Kenya’s medical insurers are putting quality ahead of quantity as they reshape portfolios to support more sustainable covers by either exiting persistently loss-making business or adjusting premiums to better reflect claims experience.
The shift marks a move towards more risk-based pricing, with insurers reviewing the claims history of groups and portfolios when deciding whether to retain accounts, reprice them or redesign their benefits. The approach is aimed at ensuring premiums remain aligned with the cost of healthcare while keeping cover viable for customers over the long term.
In March this year, Old Mutual Holdings said it had to let go of business worth KES1.3 billion (US$10 million) in 2025 “because the pricing wasn’t right”. The decision cut its premium book. However, fast forward to half-year 2026, the results justify the radical move.
The firm, which recently published results for the first six months ended June 2026, had an encouraging line in its results as it announced a net profit of KES882 million (US$6.8 million) from KES5 million (US$38,600) posted in the preceding similar period.
The half-year earnings surpassed the KES856 million (US$6.6 million) posted in the full year ended December 2025. This was thanks to a turnaround in the insurance service result to KES287 million (US$2.2 million) from a loss of KES303 million (US$2.34 million) in the preceding half year.
However, Old Mutual’s insurance revenue was flat at KES16.31 billion (US$126 million) from KES16.39 billion (US$126.6 million) in the previous period. The insurer was comfortable with the marginal decline, explaining that it has made a decision to focus on quality rather than quantity when it comes to underwriting decisions, especially when it comes to medical insurance.
“While insurance revenue growth was held back by the run-off of the South Sudan business and the exit from loss-making medical accounts across the region, these deliberate actions enhanced portfolio quality, reduced claims costs and strengthened profitability,” the insurer explained.
Old Mutual management disclosed that the business enjoyed a 2.8% profit margin from its medical business this year, being the first time it had a positive return since 2023 from the underwriting business, citing repricing of its business.
From left, Isaiah Gakonyo, chief operating officer, Habil Olaka, chairman and Arthur Oginga, group CEO at Old Mutual Holdings, during the release of H1 financial in Nairobi on 28/08/2026
The Kenyan market has seen price undercutting in classes such as medical and motor, which are the largest short-term covers in terms of premiums but also the leading underwriting loss-makers for many insurers.
Now, insurers like Old Mutual are not afraid to lose some customers in the process, for as long as they achieve a risk-reflective price that can be sustained.
“We have now priced the portfolio properly on a case-by-case basis, and really at the end of the day some people said we are expensive and went to get service from somewhere else. But we were okay with that because we were losing money on some of the accounts,” said Arthur Oginga, chief executive at Old Mutual Holdings.
Medical insurance claims have nearly doubled over the past five years to KES52.61 billion at the end of 2025, driven by rising healthcare costs and increased utilisation, piling pressure on Kenya’s general insurers.
Industry data shows claims rose by 97.7% from KES26.69 billion (US$206.2 million) in 2021 to KES52.61 billion (US$406.4 million) in 2025, underlining mounting pressure on underwriters as more insureds seek treatment and the cost of care escalates.
The surge in claims has been accompanied by a steady increase in premiums, which grew by 81% to KES93.28 billion (US$720.6 million) over the five-year period. This reflects insurers’ efforts to price in higher risks and sustain their medical books amid shrinking margins.
Medical insurance remains the largest segment in the general insurance business, accounting for 41% of the KES227.16 billion (US$1.75 billion) total premiums in 2025. The outsized share of medical insurance highlights its central role in the sector’s growth as well as its vulnerability to cost pressures.
Jubilee Health Insurance, which is part of Jubilee Holdings, is also taking the path of quality over quantity when it comes to growing its medical insurance book. The insurer is at the point that Old Mutual was in 2025 when it decided to take the radical measures.
