Understanding Congenital Diseases and Their Coverage in Health Insurance in Kenya
Health insurance is a critical tool that provides financial protection against various health risks. However, when it comes to congenital diseases, many people are often left wondering whether their health insurance policy provides coverage. This blog aims to shed light on what congenital diseases are and how they are covered by health insurance in Kenya.
What are Congenital Diseases?
Congenital diseases, also known as congenital disorders, congenital abnormalities, or birth defects, are conditions that are present at or before birth. These conditions occur during intrauterine life and can be identified prenatally, at birth, or sometimes may only be detected later in infancy, such as hearing defects. They can be caused by genetic, environmental, or unknown factors. The most common severe congenital disorders are heart defects, neural tube defects, and Down syndrome.
Coverage of Congenital Diseases in Health Insurance in Kenya
In Kenya, while internal congenital anomalies are included in health insurance policies, external congenital anomalies are not covered. Expenses towards correction of internal anomalies will be covered if and only if they are discovered after the child is covered under the health insurance policies. There may be a waiting period of 24 to 48 months depending on different insurance companies from the start of the policy before these anomalies are covered.
If, during pregnancy, some congenital anomalies are discovered and there is treatment given, then insurers may consider compensation for the treatment. However, for this, you have to have a maternity cover in place; expenses’ would be part of maternity expenses.
Conclusion:
Understanding the coverage of congenital diseases in your health insurance policy is crucial to avoid unexpected healthcare costs and ensure you’re getting the coverage you need. Always review your policy carefully and ask your insurance provider if you’re unsure about any aspect of your coverage.
