Kenyans claimed Ksh.1.3 billion from underwriters for COVID treatment

Medical Insurers spend paid out a total of Ksh.1.3 billion to cover treatment of COVID-19 in fifteen months to June 2021.

This is according to data by the Association of Kenya Insurers (AKI), representing 74 percent of the total claims lodged with medical insurers which stood at Ksh.1.7 billion.

Following the onset of COVID-19 in March 2020, it emerged that there was mixed practice when it came to coverage of pandemics.

Some insurers excluded it in their policies while some had no mention of it. Medical insurers have since been clear in their policies to state whether it is an inclusion or exclusion and, if included the cover limit is specified.

“Considering this, not all claims that were lodged during the period March 2020 to June 2021 were paid and this could be attributed to the different scope of covers,” said AKI in a statement

The rejected claims, for the period under review at Ksh396million, representing 23.3 percent of the total claims. The remaining Ksh.37million is outstanding, due to various policy conditions or terms.

A total of 15,522 claims were lodged during the period. Out of these 3,934 were inpatient claims while 11,588 were outpatient.

In 2020, the medical insurance business grew by 4.58 percent to record gross written premium of Ksh.44 billion compared to Ksh.42 billion in 2019.

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Claims incurred and total expenses also increased by 3 percent and 11 percent respectively during the same period. Underwriting profit increased from Ksh.204 million in 2019 to Ksh1.7 billion in 2020.

While gross written premium for medical insurance over the years has been on the increase, it has been loss making.

“In 2019 and 2020 we have noted growth in profitability, and this could be attributed to better management of expenses and a slight drop in re-insurance ceded. Despite the fear of hospital visitation that was witnessed in 2020, the net claims incurred increased by 3 percent.”

As part of its digitization journey, the AKI Secretariat is exploring the possibility of developing a harmonized data sharing platform for medical insurers.

The data will aid in addressing some of the pressing challenges including fraud and high cost of medical care.