Health Insurance at a glance

The current COVID-19 pandemic has made the entire world sit up and realise that medical emergencies are unpredictable and can cause a financial upheaval that is tough to handle. With a high infection rate and a slow rollout of the vaccine, people have started to understand the importance of having a good health insurance plan.

We all have at one time or another been sick or had a sick person whose medical care came with huge bills. This often results in fundraising events to raise money to offset the medical bills. Illness is a part of life, but we don’t actively prepare for it as it is a morbid thought. So when diseases and emergencies strike, we find ourselves unprepared. Not having health insurance can land you into a lifetime debt or drain your life savings in emergencies, for instance, being hit by a bus or long-term illnesses and conditions.

What is health insurance, and why do I need it?

Health Insurance is a type of insurance that covers medical expenses that arise due to illness. It is all about mitigating the risks that come with our wellbeing. Below are the reasons why we need health insurance:-

1. Peace of mind: Sickness comes at any time, and most times, we are not ready or prepared to cater for the bills that go with it. Health insurance gives us some peace of mind when such situations arise.
2. To deal with the rising medical inflation: This relates to the rise in medical costs. The current medical inflation in Kenya is at 12% compared to the global inflation rate at 9.5%. These medical expenses relate not only to hospitalisation costs but doctor’s consultation fees, diagnostic tests, and medicines. All these can pose a financial strain in case of an illness. You can cover these costs by paying a relatively affordable health insurance premium and beat the burden of medical inflation without worrying about how much it will cost you.
3. To protect your savings: Unforeseen illnesses or emergencies can cost you a pretty penny, especially if you are not financially prepared. It can leave you financially drained as you may have to go back to your savings to pay for the bills. By having suitable and affordable health insurance, you can better manage your medical expenditure without dipping into your savings.
4. To fight lifestyle diseases: With our fast-paced lives, the pressure at work, responsibilities at home, and various community commitments, we rarely get the chance to live a healthy lifestyle. We succumb to lifestyle ailments such as stress-related diseases, diabetes, obesity, respiratory problems, and heart disease, all of which are prevalent among the older generation and are now rampant in younger people. Treatment and management for these diseases can be costly, and for some, it can be for a lifestyle. An unfortunate incidence can be challenging to deal with, financially. Opting to invest in a health plan covering regular medical tests can help catch these illnesses early and make it easier to take care of medical expenses, leaving you with one less thing to worry about.

Types of health insurance?

Whether you’re selecting a health plan at work or purchasing one on your own, wading through health insurance plans can be quite intimidating since the terminology is often unfamiliar, confusing, and the stakes are high.

In Kenya, we have two main categories of health insurance, public and private. One can purchase either of the two. There is insurance for everyone, including companies, individuals which also entails the elderly. Within these, there are additional benefits which include inpatient, outpatient, dental, optical and maternity. The main benefit is inpatient, and the rest are riders or optional benefits. Within the main benefits, we have sub-benefits like chronic conditions cover, pre-existing, congenital, etc. We shall discuss this in-depth in the next series. Before purchasing a health cover, research widely, talk to a specialist to ensure you get the right cover for your needs.

What should I look out for when purchasing insurance?

Health insurance is a broad topic, so we’ll start by looking at what we need to look out for when purchasing a health policy. Below are essential items to be considered: -

1. Selecting the right package that meets your needs

When purchasing health policy, take note of the various options or benefits, including inpatient (hospitalisation), outpatient, dental, optical and maternity. When purchasing insurance for the elderly, consider the sub-limits within the main benefits, for example, chronic and pre-existing conditions. If planning to start up a family, consider taking up a maternity cover that caters for the delivery costs and any related complications.

2. Family health history

As you consider taking up health insurance, keep in mind your family members’ health history, including their current ailments and ages.  Check for any pre-existing or chronic conditions as this will guide your decision on the options to purchase and limits to consider. For example, when purchasing cover for your elderly parents who have chronic conditions, consider taking a higher inpatient limit that comes with a higher cap for these conditions and most definitely you will not take up maternity for them unless a miracle happens 😊

3. Wide provider network

One of the crucial factors to consider is the cashless provider network of the insurance company. At the time of a medical emergency, one should access the services without paying cash; the insurance company should settle the bills directly to the hospital.

Some insurance companies are on a reimbursement basis where you first pay cash for the services and then seek a refund. This approach might not be feasible, especially in emergency cases. Select the insurance company with a wide network of hospitals and specialists and allows you to receive medical attention without paying for it.

4. Budgetary considerations

Health covers can be expensive, which is a major contributor to the low uptake of health policies. However, the industry is changing, and there are new affordable options. Not having health insurance can cost you so much more in the long run. One should be able to get value for money. The insurance taken up should cater to the medical expenses for the year. Consider your age, the younger you are, the lower the insurance premiums. Select insurance policies with add-ons that are not so expensive, such as evacuation and ambulances services, and a medical check-up. There is usually a small cost that comes with it, but it is doable. It is different for various companies. Also, take note of the sum insured (the overall cover limit), it won’t fall short in case of an emergency and whose premium is not exorbitant. Have a payment plan if you cannot raise the whole amount at a go. Most banks do offer good Insurance Premium Financing (IPF) for all. This is where the bank gives you a loan to pay for the medical premiums at a small interest. Also ask if there are other charges you will be required to pay apart from the premium.

5. Renewal policy

Before buying health insurance, look for policies which offer renewal option beyond the retirement age. There is a higher chance of suffering from diseases and illnesses when you are old than when you are young—a health policy that offers senior age coverage is ideal.

A health plan is your best help during medical emergencies, take up one and give yourself and your family peace of mind. We all want to have a healthy life, but life doesn’t always give us what we want. Talk to someone, call the insurance company directly and get all facts right before purchasing a policy. It is doable.

Teresa is a health insurance expert working as a Business Development Executive at Jubilee Health Insurance Limited. For more information, you can reach her on +254726511520