Need to teach all Kenyans about insurance cover

Money rules the world. Money helps the wealthy but people with little money study life philosophy. This group retires at 99. They suffer most when sickness strikes. Today, government hospitals provide free or low-cost care.

These hospitals provide free care but lack full-time physicians, modern technology and sanitation. What does the deceased do to people’s long-term lives? Because not everyone can afford private physicians, lines start here. In smaller places, a consultation might cost Sh1,500-3,000, whereas in Nairobi it costs Sh3,000-10,000.

Kenya’s capital has 4.5 million people. The country’s oldest and largest hospital is Kenyatta National Hospital. A public tertiary referral hospital. A teaching hospital for the University of Nairobi’s College of Health Sciences.

Many private and government hospitals have incomplete facilities. During Covid-19, many ventilators arrived without operators. Emergency machines monitor blood pressure. Due to doctor shortages, the few available cannot adequately listen to or evaluate patients.

If one gets a serious illness, like cancer or a heart attack, or if there is a major accident or a ‘major surgery’ is required, then one has to go to a private hospital, where treatment is very expensive.

A ‘heart surgery’ (heart operation) in a private hospital costs Sh800,000 to Sh1 million for open heart surgery, depending on cardiac damage, and Sh500,000for closed cardiac surgery. Cancer destroys families and the hope of survival of the patient is minimal.

Many insurance companies give medical cover for many of the health issues. But an annual mediclaim policy has to be taken from them to get treatment. It seems to be a good support that, by paying a premium of a few thousand shillings, one gets an assurance of treatment if needed.

But premiums are not within everyone’s control. As age goes up, the burden increases. Policies have conditions. But most of the time, these terms are not read by common people and they get stuck when needed.

If the cost is Sh5 million but the cover is only for Sh3 million, the company has to pay only up to that, no matter whether the policy cost is much higher than the benefits. Despite limits, the corporation does not pay numerous hidden costs.

Insurers hire outside physicians. Problems arise. Consumables like bandages, clothes and diapers are excluded. The room allowance is one per cent of the total covered. If room rent exceeds this, they cut the money and distribute it to the ward.

So how many people are not educated, have no knowledge and are not aware of any hidden guidelines but the insurer did not say anything about it?

Similarly, motor vehicle insurance, which is mandatory, includes different coverage. Losses are different with this. The insurance promises are invalid. The cuts range from 10-50 per cent and you can postpone minor claims by saying the money you save will go toward the no-claim benefit the following time.

It’s a way for insurance firms to make money but, owing to inflation, individuals have to become fed up and share part of the weight, if necessary, since there’s no saving in today’s world.

- Mr Surjit is a veteran journalist and freelance writer based in Brampton, Canada. [email protected].