Data collected by the Association of Kenya Insurers (AKI) shows that a total of Ksh1.3b was paid out by medical insurance companies to cover treatment of COVID-19 for the period March 2020 to June 2021. This figure represents 74 per cent of the total claims lodged with medical insurers which stood at Ksh1.7b.

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. The rejected claims, during the stated period stood at Ksh396million, representing 23.3 per cent of the total claims. The remaining three per cent, Ksh37million 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 Ksh44b compared to Ksh42b in 2019. Claims incurred and total expenses also increased by 3 per cent and 11per cent respectively during the same period. Underwriting profit increased from Ksh204M in 2019 to Ksh1.7B in 2020.

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

As part of its digitization journey, the AKI Secretariat is exploring the possibility of developing a harmonized data sharing platform for medical insurers. Having industry wide aggregated data will aid in addressing some of the pressing challenges including fraud and high cost of medical care.

You can find the 2020 Insurance Industry Statistics on the AKI Website