In 2025, Jubilee Health saw its net profit more than halve to KES424.84 million (US$3.3 million) from KES910.47 million (US$7 million) due to higher claims. The health insurer’s insurance revenue grew 23.8% to KES16.68 billion (US$128.9 million) but service expenses, which includes claims paid, rose 31% resulting in underwriting loss of KES220.74 million (US$1.7 million).
The insurer said the health business experienced elevated claims in Kenya and Uganda. In Kenya, the impacts were concentrated within specific segments of the corporate portfolio, which weighed on the overall loss ratio.
In the half year ended June 2026, Jubilee Holdings, the parent company of Jubilee Health, had careful wording in its statement to the press as it announced a 12.7% rise in net profit to KES3.45 billion (US$26.6 million). It said insurance revenue was flat at KES16.9 billion (US$130.5 million) despite a 14% growth in the life business.
Jubilee Holdings said insurance service result declined by 60% to KES445 million (US$3.4 million), driven by “a high claims experience and medical inflation” impacting the health business. This was partly offset by positive growth in the life business at 52%.
The insurer explained that the growth in the life business was “offset by a deliberate focus of profitable portfolios to drive sustainable growth in the health business”, leading to the unchanged overall figure of insurance revenue from the life and health business. This line, tucked in the middle of its press statement, mirrors the move taken by Old Mutual.
Beyond reshaping their portfolios and repricing loss-making accounts, medical insurers are increasingly looking upstream to contain claims, shifting from simply paying for illness to preventing avoidable complications.
The approach is gaining importance as healthcare costs continue to rise. Aon’s Global Medical Trend Rates Report projects medical costs in Kenya to increase by 13.5% this year, compared with a global average of 9.8%. Kenya’s medical insurers are therefore investing in wellness programmes, chronic disease management, preventive screening, digital health platforms and health navigation to keep members healthier and reduce costly hospital admissions.
Britam General manager for corporate health David Obonyo says insurers need to engage customers before they require expensive treatment.
“If you think about the traditional medical insurance model, we often meet the member when something has already gone wrong and there is a bill to pay. We want to engage much earlier,” he says.
Britam’s Wellness 360 programme covers mental health, lifestyle disease management, reproductive wellbeing, health checks, health education and workplace health. The insurer has also introduced Pharmacy First, allowing members to access medication for selected conditions through pharmacies rather than automatically seeking hospital-based care.
At Jubilee Health Insurance, chronic disease management is central to the strategy. Chief executive Njeri Jomo says its health navigators track members with conditions such as diabetes and hypertension, including medical reviews, medication refills, nutrition and physical activity. Jubilee also provides preventive flu vaccinations to members with chronic conditions, which Jomo says has helped reduce hospital admissions.
“If you are dealing with someone with diabetes or someone with hypertension and so on, if they are not actively managed, they end up with two or three hospitalisations and they wipe out their cover,” said Jomo.
At AAR Insurance Kenya, chief executive Justine Kosgei says wellness programmes are helping members manage existing conditions before they escalate. The insurer says it has recorded more than 50% reductions in complications among members participating in its wellness programmes.
“For people who already have conditions that they are managing, the wellness helps them to manage in a way that it prevents complications and escalations, which may eventually require too much costs,” he says.
The objective of the wellness programmes is to slow the growth of claims costs without making cover prohibitively expensive, creating room for a medical insurance market that can remain viable for both providers and policyholders over the long term.
The focus on how to make medical insurance sustainable goes beyond Kenya. Kenya Reinsurance Corporation is placing medical insurance among the key issues at its upcoming 3rd annual CEOs Summit, to be held from 9-12 November in Abidjan, Ivory Coast, under the theme “Driving Sustainable Profitability in Agriculture, Health and Motor Insurance Across Africa”.
The summit will examine how insurers can build sustainable health portfolios amid rising healthcare costs and claims. The focus reflects the growing recognition that medical insurance sustainability is an Africa-wide challenge that requires innovative risk-transfer solutions and products that balance affordability with insurers’ ability to deliver long-term protection.
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