- Background
Since 1944, Heifer International has worked with more than 43 million people around the world to end hunger and poverty while caring for the Earth. Working with rural communities in 19 countries in Africa, Asia, and the Americas, including the United States, Heifer International supports farmers and local food producers to strengthen local economies and build secure livelihoods that provide a living income.
Heifer started work in Kenya in 1981. Since then, Heifer Kenya has supported more than 682,000 families working in the dairy, meat, poultry, and horticulture value chains. Heifer Kenya is working with farmers to increase production and productivity by strengthening extension services and farmers’ cooperatives where they gain vital skills that enable them to scale and sustain their businesses. Heifer Kenya implements its projects through community development and enterprise development approaches. Each project focuses on three priorities: strengthening and diversifying the resource base, strengthening country program efficiency, and increasing outreach and impact through innovative value chain systems.
- Rationale
The current medical insurance term for the last period is ending. Heifer Kenya is seeking a reputable, licensed medical insurance provider to offer comprehensive coverage to its employees and eligible dependents. The objective is to provide quality, accessible, and cost-effective health care services that support employee well-being, productivity, and retention.
The insurance cover is expected to run for one year from 1 January 2027, with the option to renew, subject to satisfactory performance, budget availability and mutual agreement.
Objectives:
The objective of this procurement is to identify and contract a medical insurance provider capable of delivering comprehensive inpatient, outpatient, dental, optical, maternity, wellness, and related health care benefits to employees and their eligible dependents.
Scope of Services:
The successful insurer shall provide and administer a comprehensive medical insurance scheme including, but not limited to, the following services:
a) Inpatient Cover
- Hospitalization expenses.
- Surgical procedures.
- Specialist consultations.
- Intensive Care Unit (ICU) and High Dependency Unit (HDU) services.
- Pre-existing and chronic condition management where applicable.
b) Outpatient Cover
- General practitioner consultations.
- Specialist consultations.
- Laboratory and diagnostic services.
- Prescription medication.
- Physiotherapy and rehabilitation services.
c) Maternity Cover
- Normal deliveries and Caesarean sections.
- Antenatal and postnatal care.
- Pregnancy-related complications.
d) Dental Cover
- Routine consultations and examinations.
- Extractions, fillings, scaling, and polishing.
- Other approved dental procedures.
e) Optical Cover
- Eye examinations.
- Prescription lenses and frames.
- Other approved optical services.
f) Emergency Services
- Emergency treatment.
- Ambulance services.
- Medical evacuation where applicable.
g) Wellness and Preventive Care
- Annual medical check-ups.
- Vaccinations
- Health education and wellness programs.
- Mental health and counseling services.
h) Additional Benefits
- Last expense benefit.
- International emergency cover (if applicable).
- Chronic disease management.
- Telemedicine services.
- Fertility Treatment
- Major disease benefits
In addition, the successful insurer will provide access to high-quality health service providers in the major counties of operation, namely: Nairobi County, Laikipia County, Samburu County, Uasin Gichu County, Isiolo County, Kajiado County, Narok County, Nakuru County, Kiambu County and their environs.
Stakeholders:
- People Department
- All Staff- Beneficiaries of the service
Expected Beneficiaries
The insurer will provide coverage for:
- Organization employees.
- Eligible spouses.
- Eligible children and dependents as defined by the organization.
- A separate intern medical cover
Indicative Population
The proposed medical insurance scheme will cover approximately 130 lives, comprising 35 employees, 23 spouses, 70 children/dependents, and 2 interns.
3.0 Mandatory Requirements
If you're interested in our insurance companies, please meet the following mandatory requirements and provide the required supporting documentation.
- Regulatory Registration: Must be registered with the Insurance Regulatory Authority (IRA) to provide medical insurance coverage and submit a valid IRA registration certificate.
- Company Registration: Must submit a Certificate of Registration/Incorporation from the Registrar of Companies and demonstrate at least 15 years of operation.
- Tax Compliance: Must provide a valid Tax Compliance Certificate issued by the Kenya Revenue Authority (KRA).
- Industry Membership: Must provide a valid 2026 membership certificate from the Association of Kenya Insurers (AKI).
- Policy Exclusions: Must provide a comprehensive list of all inpatient and outpatient exclusions. Where no exclusions apply, written confirmation must be provided. Failure to submit either will result in disqualification.
- Annual Medical Premiums: Must demonstrate gross annual medical premiums of at least KES 1 billion for each of the last three years, supported by financial statements or records verifiable through the IRA.
- Reinsurance: Must provide approval from the IRA Commissioner for quota-share reinsurance arrangements.
