• By Raymond Momanyi

Expecting? Your Guide to Maternity Cover in Kenya: SHIF vs. Private Insurance & Waiting Periods

Planning for a new baby is one of the most exciting times in life. But let's be honest, it also comes with a lot of questions, especially about finances. The single most common question we get at Imana Insurance is: "Will my insurance cover my delivery?"

The answer, especially in Kenya today, depends entirely on which insurance you have and, most importantly, when you got it.

With the rollout of the new Social Health Authority (SHA) and its Social Health Insurance Fund (SHIF), the landscape is changing. How does this new government cover work for maternity? Does it replace private medical insurance? And what about those dreaded "waiting periods"?

As your trusted insurance partner, we're here to break it all down.

1. Does the New SHA/SHIF Cover Maternity?

Yes, it does.

The new SHIF is designed to replace the old NHIF and the "Linda Mama" program, rolling them into one comprehensive fund. SHIF is set to cover maternity expenses for all registered and contributing members.

How It Works:

The goal of SHIF is to provide a standard benefits package for all Kenyans. Based on the latest proposals, this is what the SHIF maternity cover includes:

• Antenatal & Postnatal Care: Covered at primary healthcare facilities (Levels 2 and 3).
• Normal Delivery: A standard amount, proposed to be around KSh 10,000 - KSh 11,200.
• Caesarean Section (C-Section): A standard amount, proposed to be around KSh 30,000 - KSh 32,600.
• Hospital Stay: Coverage is for a standard duration, typically 2 days for a normal delivery and 3 days for a C-section.

This is a fantastic step towards Universal Health Coverage (UHC), ensuring that every contributing Kenyan has access to basic maternity services. But this brings us to the next big question.

2. The Big Question: Does SHIF Supplement Private Insurance?

Absolutely. In fact, they are designed to work together.

If you look at the SHIF coverage amounts above, you'll quickly notice they are intended to cover costs at public or faith-based facilities.

But what if you want to deliver at a private hospital, where the cost for a normal delivery can start from KSh 80,000 and C-sections can exceed KSh 200,000?

This is where the SHIF amounts are insufficient. You cannot rely only on SHIF if your goal is to use a mid-tier or upper-tier private hospital.

This is the most crucial takeaway:

Private medical insurance is no longer your primary cover; it is your "top-up" cover. It is designed to pay the large difference between the hospital's final bill and what SHIF pays out.

3. The Most Important Rule: Understanding Maternity Waiting Periods

This is the part that trips up most people. The rules for SHIF and private insurance are completely different.

Private Medical Insurance (The 10-12 Month Rule)

Private insurance companies (like the ones Imana Insurance Agency partners with) treat maternity as a planned event, not an accident or a sudden illness.

To prevent a situation called "adverse selection"—where someone only buys insurance after finding out they are pregnant—all individual and family health insurance plans in Kenya have a maternity waiting period.

• What it is: A 10 to 12-month waiting period from the day your policy starts.
• What it means: Your policy must be active for at least 10-12 months before you can be covered for childbirth.
• The Simple Truth: You must buy your private medical cover BEFORE you get pregnant. If you are already pregnant, no new individual policy will cover your delivery.

Social Health Insurance Fund (SHIF)

SHIF is a social insurance, not a private one. Its rules are different.

• What it is: A mandatory fund for all citizens.
• What it means: As long as you are a registered and active contributor to SHIF, you are entitled to the maternity benefits. The long 10-12 month waiting period for the maternity benefit itself does not apply in the same way as private insurance.

4. How to Plan: Your Smart Strategy

So, what should you do?

• If you are planning a family: This is the best-case scenario. Your first step should be to compare health insurance policies and purchase a private medical cover with a maternity benefit today. This starts the 10-12 month waiting period clock. By the time you conceive and are ready to deliver, you will be fully covered.
• If you are already pregnant (and have no private cover): You cannot buy a new private policy to cover this pregnancy. Your primary cover will be SHIF. You should ensure your contributions are up-to-date and plan to deliver at a facility that accepts SHIF (most public and faith-based hospitals).
• If you have both (The Ideal): This is the ultimate peace of mind. You will go to your private hospital of choice. The hospital will bill both SHIF and your private insurer. SHIF will pay its portion (e.g., KSh 32,600 for a C-section), and your private cover will pay the remaining balance (e.g., KSh 150,000).

5. We Can Help

Navigating the new SHIF rules and finding a private plan that offers the best "top-up" value can be confusing. You don't have to do it alone.

At Imana Insurance Agency, we specialize in finding the perfect health cover for growing families. We will help you understand the fine print, compare the best maternity plans in Kenya, and ensure you have peace of mind when your big day arrives.

Don't wait until it's too late. Contact us today for a free consultation.

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