Why it pays to sign up for medical insurance

Patients at Coast General Hospital in this picture taken on June 6, 2017. Most Kenyans do not have medical insurance. PHOTO | LABAN WALLOGA | NATION MEDIA GROUP

What you need to know:

  • For a 20-35-year-old the annual insurance premium could start from Sh22,500.
  • Insurance companies want to insure as many people as they can.

In the last few years a trend has emerged where when someone, often young, falls ill, he or she (mostly with the help of friends) starts an online campaign to fund raise for medical bills.

This trend has brought out two major points: one, we are a people who know how to bind together in times of trouble.

Two, we are also a people very poor at planning for misfortune.

Twenty-seven-year-old Richard Amolo, popularly known as DJ Namosky, is one such individual who has benefited from online financial medical appeals.

STOMACH

When he was young, Richard was insured under his parents cover but when he became an adult he didn’t get around to buying one. “I knew I needed insurance but I kept postponing the decision to sign up. After all I had never been sick and I felt I was pretty young and still healthy,” he says.

Earlier this year. however, things changed. “In June I had a stomach discomfort and I thought it was acidity, which I usually have. But on going to hospital I found out I had appendicitis. The doctor gave me two options; either do a surgery or treat it with antibiotics.

He, however, strongly advised that surgery would be better because with antibiotics it would recur.”

As soon as surgery came up, Richard was a worried man.

“Before they even put me on the system the hospital told me the surgery would cost at least Sh350,000.”

Richard went to surgery and when he woke up he found that his friends had started an online campaign to help with his medical bill.

The friends were able to raise around Sh150,000 and the rest of the bill was covered by his family. “I was very thankful to everyone who contributed and as soon as I got better the first thing I did was sign up for NHIF and I am currently in the process of getting a commercial insurer.”

LIFE SAVER

Peter Wangugi a filmmaker from Nairobi also suffered the same fate but with a different outcome. “I started travelling to dangerous places for work as a consultant. I started looking at insurance options and an insurance agent convinced me to take a cover with one of the local insurance companies. It cost me around Sh43,000 for both inpatient and outpatient.

The insurance proved to be life saver for Peter. “I have never had a serious illness in my life or ever spent a night in hospital but in December of 2015 after having a very busy year at work I started to experience some abdominal pains. One morning I decided to go for a check up and the doctor immediately advised I be admitted. He explained that my gallbladder was blocked and was affecting my digestive system he continued talking and all I heard in the end was I needed surgery.”

The cost for Peter’s surgery would amount to Sh489,000 but since he was insured, he didn’t have to worry about the money and instead focused on the surgery and what approach was best.

“The doctor recommended laparoscopy which he explained was the most effective and would leave minimum scars. I went for the surgery and got discharged 7 days later in time for Christmas,” he says.

Seeing how easy the process of getting medical care was for Peter than it was for Richard, one wonders why more young people are not taking up insurance policies.

COST

The reasons most people give is the cost factor and in some cases pre-existing conditions may prove a barrier and people are afraid that insurance companies may not honour the agreement.

Other think the covers often don’t cover the full cost of the medical bill. However, all these challenges are not as daunting as they appear.

Lebohang Thuo, an insurance agent says: “Medical Insurance is not very costly particularly for young people.

For a 20-35-year-old the annual insurance premium could start from Sh22,500 for a reasonable limit and for a 30-45-year-old the annual insurance premium could start from Sh26,800.”
This is on average about Sh2,000 per month and as Lebohang puts it, it’s usually worth every penny.

“Health insurance more than pays for itself at the time of admission. The average hospitalisation we have seen is between Sh100,000 and Sh300,000 and in the case of an accident leading to ICU it can clock over Sh1 million. Therefore for an annual premium of Sh22,500 for an individual cover, a client saves between Sh100,000 to the policy limit usually in the millions.”

In regards to pre-existing conditions and insurers not honouring their end, Lebohang has a rather positive message.

“Insurance companies want to insure as many people as they can, that is how the annual premiums drop and the business remains profitable.”