Critical Illness Insurance | Mitigating a Growing Problem in Kenya


We all like to imagine a perfect future where we are in good health. But, critical illnesses like cancer, kidney failure and heart disease have become too common in Kenya.

Some Statistics on Critical Illness in Kenya

  • According to the Economic Survey 2018, cancer is the third leading cause of death in Kenya representing 16,953 deaths in 2017 after malaria and pneumonia. And, this number continues to rise every year.
  • According to the Kenya Network of Cancer Organisations, there are 39,000 new cancer cases diagnosed every year. The jury is still out on the cause of the high cancer cases but some of the usual suspects include lifestyle changes and exposure to carcinogens in food and the air we breathe.
  • Heart disease, whose precursor is hypertension, is also among the top ten leading causes of death in Kenya.
  • Other critical illnesses that are on the rise include kidney failure. There is there is an increased prevalence of chronic kidney disease, which is also partly explained by high-risk factors such as lifestyle. Lifestyle-related diseases such as hypertension and diabetes are a precursor for kidney failure.
critical illness insurance
Source: Economic Survey 2018

The Financial Impact of a Critical Illness

Being diagnosed with a serious illness isn’t the end of the world. In many instances, people are able to extend their lives or even get cured provided they access the right treatment at the right time, and are able to pay for it.

Let’s look at some of the most pressing financial needs once a critical illness diagnosis has been made:

  • Hospital and doctors fees
  • Travelling fees
  • Cost of hospital admission
  • Drugs
  • Special diets
  • Travelling to and from the medical facility (very costly is you seek treatment abroad)
  • Living expenses because you are too sick to work

For people with medical insurance, the costs of hospital admission, doctors fees and drugs will usually be covered by the policy. But, even if you have a medical insurance plan, you still have to plug a gaping hole with regard to travelling, special diets and supplements, and living expenses to replace lost income. Also, your medical insurance provider may not cover overseas treatment and experimental treatments which may have a higher chance of success. This is where critical illness comes in.

What is Critical Illness Insurance?

Critical illness insurance is designed to pay you a lump-sum upon diagnosis. Thus, the moment a doctor carries out diagnostic tests and determines you have a critical illness, you can put in a claim and get the payment. Take note that unlike medical insurance, this money is paid to you and not to the hospital. This is a big deal because it opens up your treatment options in two ways:

  1. With money in your pocket, you aren’t restricted to seeking treatment at the health providers dictated to you by your health insurance provider. You can decide to seek the best treatment available overseas.
  2. Secondly, there are many experimental treatments and procedures (e.g. for cancer) that have a high success rate but are still in their early stages and haven’t completed clinical trials. With money in your pocket, you can travel and seek such experimental treatments.

Types of Critical Illness Insurance

There are two main types of critical illness insurance:

  1. Stand-alone critical illness cover – this is a specialized policy designed to cover the risk of a critical illness. This is not very common in Kenya and the premiums are very high.
  2. Bundled critical illness cover – in this type of coverage, the critical illness component is added as a rider to the main policy such as an Education Insurance Policy. This second form is the most common type available in Kenya.

Illnesses Covered by Critical Illness Insurance

Not all critical illnesses are covered. Every insurance company has its own definitions and policy terms that dictate when a claim becomes payable. However, in Kenya, the following are the main illnesses defined as critical illnesses:

  • Major Cancers
  • Heart Attack of Specified Severity
  • Stroke
  • Coronary Artery Bypass Surgery
  • Kidney Failure
  • Aplastic Anaemia
  • End Stage Lung Disease
  • End Stage Liver Failure
  • Coma
  • Major Organ / Bone Marrow Transplantation
  • Multiple Sclerosis

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