SHA is now the mandatory base for every resident, at 2.75% of income, but it only buys you the basic package at contracted hospitals. Private medical cover is what you add on top for private hospitals, higher limits, shorter waits and benefits SHA does not fund. The main private insurers in Kenya are Jubilee Health, Britam, AAR, UAP Old Mutual, Madison, APA, CIC, Sanlam and First Assurance, all licensed by the Insurance Regulatory Authority. Premiums are age-banded and quote-based, so there is no single price; below is how the covers compare and exactly how to choose, then you can get a personalised quote from a licensed broker.
Do you still need private cover if you have SHA?
SHA (which replaced NHIF in October 2024) is compulsory and it is the floor, not the ceiling. It covers a defined basic package at contracted facilities. Private cover exists for what that floor leaves out: treatment at private hospitals of your choice, much higher annual limits for a serious admission, shorter or no waiting for elective care, and extras like maternity, dental, optical and overseas referral. From 2025 the government and insurers began linking private cover to SHA, with SHA increasingly acting as the first payer and private plans topping up, so the two are designed to work together rather than instead of each other. If you can only afford one thing, SHA is mandatory anyway; private cover is the upgrade when a single ICU stay could otherwise wipe out your savings.
The main private medical insurers in Kenya
All are IRA-regulated. Positioning below is a guide, not a ranking, because the right insurer depends on your hospitals, your age and your budget.
- Jubilee Health. The market leader, broad hospital network, strong family and senior packages (J-Care, J-Seniors).
- Britam. Value and mass-market, low-cost individual and family entry tiers.
- AAR. Its own clinic network, outpatient-strong, popular with young professionals.
- UAP Old Mutual. Very large provider network, flexible individual, family and self-employed plans.
- Madison. Simple, affordable, noted for handling chronic illness.
- APA (Apollo). Strong with families and business owners.
- CIC. Cooperative and SACCO-linked distribution.
- Sanlam. Large pan-African group, corporate and retail.
- First Assurance. No-frills, inpatient-focused, affordable.
Others offering medical cover include Heritage, GA Insurance, Pacis and ICEA Lion.
How private plans are structured
Every plan splits into two parts. Inpatient is the core: admission, surgery, bed, ICU. It is sold in annual limit tiers, laddered from an entry limit of a few hundred thousand shillings up to several million on executive plans. Outpatient (consultations, drugs, labs) is usually a separate optional add-on with a much smaller limit, often in the tens of thousands. On top of those you can add riders: maternity, dental, optical, last expense, and overseas or regional treatment on the higher tiers. The single most important thing to understand is that the big number on the brochure is the inpatient limit, but each benefit inside has its own sub-limit. Maternity, chronic conditions, ICU, dental and optical each cap out separately, so a plan is only as good as its sub-limits, not its headline figure.
What it costs (indicative only)
Premiums are individually underwritten and rise with the age of the oldest member, the inpatient limit you choose, family size and the riders you add, so treat everything here as an indicative range from insurer and broker material, not a quote. As a rough guide, a basic individual inpatient plan is often quoted in the low tens of thousands of shillings a year, a mid tier around the KES 40,000 to 100,000 a year mark, and a comprehensive high-limit plan well above that. Family cover for four or five people commonly runs from roughly KES 120,000 a year upward depending on the adults’ ages and whether maternity is included. Older applicants pay materially more, and there is no reliable public age-band table, which is exactly why the only accurate number is a personalised quote. [Refresh these ranges from current insurer material each quarter and keep them labelled indicative.]
How to choose the right cover
Start with the hospitals. Check that the insurer’s panel includes the facilities near your home and work, because panel restrictions are the most common nasty surprise. Then compare the sub-limits, not the headline, since maternity, chronic and ICU caps are what actually pay when you need them. Weigh the annual inpatient limit against a real big bill: a KES 300,000 limit can be swallowed by one serious admission or a short ICU stay, so the cheapest tier can leave a large gap. Decide early whether you need maternity or chronic cover, because those carry the longest waits and the thinnest sub-limits on budget plans. And use a licensed broker to compare, because a good one earns their keep on disclosure and claims advocacy, not on price.
The watch-outs nobody tells you about
Waiting periods are real: usually about 30 days before general illness is covered, around 10 to 12 months for maternity, and up to a year for pre-existing and chronic conditions. Pre-existing conditions are often excluded or heavily sub-limited in the first year, and a condition diagnosed just after you join can be reclassified as pre-existing, so declare your health history honestly to avoid a disputed claim later. Some plans carry a co-payment, especially if you use a hospital outside the panel. Standard exclusions include cosmetic surgery and non-medical items. And missing a renewal can void your cover or reset your waiting periods, so never let a plan lapse.
The cheaper halfway option: a SHA top-up
If a full private plan is out of reach, several insurers now sell low-cost SHA top-up riders that bridge the gap between SHA’s basic benefit and private-hospital charges, typically for a modest annual premium. It is not the same as comprehensive private cover, but it is a sensible middle step above SHA alone. Ask a licensed broker whether a top-up or an entry inpatient plan is better value for your situation.
Private medical cover in Kenya, frequently asked questions
What is the best medical cover in Kenya?
There is no single best. Jubilee, Britam, AAR, UAP Old Mutual, Madison and APA are the main players; the right one depends on your hospitals, your age and your budget. Compare on panel hospitals and sub-limits, not the headline limit.
How much is private medical insurance in Kenya?
Premiums are age-banded and quote-based. As an indicative guide, basic individual cover starts in the low tens of thousands of shillings a year and rises with your limit, age and family size. Get a quote for an accurate figure.
Do I still need private cover if I have SHA?
SHA is mandatory and covers the basic package at contracted hospitals. Private cover adds private hospitals, higher limits, shorter waits and extras like maternity and overseas care. Many people run SHA as the base with a private top-up.
What is the waiting period on medical insurance?
About 30 days for general illness, 10 to 12 months for maternity, and up to a year for pre-existing conditions.
Is it cheaper to buy from a broker or direct?
The premium is the same either way, because the agent or broker commission is built into the insurer's price rather than added on top. A broker's value is comparison and claims help, not a lower price.
Verified line: Insurers and structure verified against IRA-regulated providers and current insurer material. All premium figures are indicative ranges, not quotes; your actual premium is individually underwritten. Last checked 8 September 2026. paybillke is an independent guide, not an insurer, agent or broker. We refer you to a licensed IRA-registered broker for advice and quotes.