Medical covers look similar on a brochure and behave very differently in a hospital. Before comparing premiums, compare these four things.
1. Inpatient vs outpatient
Inpatient cover pays when someone is admitted to hospital. Outpatient cover pays for consultations, tests and medicine without admission. A cheap 'inpatient only' plan is still valuable — admissions are where the large bills are — but know which one you are buying.
2. The limits and sub-limits
A KES 1,000,000 inpatient limit sounds generous, but look inside it: maternity, dental, optical, chronic conditions and ICU stays often carry their own sub-limits. Ask what the maternity sub-limit is before you need it, not during.
3. Waiting periods
Most covers cannot be claimed immediately for certain benefits — maternity typically waits around 9–12 months, and some pre-existing conditions wait longer. Waiting periods differ between insurers, and group covers sometimes waive them. This is one of the first questions we ask on your behalf.
4. Declare every condition honestly
Pre-existing conditions are often covered after a waiting period — but only if declared on the application. A condition discovered later that was never declared is the single most common reason medical claims are refused. Declare everything; the right insurer for you is the one whose terms accept your history.
Where SHA fits
Private cover works alongside the Social Health Authority rather than replacing it. Private medical cover buys you choice of hospital, faster access and benefits SHA does not reach.
Send us who you want to cover, their ages and your rough monthly budget — we will come back with options that actually fit, and explain the fine print that matters.