the price. Policyholders should always ensure the price is worth the value and that the package includes only the necessary add-ons. There is no need to pay extra for services that are not required. Below is a range of prices that one would typically see in the Kenyan health insurance market.

Inpatient Coverage

Inpatient coverage is typically offered in three cover limit plans that the applicant can choose from. The prices range from KES. 500,000 to KES 10M. Inpatient coverage is shared among the policyholder and all dependants included in the policy.

Outpatient Coverage

Outpatient coverage is typically offered in three or more cover limit plans from which the applicant will be required to choose. The prices range from KES. 50,000 to KES. 20,000. This can be individual use or shared among the policyholder and dependants.

Dental and Optical Care

With most outpatient coverage, routine dental and optical care is covered in the price of the plan, if it is added. It covers the cost of frames, lenses, and regular check-ups. If it is not included, the insurer can add it to the coverage for an additional price.


Maternity benefits are an add-on to inpatient coverage and cover all pregnancy-related treatment. There is no added cost to this benefit as it is included in the inpatient policy.

How To Apply For Health Insurance In Kenya

Applying for health insurance in Kenya is relatively straightforward. Most companies require the applicant to follow a step-by-step process that entails all the pertinent information, which will then be used in the underwriting and approval process. Below is a sample guide on what a typical application will look like.

Step 1: Personal Information

This section includes all the principal member details such as name, DOB, gender, marital status, occupation, ID No., weight & height, mailing & physical address.

Step 2: Dependency Information

This section includes all the dependant member’s details such as name, DOB, gender, weight & height.

Step 3: Coverage Option

This section is where the applicant will select the most appropriate plan. Note that inpatient coverage will include all dependants under the policyholder with most health insurance companies. If outpatient care is required, the applicant must select it for each dependant as it is not automatically applied to all dependants.

Step 4: Insurer Information

This section will require the applicant to disclose their current insurance plan if they have one. If they do not, it will not be applicable. Additionally, the applicant will be required to disclose if they or any dependants have even been denied a premium from any other health insurance company in the past.

Step 5: Next of Kin (Benifieciery) Details

This section includes the next of kin details such as their full name, ID No., relationship to the principal member, and phone number.

Step 6: Document Upload (If completed online)

This section will require the applicant to upload all pertinent documents as part of the application process. It includes a copy of the ID listed, a copy of the KRA pin, a copy of the marriage certificate (if any), and a passport size photo.

Step 7: Medical History

This section will require the applicant to disclose the medical history of all applying members, including the principal member and the dependants. This information is entirely confidential and is required as part of the underwriting and application process.

Is Health Care In Kenya Free

The Kenyan health care system is divided into a three-tier system; public providers, private non-profit organisations, including faith-based and mission hospitals, local & international NGOs, and private for-profit health care providers.

Health care in public hospitals and public clinics offers free maternity care, and most inpatient treatment. However, anything not covered by the public hospitals or the patients’ health insurance policy will be an out-of-pocket expense.


As we all know, good health is the most important asset one has in their life. We can take care of our health and constantly work toward a healthier lifestyle, but illness is still inevitable. The financial burden is far too steep for many people to seek care even if they are in desperate need. You don’t need to let this stop you.

With Lifecare International, there is a range of coverage options to choose from that are affordable and will prevent you from enduring large medical bills in the future. As a certified insurance broker, they have access to an array of plans that range in price so they can work with you to secure the most suitable coverage. Do not wait until you think you need it; health care is essential for everyone. If you don’t have access to free or affordable health care, signup with Lifecare International today to secure your future.