Comprehensive Health Cover for Individuals, Families & Businesses
Access quality healthcare without draining your savings. Vike compares medical schemes from Kenya's leading insurers to find a plan that fits your budget and needs.
Inpatient and outpatient cover for individuals: hospital stays, surgery, specialist consultations, and chronic condition management.
Since the transition from NHIF to the Social Health Authority (SHA) in October 2024, private medical cover has become more important than ever for Kenyans who want predictable access to quality healthcare. Individual medical insurance fills the gap between SHIF's public-scheme limits and the actual cost of care at Aga Khan, Nairobi Hospital, MP Shah, Karen Hospital, Avenue, and the country's other leading private facilities.
What it covers
Inpatient: hospital admission, surgery, ICU, theatre fees, drugs, and consumables
Outpatient: GP and specialist consultations, diagnostics, and prescribed drugs
Pre- and post-hospitalisation expenses (typically 30–90 days each side)
Day-care procedures: minor surgeries not requiring overnight admission
Emergency local and overseas evacuation on most schemes
Who it is for
Self-employed Kenyans and freelancers without employer medical cover
Retirees and pre-retirees wanting predictable private healthcare access
Spouses of employed members topping up corporate cover with personal extras
One plan covering you, your spouse, and your children, with maternity, paediatric, and dental options under a shared limit.
Family medical insurance covers a principal member, their spouse, and dependants, typically children up to age 18 (or 23 if in full-time tertiary education): under a single contract. The benefits, limits, and excess are usually shared across the family, though some insurers offer per-member limits for higher-tier plans.
What it covers
Inpatient: admission, surgery, ICU, and maternity for the whole family
Outpatient: GP, specialist, diagnostics, and pharmacy
Maternity: antenatal, normal delivery, C-section, and post-natal care
Affordable group medical schemes for small and medium businesses, covering 5 to 50 employees with optional dependant cover.
Group medical cover is the single most valued benefit Kenyan SMEs can offer their staff. It is also one of the most cost-effective: from five lives upward, insurers price group medical 20–40% below the equivalent individual cover, because risk is pooled across the group and the underwriting overhead is lower per member.
What it covers
Inpatient: admission, surgery, ICU, maternity per employee (and dependants if added)
Bespoke medical schemes for corporates above 50 lives: banded benefits, broad hospital panels, and a dedicated relationship manager.
At 50+ lives, group medical pricing transitions from book rates to experience-rated underwriting: your scheme's own claims history starts to drive the premium at renewal. That is an opportunity: well-managed schemes reward employers with better terms each year, but it also requires the right broker to structure benefits, monitor utilisation, and challenge insurer renewal proposals on the numbers.
What it covers
Inpatient: multi-tier limits across staff bands, including overseas treatment for executives
Outpatient: flat or tiered limits with chronic condition management built in
Maternity: full antenatal, delivery, post-natal, and neonatal cover
Dental and optical: included by default on most corporate schemes
Pre-employment and annual medical examinations
Who it is for
Kenyan corporates and multinationals with 50+ employees
HR and benefits leaders managing schemes across multiple staff bands
Listed companies needing ESG-aligned employee health reporting
Standalone outpatient cover for Kenya: GP and specialist consultations, lab tests, and prescribed drugs, without inpatient. From about KSh 18,000 a year.
Outpatient-only medical insurance covers the everyday healthcare you use without being admitted to hospital, seeing a GP or specialist, having lab tests and scans, and collecting prescribed medication. In Kenya these visits are where most households actually spend on health: a consultation and a course of drugs can run KSh 3,000–8,000 each time, several times a year, and none of it touches an inpatient policy. A standalone outpatient plan turns those unpredictable cash payments into one annual premium from about KSh 18,000.
What it covers
GP and general-practitioner consultations at panel clinics
Specialist consultations on referral (e.g. dermatology, ENT, paediatrics)
Laboratory tests and diagnostics: bloodwork, urinalysis, basic imaging
Prescribed drugs and common medication dispensed at panel pharmacies
Routine outpatient procedures not requiring admission
Who it is for
Young, single, or generally healthy adults whose main health spend is consultations and drugs
Freelancers, gig workers, and the self-employed without any employer medical cover
Employees whose company scheme covers inpatient only, leaving outpatient out of pocket
Pay-monthly medical insurance in Kenya. Spread the cost of inpatient and outpatient health cover from about KSh 1,800 a month, no big annual lump sum.
Monthly medical cover is private health insurance you pay for in monthly instalments rather than as a single annual premium. The benefits are the same as a standard medical plan: inpatient admission and surgery, plus outpatient consultations, tests, and drugs where the plan includes them, but instead of finding KSh 25,000 or more at once, you pay from about KSh 1,800 a month. For salaried earners, freelancers, and small-business owners with steady monthly cash flow, it makes quality private cover affordable month to month while still sitting on top of mandatory SHIF.
What it covers
Inpatient: hospital admission, surgery, and ICU up to the plan's annual limit
Outpatient: consultations, diagnostics, and prescribed drugs where included
Maternity, dental, and optical on plans and tiers that offer them
Cashless admission and treatment at the insurer's panel facilities
The convenience of monthly billing with no large annual lump sum
Who it is for
Salaried earners who would rather budget monthly than pay a yearly premium
Freelancers and small-business owners with steady month-to-month income
Young families spreading the cost of their first private medical plan
It depends on disclosure and the insurer. Most plans either (a) cover declared pre-existing conditions after a 12-month waiting period, (b) cover them at an additional premium, or (c) exclude them outright. Honest disclosure on the application form is critical. Undisclosed conditions void claims.
Up to what age are children covered?
Standard family policies cover children up to age 18, or up to age 23 if in full-time tertiary education with a school letter. Above that, children move to their own individual policy. We handle the transition.
What is the minimum number of staff for a group scheme?
Most insurers accept group medical from 5 lives. Below that, you can either combine with another SME under a small-group facility, or buy individual policies for each staff member.
How is the renewal premium calculated for a corporate scheme?
Above 50 lives, insurers use a loss ratio model: total claims paid divided by total premium charged for the prior year. Loss ratios under 70% typically attract favourable renewals; above 90% trigger increases. We provide loss ratio analysis at every renewal so the discussion is on the numbers, not the insurer's narrative.
How much is outpatient insurance in Kenya?
Standalone outpatient-only cover starts from about KSh 18,000 a year, with the premium rising as the annual outpatient limit increases (typically KSh 50,000 to KSh 150,000). The exact figure depends on the limit you choose, your age, and whether optical and dental are added. All figures are illustrative pending your quote.
Can I pay for medical insurance monthly in Kenya?
Yes. Several IRA-regulated insurers and premium-financing arrangements let you pay your medical insurance in monthly instalments instead of a single annual premium, from about KSh 1,800 a month. The benefits are the same as the equivalent annual plan; you are simply spreading the cost.
Ready to get the right cover?
Our advisors will compare quotes and find the best fit for you, at no extra cost.