- Paid-Up Capital: Must demonstrate gross paid-up capital of at least KES 1 billion for each of the last three years, supported by financial statements.
- Mandatory Scheme Compliance: Must explicitly confirm compliance or non-compliance with each of the following requirements:
- Inpatient and outpatient medical cover must be provided as one package under a single underwriter.
- Cover must include the principal member, spouse, and up to four child dependents. The principal member and spouse must be aged 18–65 years, while children must be covered from birth to 25 years. Children with disabilities must remain covered for as long as they depend on the principal member.
- Cover must include chronic, congenital and pre-existing conditions; HIV/AIDS; ambulance and air evacuation; maternity; dental and optical care; mental health and psychiatric treatment; and pandemics, under inpatient and outpatient benefits as applicable.
- Biometric identification systems must be provided at no additional premium.
- Members must have direct access to approved health care providers without mandatory referral through insurer-owned clinics.
- The policy cancellation notice period must be 60 days.
Note: Bidders must meet all mandatory requirements to proceed to the technical evaluation stage.
4.0 Technical Evaluation – 100 Marks
4.1 Corporate Experience, Financial Capacity and Provider Network – 30 Marks
TC1. Previous Experience – 10 Marks
Submit certified contracts or recommendation letters clearly indicating the total written premiums from corresponding clients or their brokers.
TC2. Countrywide Healthcare Provider Network – 7 Marks
Provide a list of approved health care providers across Kenya where the underwriter maintains active credit facilities. Heifer reserves the right to verify these arrangements directly with providers.
The stated geographical scoring bands are 1 mark for coverage in 1–15 counties, 2 marks for 16–30 counties, and 4 marks for more than 30 counties.
TC3. Audited Financial Statements – 2 Marks
Submit audited annual financial statements for 2023, 2024, and 2025.
TC4. Gross Premiums – 2 Marks
Demonstrate gross premiums of at least KES 2 billion over the last three years, excluding motor insurance premiums.
TC5. Corporate/Government Client Portfolio – 2 Marks
Provide evidence of three of the underwriter's largest current corporate or government medical insurance clients during 2024 and 2025, each having paid premiums of at least KES 100 million.
TC6. Health Education – 2 Marks
Commit to facilitating health talks at least twice annually.
TC7. Executive Medical Checkups – 5 Marks
Provide at least one annual executive medical examination for members and one spouse, including a personal one-on-one consultation with an executive health physician.
4.2 Quality of Service and Value Addition – 25 Marks
TR8. Service Delivery, Underwriting and Claims Management
Bidders should provide a clear description of their service delivery arrangements, including:
- Credit facility payment timelines: 30 days or less (4 marks), 45 days (2 marks), and more than 45 days (0 marks).
- A dedicated key account manager for Heifer (1 mark).
- Proposed schedule of wellness education and clinics (2 marks).
- Quarterly reporting schedule to Heifer (1 mark).
- Addition or deletion of scheme members within one working day (1 mark).
TR9. Value-Added Benefits and Extensions
Bidders should demonstrate additional benefits, concessions, wider coverage, or extensions beyond standard medical schemes, including:
- Proposed cover for premature babies born before 37 weeks (3 marks).
- Cover for dependents beyond Heifer's approved limits (M+5) (2 marks).
- Cover extending to East African countries and overseas during short-term visits (2 marks).
- Access to treatment outside Kenya (2 marks).
- Other unique value-added benefits (4 marks).
TR10. Cash Claims and Reimbursement – 4 Marks
Demonstrate provisions for reimbursement of cash claims where members access treatment in areas without approved providers or where a treating doctor is outside the insurer's panel, particularly where the member has an established treatment history with that doctor.
4.3 Medical Benefits and Sub-Limits – 45 Marks
Bidders must respond to the minimum benefit limits and sub-limits under both Options 1 and 2.
Full marks will be awarded where the proposed cover meets the prescribed limits and sub-limits under both options. Zero marks will be awarded where the requirements are not met.
- TR11. Inpatient Chronic Conditions – 15 Marks: Compliance with the prescribed annual sub-limit for chronic conditions.
- TR12. Inpatient Psychiatric Conditions – 3 Marks: Compliance with the annual psychiatric treatment sub-limit.
- TR13. Congenital Conditions and Birth Defects – 13 Marks: Compliance with the prescribed inpatient sub-limit.
- TR14. Inpatient Dental Conditions – 3 Marks: Compliance with the prescribed sub-limit.
- TR15. Inpatient Optical Conditions – 3 Marks: Compliance with the prescribed sub-limit.
