“Don’t Just Buy Insurance — Understand It. Choose Wisely .”

In today’s unpredictable world, health insurance is no longer a luxury — it’s a necessity. Yet, one of the most misunderstood and often frustrating components of a health insurance policy is the “waiting period.” Many Kenyans ask: Why can’t I use my insurance immediately? Why do insurance companies impose waiting periods? Even worse, when someone is diagnosed with a life-threatening illness like cancer and can’t access immediate treatment, emotions run high.

This article speaks directly to you, the reader. Whether you’re seeking clarity, exploring insurance options, or have been disappointed before, you deserve honest, practical answers. Let’s demystify the concept of waiting periods and uncover the truths many policyholders — and potential ones — need to know. This comprehensive guide not only explains waiting periods but addresses common fears, identifies root problems, and offers actionable solutions for Kenyans considering or already holding health insurance.

What Is a Waiting Period in Health Insurance?

A waiting period refers to a specified period after the start of your policy during which certain benefits or claims cannot be accessed. This mechanism is primarily

designed to prevent abuse and ensure the sustainability of health insurance products. It helps ensure that people don’t sign up for a policy only when they’re already aware of a major illness or scheduled for treatment.

Let’s explore some of the different categories of coverage in more detail:

Inpatient Coverage

Inpatient cover includes costs associated with being admitted to hospital for at least 24 hours — for surgeries, extended treatment, or other serious medical cases. Most Kenyan insurers place a 30 to 90-day waiting period on inpatient services. This means that if you are admitted within that time for a non-accident-related illness, your claim could be denied.

This waiting period protects the insurer from people who might buy cover just after discovering they need an expensive surgery. Insurers need time to verify that the condition was not pre-existing or deliberately hidden.

Outpatient Coverage

Outpatient services are non-admission-related treatments such as general consultations, diagnostics, drugs, and minor procedures. Most insurers provide outpatient coverage after a 30-day waiting period, although some higher-tier products offer immediate access.

This delay helps prevent abuse of benefits. For instance, someone might sign up, consult several specialists in a week, fill expensive prescriptions, and then cancel the policy — a behavior that would drive up costs for all policyholders.

Accidental Injuries

Unlike illnesses that may have a history or lead time, accidents are unpredictable. This is why most insurance companies provide immediate coverage for accidents. If you break a leg or are burned in an incident the day after enrolling, your treatment will likely be covered. The assumption is that accidental injuries couldn’t have been anticipated.

This makes insurance particularly valuable even within the first few days of enrollment and is one of the strongest arguments for not delaying purchase. Accidents are costly and unpredictable.

Chronic and Pre-existing Conditions

Chronic illnesses like diabetes, cancer, asthma, and hypertension are typically subject to 6–12 month waiting periods — or may even be permanently excluded if not disclosed. These conditions are considered high risk and often require expensive, long-term treatment.

A client diagnosed with stage one cancer a week after buying a policy may not access full coverage for up to a year — and in some plans, may never access it if it’s considered a pre-existing condition. This can be painful, but it underscores the importance of insuring yourself before illness strikes.

Maternity Cover

Maternity coverage is one of the most delayed benefits. Most insurance providers impose 9 to 12-month waiting periods for prenatal visits, delivery, and postnatal care. The reason? Pregnancy is usually planned. Without a waiting period, many clients would enroll when pregnant and cancel right after delivery — leaving insurers exposed.

A private maternity package in Nairobi today ranges from KES 70,000 to KES 150,000, or higher in premium hospitals. If you’re planning to start a family, it’s advisable to purchase maternity cover at least a year in advance.

Dental and Optical Benefits

Routine dental check-ups, cleanings, and optical exams are often included as add-ons and come with 3–6 month waiting periods. These are viewed as low-risk but high-volume benefits. Additionally, cosmetic procedures like teeth whitening or non-corrective lenses are often excluded.

