The Best & Most Affordable Medical Insurance in Kenya 2025: A Comprehensive Guide
Step by Step Insurance is proud to introduce its flagship micro health insurance product – a one-limit, all-inclusive medical cover designed with affordability and simplicity in mind. Tailored for Kenyan families and individuals, this product offers essential healthcare services covering inpatient, outpatient, maternity, dental, and optical care, all under one flexible limit. Whether you’re an individual, part of a small group, or a larger organization, our product is engineered to provide comprehensive protection at the best value.
Key Takeaways
- Next Afya offers affordable micro health insurance with plans starting from KES 100,000 coverage
- All plans include inpatient, outpatient, maternity, dental and optical care under one flexible limit
- Suitable for individuals (18-100 years) and families with minimal waiting periods
- Simple enrollment process with flexible premium payment options
- Special considerations for groups with reduced waiting periods
Table of Contents
What Is Micro Health Insurance?
Micro health insurance is designed especially for those who need reliable healthcare coverage without the high premiums of conventional plans. It is characterized by:
- Affordability: Low-cost premiums to ensure that quality healthcare is accessible.
- Simplicity: Straightforward products that are easy to understand.
- Comprehensive yet Focused Coverage: A single limit can be used for a range of services—from hospital stays to dental check-ups.
Introducing the Next Afya Plans
Step by Step Insurance offers a range of plans under the “Next Afya” family. These plans are structured to meet different needs and budgets, always ensuring you get the best value for money.
Coverage Options at a Glance
Below is a table summarizing the key features of our Next Afya plans:
| Plan Name | Coverage Limit | Dental & Optical Bonus | Services Covered |
|---|---|---|---|
| Next Afya Starter | KES 100,000 | KES 5,000 | Inpatient, Outpatient, Maternity, Dental, Optical |
| Next Afya Basic | KES 250,000 | KES 5,000 | All essential medical services |
| Next Afya Plus | KES 500,000 | KES 5,000 | All essential medical services |
| Next Afya Premium | KES 750,000 | KES 7,500 | All essential medical services |
| Next Afya Ultimate | KES 1,000,000 | KES 10,000 | All essential medical services |
Each plan is designed so that the single limit can be applied flexibly across any of the services listed.
Key Features & Benefits
- Eligibility:
- Open to individuals aged 18 to 100 years.
- Families can include spouses, biological, legally adopted, or foster children (from birth to 18 years). Children aged between 18 and 25 can also be covered if proof of schooling is provided.
- Simple Enrollment:
- Enrollment is streamlined through minimal documentation (e.g., copy of ID, KRA pin, and birth certificate) and can be completed via various channels including mobile money.
- No Inpatient Sublimit:
- There is no sublimit on inpatient benefits, ensuring that you get the full benefit when you need hospitalization.
- Flexible Premium Payments:
- Premiums can be paid monthly, quarterly, or annually according to your convenience.
- Age-Based Medical Exam:
- New members aged 55 and above may need to undergo a medical examination prior to acceptance.
- Group Considerations:
- Special provisions are made for groups, including flexible waiting periods and potential age-based loadings for larger groups.
Fine Print & Special Conditions
Understanding the fine print is crucial to getting the most out of your coverage. Below are the important conditions and waiting periods associated with our Next Afya plans.
Waiting Periods
| Condition | Waiting Period |
|---|---|
| Illness Admissions and Outpatient Visits | 1 Week |
| Pre-existing/Chronic Conditions (Inpatient) | 10 Months |
| Pre-existing/Chronic Conditions (Outpatient) | 3 Months |
| Non-Accident Surgeries, Pregnancy, & Childbirth | 10 Months (both inpatient and outpatient) |
| Groups with 15+ Families | No Waiting Period |
Coverage Exclusions
Certain treatments and expenses are not covered. These include:
- Cosmetic treatments
- Infertility treatments
- Hearing aids
- Treatments deemed experimental or investigational based on accepted medical standards
- Any expense not aligned with approved ethical/practice guidelines
Additional Special Conditions
- Outpatient Benefits Cap:
Outpatient claims are capped at 30% of the overall annual limit. Pre-authorization is required for outpatient bills exceeding KES 6,000.
- Medical Underwriting:
Membership acceptance is subject to a standard medical underwriting process. This may include completing application forms and, for individuals aged 55+, undergoing a medical examination.
- Age-Based Loading for Groups:
- Groups with over 100 members and 15% of members aged 60+ may see a 10% loading on family rates.
- Groups with fewer than 100 members and 15% of members aged 60+ may be subject to a 15% loading.
- Groups with 5%-10% of members aged 60+ may incur a 6% loading.
How to Enroll
Enrolling in a Next Afya plan is straightforward:
- Gather Documents:
- Individuals: Copy of your ID, KRA pin, and birth certificate.
- Groups: Registration certificate, group KRA pin, and CR12 (for limited companies), along with IDs of directors.
- Contact Our Agents:
- Reach out to our dedicated customer service team or authorized agents.
- Choose Your Plan:
- Select from Next Afya Starter, Basic, Plus, Premium, or Ultimate depending on your healthcare needs and budget.
- Complete the Underwriting Process:
- Provide necessary details and, if applicable, complete a medical examination (for members aged 55+).
In Summary
Step by Step Insurance’s Next Afya plans provide comprehensive medical insurance in Kenya. With flexible coverage that meets all your healthcare needs, minimal waiting periods for urgent services, and clearly defined terms, our product is designed to offer peace of mind for individuals, families, and groups alike.
For anyone looking to secure quality healthcare with simplicity and affordability, Next Afya is the smart and straightforward choice. For a comparison between SHIF and private health insurance in Kenya, check out our comprehensive guide.
