07/04/2026
I have deen several people seeking health insurance for already pregnant mothers and people with existing conditions..please note this, before you get dissapointed.
Insurance has clear limits and understanding them upfront can save you from major financial setbacks.
Many claim rejections are not because insurance “failed,” but because key exclusions and conditions were not well understood. Here’s a more detailed breakdown:
HEALTH INSURANCE – Exclusions & Waiting Periods
• Pre-existing conditions
Conditions you already have (e.g. diabetes, hypertension, ulcers) are not covered immediately.
Typical waiting period: 12–24 months before full benefits apply.
• Maternity cover
This is a planned risk, not emergency cover.
Waiting period: 9–12 months before eligibility.
• Chronic conditions
Even after waiting periods, these are often subject to annual limits or caps, not unlimited cover.
• Dental, optical & specialized treatment
Usually restricted to small limits or available only on higher plans.
• Self-inflicted injuries / substance-related cases
Claims linked to alcohol, drugs, or intentional harm are excluded.
• Non-disclosure
Failure to declare a condition at onboarding can lead to complete claim rejection, even years later.
MOTOR INSURANCE – Key Exclusions & Conditions
• Owner/Family limitations
In many policies, the owner or close family members may not be fully covered under certain sections unless specifically included. Always confirm who is insured to drive.
• Authorized drivers only
Claims are valid only if the driver is licensed and authorized under the policy.
• Driving under the influence
Any accident involving alcohol or drugs is automatically excluded.
• Usage limitations
A private vehicle insured for personal use will not be covered if used for commercial purposes (e.g. ride-hailing, deliveries) without proper endorsement.
• Underinsurance (Average Clause)
You are only compensated proportionately to the value you insured.
Example:
If your car is worth KES 2M but insured at KES 1M, you effectively carry 50% of the risk — and any claim is reduced accordingly.
• Wear, tear & mechanical failure
Insurance does not cover maintenance issues, ageing parts, or breakdowns.
• Excess/Deductibles
Every claim has a portion you must pay first before the insurer settles the rest.
WAITING PERIODS – The Reality
Insurance is not designed for immediate use after purchase.
•Some covers activate immediately (e.g. accidents)
• Others take months or years (e.g. maternity, pre-existing conditions)
Taking cover when a risk is already imminent often means you won’t be covered in time.
Key Takeaway
Insurance is a contract — not a blanket guarantee. It works best when structured correctly and understood clearly.
Before taking any policy:
• Confirm who is covered (especially in motor policies)
• Insure assets at their correct value
• Understand limits, exclusions, and waiting periods
• Disclose all relevant information honestly
Well-structured cover pays. Poorly understood cover disappoints.