- TR16. Outpatient Dental and Optical Cover – 3 Marks: Compliance with the prescribed outpatient sub-limits.
- TR17. Inpatient Maternity Cover – 3 Marks: Compliance with the prescribed maternity benefits.
- TR18. Additional Sub-Limits – 2 Marks: Disclosure of any other applicable sub-limits.
Total Technical Evaluation Score: 100 Marks
Minimum qualifying score: Bidders must attain at least 80% in the technical evaluation to qualify for financial evaluation.
5.0 Proposed Medical Benefits and Annual Limits
All limits below are expressed in Kenya Shillings (KES) per person unless otherwise indicated.
5.1 Geographical Area of Cover
The standard geographical area of cover shall include Kenya, Uganda, Tanzania, Rwanda, Burundi, and South Sudan.
5.2 Inpatient Benefits
The proposed annual inpatient limit is KES 8,000,000 per person, with the following benefits and sub-limits:
- Accommodation: Standard private room up to KES 30,000, net of SHIF.
- Accident and non-chronic specialist treatment: Specialist fees, theatre costs, ward and theatre medication, subject to the annual inpatient limit.
- Emergency ambulance services: Road and air ambulance within the country, subject to the inpatient annual limit.
- High Care and Intensive Care: KES 2,000,000.
- First-ever emergency Caesarean section: KES 350,000.
- Inpatient maternity childbirth: KES 300,000.
- Post-delivery maternity complications: KES 800,000.
- Neonatal care: KES 1,200,000, including incubator care, phototherapy, congenital conditions, and prematurity.
- Psychiatric hospitalization: KES 2,000,000.
- Prosthesis: KES 300,000.
- External medical appliances: KES 70,000.
- Specialized radiology: KES 100,000.
- Infertility treatment: KES 300,000.
- Circumcision: KES 250,000.
- Hospitalization related to chronic conditions: KES 3,000,000.
- Optical surgery: KES 350,000.
- Dental surgery: KES 350,000.
- Last expense benefit: KES 100,000 per person.
5.3 Maternity Benefits
The following additional maternity benefit limits are specified:
- Emergency Caesarean delivery: KES 300,000.
- Pre- and post-delivery maternity complications: KES 300,000, within the annual inpatient limit.
5.4 Major Disease Benefits
Major disease treatment shall fall within the chronic conditions benefit limit, subject to applicable clinical and treatment protocols.
Conditions include cancer treatment, organ transplants, and kidney dialysis.
5.5 International Emergency Evacuation and Treatment
- International emergency evacuation and repatriation: Available to India or South Africa where treatment is not locally available.
- Compassionate travel: Provision for one accompanying person.
- Repatriation of mortal remains: To be included in the proposed cover.
- Emergency treatment outside the geographical area of cover: Available during travel for up to 60 days per annum, subject to applicable benefit sub-limits.
5.6 Outpatient Benefits
The proposed annual outpatient limit is KES 200,000 per person, covering general practitioner and referred specialist consultations, pathology, basic radiology, diagnostic tests, auxiliary services, prescribed medication for acute and registered chronic conditions, antenatal and postnatal care, and passive acts of terrorism.
Additional outpatient benefits and sub-limits include:
- Dental: KES 60,000 per person.
- Optical: KES 60,000 per person, with frames replaceable annually.
- KEPI and KEPI baby-friendly vaccines: Covered for children up to five years within the outpatient limit.
- Annual medical checkups: KES 50,000 per person, within the outpatient limit, for employees and spouses only.
- Family planning: KES 20,000.
- Soaps and creams: Within the outpatient limit.
- Private vaccines: Within the outpatient limit.
- Travel vaccines: KES 20,000.
6.0 Bidder Confirmation and Compliance
For each proposed benefit and sub-limit, bidders must indicate whether they accept the prescribed limit by responding Yes or No and specify any proposed extension beyond the stated limits.
No changes to the benefit sub-limits that disadvantage Heifer International Kenya may be introduced after contract award.
7.0 Financial Evaluation and Contract Award
Only bidders who attain at least 80% in the technical evaluation shall proceed to the financial evaluation.
Heifer International Kenya will pay medical insurance premiums directly to the successful service provider.
Negotiations may be undertaken with the most competitive bidder. Where negotiations are unsuccessful, Heifer may invite the second-most competitive bidder to negotiate and possibly award a contract.
Financial Evaluation
Financial Evaluation will be conducted for bidders who score 80% or higher in the Technical Evaluation stage. It includes.
- Checking of arithmetic errors
- Financial Comparison
- Ranking of Bids
- The most competitive bidder will be recommended.