Best health insurance companies in Kenya

Why no one can honestly name the best health insurer in Kenya

Medical cover is the largest class of general insurance in Kenya: KES 93.29 billion of premium in 2025, 41.1% of all general insurance premium, according to Table 16 of IRA's Q4 2025 industry release. Yet the regulator publishes no satisfaction survey, no star rating and no claims-speed ranking for medical insurers.

• "Best" depends on you. A family in Mombasa, a retiree with a chronic condition and a young employee in Nairobi need different hospitals, limits and benefits.
• Ratings without a source are opinions. If a list does not say which official data it ranks on, you cannot check it.
• What can be checked is published by IRA: each insurer's licence, its medical premium, its medical claims ratio and the complaints it receives.

The rest of this page sets out those figures, explains what they say and what they do not, and lists the checks that decide which policy suits you.

Health insurers in Kenya: the IRA figures for 2025

The table lists every general insurer that wrote more than KES 1 billion of medical premium in 2025, in the alphabetical order of IRA's appendices. It is a reading of the regulator's figures, not a ranking:

Source: IRA Q4 2025 industry release, Appendix 18 (gross premium by class, converted from KES thousands) and Appendix 22 (incurred claims ratios by class). Premium measures how much medical business an insurer writes, not how well it serves its members; for the size of each insurer across all classes, see our licensed insurance companies page.

How to read a medical claims ratio, and what it does not tell you

IRA defines the incurred claims ratio as "the net claims incurred as a percentage of net earned premium income" (footnote to Table 18 of the release). Applied to medical cover, it shows how much of the premium kept by the insurer was used for members' treatment in the year.

• A ratio close to the market (77.7% in 2025) means the insurer spends on claims about what the market does.
• A much lower ratio can mean fewer or smaller claims, stricter limits, or a younger and healthier membership: on its own it does not prove good or bad service.
• A much higher ratio means claims took a larger share of premium; it can come before price increases or tighter benefits at renewal.
• It says nothing about speed: the ratio does not show how long an insurer takes to pay a hospital or to refund you, nor how many claims it rejects.

The ratio also mixes all of an insurer's medical business, group schemes bought by employers as well as individual and family policies. Read it with the complaints IRA receives about each company (complaints by insurer) and with the policy wording itself.

Six checks before you choose a health insurer

1. Check the licence. The company must be on IRA's list of licensed insurers, which we reproduce on our licensed insurance companies page; an intermediary must be in IRA's registry.
2. Read the hospital panel. Ask for the list of hospitals, clinics and pharmacies where the card works, and check that the ones you actually use are on it, for inpatient and outpatient care.
3. Compare the limits. Inpatient, outpatient, maternity, dental and optical limits differ from one plan to the next; check each one per person and per family.
4. Ask about waiting periods and exclusions. Get in writing how long you wait before some benefits start, how pre-existing and chronic conditions are treated, and what is excluded.
5. Ask how claims are paid. Direct billing at the hospital or refunds after you pay, which documents are needed and who approves admissions.
6. Decide how it fits with SHA. Private cover sits on top of the public scheme; our health insurance guide explains SHA contributions and what private cover adds.

Compare at least two written quotes for the same members and the same benefits before you pay.

If a health insurer delays or refuses your claim

Section 203 of the Insurance Act applies to every insurer, whichever you choose. Once you have submitted all the relevant documents, the insurer must admit or deny liability, determine the amount due and pay the claim within 90 days of the claim being reported. If it cannot, it must apply to the Commissioner, who may extend the period by up to 30 days. A claim still unpaid after that deadline carries a penalty of 5% of the unpaid amount. Where the claim was assessed, you are entitled to a copy of the assessment report.

Under section 204A, any customer may lodge a written complaint with the Commissioner against a regulated entity; the Commissioner's determination binds both parties, and either may appeal to the Tribunal within 30 days. Our guide on how to complain about an insurer walks through the steps.

What individual insurers publish about their own family packages and prices is in our articles on AAR, APA, Britam, CIC, First Assurance, Jubilee, Madison. To receive health insurance quotes from licensed insurers for you or your family, ask for quotes here.

Sources

1. IRA Kenya — Insurance Industry Release Q4 2025: Table 16 (class-wise premium), Table 18 footnote (claims ratio definition), Appendix 18 (gross premium by insurer and class) and Appendix 22 (incurred claims ratios by insurer and class) (Web Archive copy of 18 August 2026)
2. Insurance Act, Cap. 487 (Rev. 2022) — s.203 (settlement of claims) and s.204A (power of the Authority to settle disputes)