A gym session, a flu jab, a health check or a reminder to take medicine may not look like typical insurance business. Kenya’s medical insurers are increasingly treating such interventions as part of the business, hoping that keeping customers healthier will also keep claims under control.
Many insurers are shifting focus from paying for illness to preventing it as a sharp rise in healthcare costs threatens to make medical cover increasingly expensive for employers and households.
The industry is turning to wellness plans, chronic disease management, digital health platforms, screening and health navigation in a bid to keep policyholders healthier and reduce the frequency and severity of claims.
Insurance Regulatory Authority (IRA) data shows claims almost doubled from Sh26.69 billion in 2021 to Sh52.61 billion in 2025 as insurers grappled with higher healthcare prices and increased use of medicare.
The increase followed an 81.1 percent rise in premiums to Sh93.28 billion over the same period as insurers adjusted prices to reflect higher healthcare costs and higher usage.
However, insurers fear that continued premium increases could make medical cover increasingly unaffordable. They now say early detection and better management of conditions can reduce hospital admissions and prolonged treatment.
The traditional model tends to engage customers when illness has struck, says David Obonyo, the Britam General manager for corporate health.
“In the traditional insurance model, we often meet the member when something has already gone wrong and there is a bill. We want to engage much earlier,” he says.
Mr Obonyo adds that the aim is to “evolve our offering beyond merely paying claims and position ourselves as an active confidant and partner in our members’ health journey”.
Medical cover accounted for 41 percent of the Sh227.16 billion general insurance market in 2025, making it the largest class of the business in Kenya but also one of the biggest sources of pressure on insurers’ margins.
Healthcare costs are projected to rise by 13.5 percent in Kenya this year, according to Aon’s Global Medical Trend Rates Report 2026, compared with a global average of 9.8 percent.
The wellness approach mirrors a global shift. Aon, which tracks employer-sponsored medical plans in more than 100 countries and locations, says wellbeing initiatives are the leading cost-mitigation strategy, with 86 percent of countries reporting them as the most prevalent measure.
“By encouraging utilisation of preventative care, they can avoid more expensive care. Second, by keeping employees engaged in their wellbeing, they can reduce the stress that can exacerbate other health conditions,” Aon says.
Jubilee Health Insurance CEO Njeri Jomo sees chronic disease management as one of the most direct links between wellness and claims control.
Jubilee, which had the largest market share at 14.08 percent in the first quarter of 2026, uses health navigators to monitor members with chronic illnesses, including tracking medical reviews, medication refills, nutrition and physical activity.
For patients with diabetes, hypertension, heart disease or other conditions, the aim is to prevent deterioration that could result in repeated hospitalisation. Jubilee runs Maisha Fiti wellness programmes for individuals and corporates.
“If someone with diabetes or hypertension is not actively managed, they end up with two or three hospitalisations and wipe out their cover,” she says.
The insurer also administers flu jabs to policyholders with chronic conditions before the flu season, seeking to prevent infections from triggering complications.
“That has been one of our biggest success tools because they end up not being admitted,” Ms Jomo adds.
Britam runs its Wellness 360 programme covering mental health, lifestyle disease management, reproductive wellbeing, general checks, health education and workplace and occupational health.
The insurer has also introduced Pharmacy First, enabling members to access medication for selected conditions through pharmacy channels rather than automatically going to a hospital.
“It is about helping members access the right care at the right time and right cost. Some of the most expensive claims are not necessarily because a disease could not have been treated, but because it was identified late, was poorly controlled or became complicated,” Mr Obonyo says.
For insurers, the appeal of interventions is particularly strong in managing non-communicable diseases, where regular reviews, medication adherence and lifestyle changes can help prevent complications requiring admission, surgery or prolonged treatment.
“Wellness allows us to intervene upstream rather than wait to manage the cost downstream,” Mr Obonyo says.
For firms like Jubilee, intervention goes beyond reminding members to take medication. Navigators follow patients through their treatment, ensuring they attend reviews and obtain drugs.
The insurer also provides longer medication refills for some patients, allowing it to monitor adherence while reducing the need for repeated visits to hospital.
Ms Jomo says the approach has shown encouraging results as members with chronic illnesses can become fatigued by the demands of long-term treatment. The focus on prevention has also extended to maternity care, where Jubilee provides information to expectant mothers to help them make informed decisions about childbirth.
