Medical Cover Compared
Individual, family, SME group, corporate, outpatient-only, and pay-monthly cover: what each includes, what it typically costs, and which is right for you.
How much is medical insurance in Kenya? An individual inpatient plan starts from about KES 25,000 a year and a family of four from about KES 80,000. Standalone outpatient-only cover is priced individually against the limit you choose, and any plan's annual premium can be shown broken down to a monthly-equivalent figure, from about KES 1,800 a month, though it is paid upfront as one premium. Businesses get cheaper per-head rates through an SME or corporate group scheme. Every private plan sits on top of mandatory SHIF, not instead of it.
| Cover | Individual Solo cover | Family Households | SME Group 5–50 staff | Corporate 50+ staff | Outpatient-Only No inpatient | Monthly Priced per month |
|---|---|---|---|---|---|---|
| Inpatient: admission & surgery | Included | Included | Included | Included | Not included | Included |
| Outpatient: consultations & drugs | Add-on | Included | Included | Included | Included | Add-on |
| Maternity cover | Add-on | Included | Included | Included | Not included | Add-on |
| Dental & optical | Add-on | Add-on | Included | Included | Add-on | Add-on |
| Who it covers | One adult | You + spouse + children | 5–50 employees | 50+ employees | Individual or family | Individual or family |
| Billing | Annual | Annual | Annual | Annual | Annual | Annual (shown per month) |
| Typical cost (illustrative) | From KES 25,000/yr | From ~KES 80,000/yr | ~KES 35k–80k/employee/yr | Experience-rated | Priced by outpatient limit | ~KES 1,800/mo equivalent |
| Best for | Solo adults & retirees | Households with children | Businesses with 5–50 staff | Employers with 50+ staff | Clinic costs alongside SHIF/employer | Spreading cost month to month |
| View Individual → | View Family → | View SME Group → | View Corporate → | View Outpatient-Only → | View Monthly → |
Figures are illustrative; your premium depends on age, the inpatient and outpatient limits chosen, dependants covered, and benefits like maternity, dental, and optical.
SHIF vs private medical cover
Since NHIF became the Social Health Insurance Fund (SHIF) in the 2024 SHA transition, every resident contributes to a mandatory public scheme, but SHIF's benefits, panels, and limits leave real gaps in private hospital access and outpatient care. Private medical insurance does not replace SHIF; it sits on top, paying for treatment at facilities like Aga Khan, Nairobi Hospital, and MP Shah and covering what SHIF does not. Most insurers now expect SHIF to be used first for eligible benefits, with your private plan covering the balance.
You're a solo adult, retiree, or self-employed without employer cover and want predictable private treatment under your own limit.
Individual Medical →You're covering a spouse and children and want maternity, paediatric, dental, and optical under one household policy.
Family Medical →Your hospital costs are already covered by an employer scheme or SHIF, but you pay cash for every consultation, test, and prescription.
Outpatient-Only Cover →You want to see the annual premium broken down to a clear monthly-equivalent figure, from about KES 1,800, even though it is paid upfront as one premium.
Monthly Medical Cover →You run a business with 5–50 staff and want group-rate cover that's cheaper per head than individual policies and easy to administer.
SME Group Medical →You manage 50+ employees and need banded benefits, broad hospital panels, and experience-rated renewals with a dedicated account manager.
Corporate Medical →Tell us who needs cover and your budget, and we'll recommend the right plan and compare quotes from 9+ IRA-regulated insurers. Private cover that works alongside your SHIF contributions.