Because such services are frequently used, insurers impose short-term waiting periods to manage overutilization.

Why Do Insurance Companies Insist on Waiting Periods?

Insurers use waiting periods as a safeguard against loss, manipulation, and financial instability. Here’s why:

• To Prevent Adverse Selection: This is when people purchase insurance knowing they are already sick or require immediate care, which threatens the insurance pool’s stability.
• To Ensure Financial Sustainability: Insurers need time to accumulate premiums before they begin settling high-cost claims. Otherwise, the math doesn’t work.
• To Minimize Fraud: There have been cases of collusion with providers or attempts to backdate illness — waiting periods help prevent these scams.
• To Encourage Long-Term Participation: Insurance is most beneficial when held consistently. Waiting periods discourage the “use and drop” behaviour that threatens sustainability.

 “Health insurance is not for the sick. It is for the wise.” Selestine Were

Should You Just Invest the Money Instead?

Many clients often ask: “What if I just save or invest the money I would pay for health insurance?” At first glance, this seems reasonable. However, healthcare emergencies are often expensive and immediate, while investments grow gradually over time.

Imagine you invest KES 60,000 annually for three years in a money market fund. At 10% annual interest, that grows to about KES 210,000. However, a single hospital bill — say for surgery or ICU admission — could cost KES 300,000 or more. In such a case, your investment would fall short.

Now imagine you fall ill in the first year. Your investment may only be KES 66,000 (principal + interest), which won’t help much in covering a major procedure. But with health insurance — even with a waiting period — you’ll likely be covered.

The most effective approach? Use both. Let your insurance cover the unpredictable emergencies, and let your investments grow for long-term goals and flexibility.

“Financial planning is not choosing one tool over another. It is building a toolbox that works when life breaks unexpectedly.” Selestine Were

Legal Safeguards: Know Your Rights

• The Insurance Act Cap 487 and the IRA Consumer Protection Guidelines (2017) provide clear guidance to protect policyholders:
• Insurers must clearly disclose all waiting periods in writing.
• Clients have a 30-day cooling-off period to cancel or change plans.
• Any form of misleading marketing is subject to regulatory penalties.
• If a claim is unfairly denied, clients can file complaints with the Insurance Regulatory Authority (IRA), which offers a redress mechanism through its Complaints Bureau.
• Being informed about these rights can save clients from stress, loss, and misinformation.

Let’s Fix It: Solutions for Clients, Insurers & Regulators

To improve trust and access in health insurance, we need action from all sides:

For Clients:

Clients must plan ahead. Purchase insurance when healthy, read policy documents thoroughly, and ask clear questions about exclusions and waiting periods. Also, consult a qualified financial advisor to help you choose wisely. Consider supplementing your medical cover with an emergency fund or flexible savings plan.

For Insurance Companies:

Providers should simplify policy wording and ensure agents disclose all terms transparently. Training field staff on ethical sales practices and improving claims response time are also critical to rebuilding public trust.

For Regulators (IRA):

The IRA must enforce standard language in contracts, conduct nationwide public awareness campaigns (especially in schools and media), and crack down on insurers or agents who hide or misrepresent waiting periods.

“Trust in insurance grows not by aggressive sales — but by compassionate clarity.” I emphasize

Waiting periods may feel inconvenient, especially when emergencies arise — but they play an important role in keeping insurance fair, affordable, and functional for everyone. As a client, understanding these clauses before a medical crisis hits can save you time, money, and frustration.

At Tamara’s Financial Planning & Consultancy, our mission is to help Kenyans make empowered, informed decisions — whether for health, education, retirement, or wealth protection.

If you’re considering health insurance, reviewing a current plan, or wondering how to blend insurance with investment strategies for your loved ones, get in touch with us today for proper advisory.

Visit: www.tamaras.co.ke

Email: info@tamaras.co.ke

WhatsApp: 0777675977

Let’s walk your health protection journey — wisely, clearly, confidently.