The insurer says pregnancy intervention has helped reduce elective Caesarean section (C-section) rates.
Government data showed 20.1 percent of hospital-based deliveries in 2025 were through C-section, above the WHO’s recommended upper limit of 15 percent and higher than the sub-Sahara average of 12 percent.
Ms Jomo says women are taken through the pregnancy journey early enough to understand the circumstances under which a C-section may be necessary, “instead of making the decision based on perceptions”.
At AAR Insurance Kenya, CEO Justine Kosgei says wellness programmes are producing benefits on both sides of the insurance relationship.
“The wellness helps members to manage their conditions. It prevents complications and escalations,” Mr Kosgei says.
He adds that AAR has recorded reductions of more than 50 percent in complications among members taking part in the wellness programmes. AAR’s approach is built around knowing one’s health, managing it and tracking outcomes.
Mr Kosgei says early identification can help members change behaviour before they develop conditions like hypertension.
AAR has invested in digital tools and a call centre with wellness staff to improve enrolment and adherence. It has also partnered with telehealth providers to widen reach and follow ups.
However, he says there is a challenge in getting more people to enrol, participate and be consistent.
Old Mutual General Insurance MD Japheth Ogalloh says the case for wellness is also rooted in shifting healthcare intervention from treatment to prevention, early detection and proactive management.
The insurer operates Thrive, a digital platform built around physical, mental and financial wellness. Old Mutual also runs chronic disease management, medication delivery, telemedicine, medical camps, talks and vaccination drives.
Mr Ogalloh says the Pharmacy First programme can redirect treatment for minor ailments away from more expensive care, while telemedicine can provide consultations at a lower cost and reduce physical visits.
Insurers’ interventions have become more important as employers grapple with the rising cost of medical benefits. Companies spend millions of shillings on staff medical schemes every year.
KCB Group’s medical costs, for instance, rose to Sh2.37 billion last year from Sh1.94 billion in 2024, while NCBA’s shot to Sh727.76 million from Sh632.36 million. Co-operative Bank’s medical costs hit Sh962.12 million from Sh849.92 million.
Aon says employers are increasingly looking beyond negotiations with insurers to a broader mix of cost-containment measures, including wellness initiatives, telehealth, mental wellbeing and physiotherapy.
However, the local market faces another challenge of customers shifting from one insurer to another. On many occasions, the relationship between insurers and employers can be too short for the full benefits of wellness interventions to emerge.
Ms Jomo says corporate medical schemes frequently change insurers at renewal, meaning an insurer that begins managing a worker with diabetes may lose visibility of the patient after a year.
“For some of these interventions, the impact is not immediate. If I am tracking someone being managed for diabetes, I need to track them for 18 to 24 months. If they move to another insurer, I lose sight,” she says.
It creates a disconnect between the duration of wellness interventions and the annual nature of corporate insurance procurement. It also complicates the possibility of an industry-wide health database that could allow members to carry their wellness history from one insurer to another.
Ms Jomo sees room for greater industry collaboration, though she acknowledges that sharing health data is sensitive. Claims experience is one of the factors insurers use in pricing corporate schemes, making health data commercially valuable.
Beyond the data question, Ms Jomo says many buyers of medical insurance continue to prioritise price, meaning wellness can be treated as an extra rather than a core component of the product.
Jubilee is experimenting with incentives to encourage healthier behaviour, including tracking physical activity through digital apps, with some retail customers receiving discounts for meeting exercise targets.
“Insurance still mainly attracts the sick, something that is not desirable because you end up with every person claiming. If all you focus on is curative, then those you attract are unwell. Wellness programmes will change this,” Ms Jomo says.
Jubilee is collecting health and activity data it hopes will eventually support predictive analytics and help identify the likelihood of illness and enable early intervention.
Mr Obonyo says while wellness cannot eliminate medical inflation – particularly as hospitals, medicines, technology and specialist services become more expensive – the opportunity lies in slowing the rate at which claims costs grow.
“Wellness programmes will not remove medical inflation, but if we can reduce preventable complications, unnecessary admissions and repeated utilisation, we can slow the growth in claims costs. That gives us a better opportunity to keep medical insurance affordable and sustainable,” Mr Obonyo says.
As insurers step up wellness programmes, the real test is in measuring whether such interventions are actually changing health outcomes and healthcare utilisation. Mr Kosgei says the industry is still at an early stage in building this evidence base.
