Many Kenyan companies are providing uniform medical cover to their employees, despite having diverse healthcare needs. A 24-year-old graduate may require quick general practitioner visits and mental health support, while a colleague nearing retirement needs to know if their inpatient cover will be sufficient. This one-size-fits-all approach may have been efficient in the past, but it no longer suits the varied needs of today's workforce.
The traditional uniform benefits approach was based on a workforce that looked broadly similar in age and life stage. However, Kenyan offices now comprise new graduates, young parents, employees managing chronic conditions, and people approaching retirement, often within the same department. Their healthcare needs vary significantly, and a flat medical scheme may not be the most effective solution. In an economy where people expect personalized experiences, a standardized medical scheme feels like an exception rather than the norm.
Insurance penetration in Kenya has fallen to 2.2 percent of GDP in the first half of 2025, down from 2.4 percent in 2024. Despite this, the industry is growing, with gross written premiums increasing by 19.9 percent to Sh155.3 billion in the first quarter of 2026. The industry's growth is not driven by an increase in the number of policyholders, but rather by the need to design products that are relevant and valued by those already covered.
Kenya's disease profile is shifting, with 41 percent of all deaths and half of all hospital admissions attributed to non-communicable diseases such as cardiovascular diseases, cancer, and diabetes. These conditions require ongoing management, making prevention economically important. Forward-looking employers are starting to act on this logic, recognizing that healthcare should begin with annual screening, nutrition, and mental health support, rather than just episodic treatment.
Employers and insurance providers in markets such as India and South Africa have been moving toward a core-plus-flex structure for several years. This approach involves fully insuring essential benefits, such as inpatient hospitalization and emergency treatment, while providing employees with a flexible allocation to direct toward benefits that matter most to them. This might include enhanced outpatient care, maternity support, or wellness programs.
The core-plus-flex structure offers structured flexibility, allowing employees to gain relevance while employers and insurers maintain actuarial discipline. Claims analytics, predictive modeling, and digital health platforms make this design achievable, providing insurers with utilization data to personalize benefits. The conversation employers need to have is no longer about how much medical cover to provide, but rather whether what they provide reflects the diverse healthcare needs of their employees.
To implement this approach, employers should consider maintaining core protections, such as inpatient hospitalization and emergency care, while offering flexible benefits that cater to individual needs. By doing so, companies can improve employee well-being, reduce long-run claims costs, and create a more effective medical cover scheme. Employers and insurers must work together to design products that are relevant, valued, and tailored to the unique needs of their employees.
Key points
- Kenyan companies are urged to rethink their one-size-fits-all medical cover approach to better suit the diverse healthcare needs of their employees.
- The industry's growth is driven by the need to design products that are relevant and valued by those already covered.
- A core-plus-flex structure, offering structured flexibility, can help employers and insurers provide more effective medical cover.
