Most SME owners ask the same question when they start thinking about medical cover:
“How much will this cost me per employee – and is outpatient really worth it?”
Below is a simple breakdown using a real example of a Nairobi SME with about 15 employees, most of them in their 20s and 30s with young families.
1. Snapshot of the quotes
Team size: 15 employees (family cover)
Option 1 – Inpatient + Outpatient (IP + OP)
- Average cost per employee per year: KES 108,214
- Average cost per employee per month: ≈ KES 9,018
Option 2 – Inpatient only (IP)
- Average cost per employee per year: KES 47,702
- Average cost per employee per month: ≈ KES 3,975
The extra cost is driven by outpatient.
Extra cost for outpatient (per family):
- Per family per year: ≈ KES 60,512
- Per family per month: ≈ KES 5,044
So the real question becomes: Does each family get at least KES 5,044 of outpatient value every month?
2. When does outpatient make sense?
Think about your team’s normal year:
- How many times do they visit the doctor?
- Do they prefer private hospitals?
- Do they have young children who fall sick often?
If a family only goes to the doctor once a year, they are paying about KES 60,512 for that single visit. If they go three times, the effective cost per visit drops to about KES 20,000. The more they actually use outpatient, the more it justifies the extra spend.
3. When inpatient-only is enough
Inpatient-only cover can work well if:
- Your team is young and generally healthy.
- Most staff are comfortable paying for minor visits in cash.
- Your main worry is big, unexpected costs like surgery or admissions.
- Your budget is tight and you need to start with a basic, solid benefit.
In our example, moving from IP + OP to IP-only reduces the average spend per employee from about KES 9,018 per month to about KES 3,975 per month.
4. A quick checklist before you decide
Ask yourself:
- What is my total annual budget for staff medical?
- What is my target cost per employee per month?
- How often does my team realistically use outpatient care?
- Do I want to prioritise protection from big shocks or everyday care?
- Would a smaller outpatient limit still give peace of mind?
You don’t have to choose between “very expensive” and “no cover”. You can:
- Start with inpatient-only.
- Add a modest outpatient limit.
- Structure different benefits for different staff categories.
5. What this means for your SME
For many SMEs, inpatient is the non-negotiable foundation. Outpatient is the flexible layer you add or trim depending on your budget and how your people actually use care.
If you’d like help breaking down your own quotes into clear cost per employee numbers and choosing between IP-only and IP + OP, we can walk you through it step by step.
Talk to us about your SME cover