Group Medical Insurance for Small Businesses in Kenya: A No-Fluff Guide
You've got a small team. Five people. Maybe eight. They show up, they work hard, and they trust you.
Then one of them gets sick. Really sick. And they come to you — not the hospital, not their family — you.
"Boss, I need help."
That moment changes how you think about group medical insurance. It's not a line item in a budget anymore. It's a person standing in your office.
This guide is for Kenyan small business owners who want to do right by their team without getting ripped off. No jargon. No sales pitch. Just what you actually need to know.
Table of Contents
- What Is Group Medical Insurance?
- Minimum Number of Employees
- What a Typical Plan Covers
- How Much Does It Actually Cost?
- How to Compare Plans (Without Losing Your Mind)
- What to Watch Out For
- Should You Offer Group Medical If It's Not Required?
- Getting Started: A Step-by-Step Plan
- Final Word: Good Cover Doesn't Have to Break the Bank
What Is Group Medical Insurance?
Group medical insurance is a health cover plan that a business purchases for its employees (and often their dependants).
Instead of each person buying their own policy, the employer negotiates one plan for everyone. The insurer covers the group as a unit.
Why this matters for small businesses:
- Lower premiums per person than individual plans
- No individual medical underwriting — pre-existing conditions are usually covered from day one
- Simplified administration — one policy, one renewal, one point of contact
This is the single biggest advantage of group cover: your employee with diabetes or hypertension gets covered without exclusions. That doesn't happen with individual policies.
Minimum Number of Employees
This is the first question every small business owner asks.
The answer varies by insurer, but here's the general picture:
- Most insurers: Minimum of 3-5 employees (sometimes called "lives")
- Some insurers: Accept groups as small as 2 employees
- SME-focused products: Designed for groups of 5-20
Dependants (spouse + children) are usually included in the count, which helps smaller teams qualify.
If you have 3 employees, each with a spouse and one child, that's 9 lives. Most insurers will take that group.
What a Typical Plan Covers
Group medical plans in Kenya generally include:
Inpatient (Hospitalisation)
- ✔️ Hospital admission
- ✔️ Surgery
- ✔️ ICU/HDU
- ✔️ Maternity (often with a waiting period)
- ✔️ Pre-existing conditions (from inception in most group plans)
Outpatient
- ✔️ Doctor consultations
- ✔️ Lab tests and diagnostics
- ✔️ Prescriptions
- ✔️ Minor procedures
Optional Add-Ons
- Dental cover
- Optical cover
- Maternity (enhanced limits)
- Last expense (funeral cover)
The exact limits depend on the plan tier you choose. Basic plans might offer KSh 200,000-500,000 inpatient and KSh 30,000-50,000 outpatient per person per year. Premium plans go much higher.
How Much Does It Actually Cost?
Let's talk real numbers. For a small business in Kenya:
| Plan Level | Inpatient Limit | Outpatient Limit | Approx. Cost Per Person/Year |
|---|---|---|---|
| Basic | KSh 200,000-500,000 | KSh 30,000-50,000 | KSh 15,000-25,000 |
| Mid-range | KSh 500,000-1,000,000 | KSh 50,000-80,000 | KSh 25,000-45,000 |
| Premium | KSh 1,000,000+ | KSh 80,000-150,000 | KSh 45,000-80,000 |
These are per-person costs. For a team of 5 on a mid-range plan, expect to budget KSh 125,000-225,000/year total.
Some businesses split the cost: employer pays inpatient, employee tops up for outpatient. Others cover everything. Your call.
How to Compare Plans (Without Losing Your Mind)
This is where most business owners get overwhelmed. Quotes come in from different insurers with different formats, different exclusions, different networks. It’s chaos.
Here's what to actually compare:
1. Hospital Network
Does the plan include hospitals your team can realistically access? A great plan is useless if the nearest network hospital is 50km away.
Check for:
- Hospitals near your office
- Hospitals near where employees live
- At least one Level 5 or teaching hospital for serious cases
2. Inpatient vs Outpatient Limits
Inpatient is non-negotiable. Outpatient is where you can adjust based on budget. If money is tight, prioritise inpatient limits.
3. Maternity Benefits
If your team includes women of childbearing age, maternity matters. Check:
- Waiting period (usually 9-12 months)
- Normal delivery vs caesarean limits
- Whether newborn is automatically covered
4. Pre-existing Conditions
Most group plans cover pre-existing conditions from day one. But confirm this in writing. Some cheaper plans have exclusions.
5. Claim Process
How does the insurer handle claims? Smart cards? Pre-authorisation calls? How fast do they respond? This is where day-to-day experience lives.
Your agent or broker can use tools like BimaSasa to compare medical quotes from 40+ Kenyan insurers side by side. It saves days of back-and-forth and gives you a clearer picture of what's available.
What to Watch Out For
Group medical is great. But there are traps.
Co-pays that eat into value
Some plans look affordable but require employees to pay 10-20% of every outpatient visit. That adds up fast and makes employees avoid using the cover.
Low sub-limits on key services
The headline limit might be KSh 1M inpatient. But if the sub-limit on surgery is KSh 200,000 and your employee needs a KSh 500,000 procedure, they're out KSh 300,000.
Always read the sub-limits table. That's where the real story is.
Slow pre-authorisation
If your insurer takes 4 hours to approve an admission while your employee is in pain at the hospital, that's a problem. Ask about turnaround times.
Renewal surprises
Had a bad claims year? Some insurers will hit you with a 40-80% premium increase at renewal. Ask upfront about their claims ratio tolerance and renewal pricing policy.
Should You Offer Group Medical If It's Not Required?
Short answer: yes.
Here's why:
- Talent retention — In Kenya's job market, medical cover is a dealbreaker for most professionals. Offer it or watch your best people leave.
- Productivity — Sick employees who can't afford a doctor don't recover. They come to work sick, infect others, or just stop showing up.
- Loyalty — Covering someone's family health creates a bond that a salary alone can't.
- Tax benefit — Group medical premiums are a deductible business expense. The taxman is essentially subsidising your employees' health.
Even a basic plan says something: "I care about the people who build this business."
For more on structuring health coverage alongside family needs, check out our family insurance plans guide.
Getting Started: A Step-by-Step Plan
- Count your team — Include employees and dependants who'll be covered
- Set a budget — Decide what you can realistically spend per person per year
- Talk to a broker — A good broker will get you 3-5 quotes and explain the differences
- Compare quotes side by side — Focus on networks, limits, sub-limits, and exclusions
- Pick a plan — Don't just pick the cheapest. Pick the one that actually works for your team
- Communicate clearly — Tell your employees what's covered, what's not, and how to use it
Visit our group insurance solutions page for a broader view of what's available.
Final Word: Good Cover Doesn't Have to Break the Bank
Group medical insurance for a small Kenyan business isn't as expensive as you think. And it's infinitely cheaper than losing your best employee because they couldn't afford a hospital visit.
You don't need the most expensive plan. You need one that covers the basics well, works at hospitals your team can access, and doesn't ambush you at renewal.
Start small. Start now. Build from there.
🟢 What This Means for You
If you're a small business owner with 3+ employees, group medical is within your reach. Even a basic plan protects your people and strengthens your business.
Get quotes. Compare properly. Choose a plan that works — not just one that looks good on paper.
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