SHA gives every registered resident a basic level of cover. Many people in Nairobi also buy private health insurance, for faster access to private hospitals, higher limits and cover SHA does not give. Employers often provide it, and it is a common part of expatriate packages.
This guide explains what to compare. It is not a recommendation of any insurer.
Local or international?
- Local plans are sold by Kenyan insurers, in shillings, and cover treatment in Kenya and sometimes East Africa or India. Many insurers sell them, including Jubilee, AAR, Britam, CIC, APA, Madison, Old Mutual and others. They are regulated by the Insurance Regulatory Authority.
- International plans are priced in dollars or euros and can cover treatment abroad, including evacuation. They cost far more, and suit expatriates who want treatment at home or cover for serious illness outside Kenya.
How cover is built
Most plans are made of parts you choose separately:
- Inpatient - hospital stays, surgery, and usually the core of any plan. Often has the highest limit.
- Outpatient - doctor visits, tests and prescriptions. It costs relatively more, because most people use it.
- Maternity - pregnancy and birth, usually with a waiting period.
- Dental and optical - small limits, often worth it only for families.
- Evacuation and last expense - emergency transport, and funeral costs.
What to compare
Limits. Each part has an annual limit per person or per family. A serious illness or a complicated birth can use up a low inpatient limit fast.
Waiting periods. New members often wait before cover starts for some conditions - commonly 30 days for general illness, and much longer for maternity, chronic conditions and some surgery.
Pre-existing and chronic conditions. Many plans exclude conditions you already have, or cover them only after a waiting period and up to a lower limit. Declare everything honestly; a claim can be refused if you did not.
Age limits. Many plans stop accepting new members above a certain age, and premiums rise with age.
Co-payments. Some plans require you to pay part of each bill, which lowers the premium.
The hospital panel. Check that the hospitals and clinics you actually use are on the insurer’s panel, and whether you pay upfront and claim back, or the insurer pays the hospital directly.
Claims service. Ask people who have claimed. How an insurer handles a large claim matters more than a small difference in premium.
Buying cover
- Through a licensed broker. A broker compares several insurers at no extra cost to you, and helps with claims.
- Directly from an insurer’s website or office.
- Through your employer, where family members can often be added.
How it works with SHA
Keep your SHA contributions up to date even with private cover: hospitals often bill SHA first, and some private plans expect it. See Registering for SHA.