Management assessment

The experience to date raises concerns about renewing senior products at current premium rates. We have reviewed the Retail and Community medical products for underwriting years 2024–2026. Community experience is adverse, although the available data do not allow us to isolate the results for senior members.
Written premiumKES 516.99m
Estimated earned premiumKES 427.43m
Recorded payable claimsKES 468.44m
Observed earned loss ratio109.6%
What the figures say. Recorded payable claims exceed estimated earned premium by KES 41.01m, giving an earned loss ratio of 109.6% (written loss ratio 90.6%). Community records 132.4% compared with 87.2% for Retail. The written loss ratio is shown as a secondary comparison; the earned loss ratio is the primary experience measure. Results exclude expenses and unestimated claims development.

Senior-product renewals. Based on the experience to date, we do not have enough evidence to support renewing senior products at the current premium rates without further consideration of the pricing structure and underwriting terms. Most senior members are understood to be insured under Community products, but our data do not isolate their experience. We have therefore not calculated a separate senior loss ratio or recommended a specific rate change.

Scope. Underwriting years 2024–2026. Claims valuation: 2026-08-26. Written premium is invoice-level; estimated earned premium uses inferred policy periods where necessary. IBNR has not been estimated. The 2026 experience is incomplete. Primary measure: observed payable claims / estimated earned premium. Written loss ratio (observed claims / written premium) is supplementary. Neither is ultimate.

1. How does the experience differ by underwriting year?

The portfolio result masks differences between Retail and Community. Community’s observed earned loss ratio is 132.4%, compared with 87.2% for Retail. The chart below shows how the results differ by underwriting year.

We have separated the underwriting years to check whether the adverse experience is limited to a particular cohort. The 2026 figures are not yet mature.

Community: Its observed loss ratio exceeds 100% in every available underwriting year. The results are adverse across the available cohorts, although the cause is not established.

Retail: The highest observed loss ratio is in UWY 2025 (115.3%). This is not apparent from the overall Retail result.

The 2026 underwriting year is incomplete at the valuation date. Underwriting-year loss ratios are not directly comparable without considering earning assumptions and claim development.

2. Which products contribute most to the observed deficit?

We have ranked products by the difference between recorded claims and estimated earned premium. This shows where the largest financial gaps arise, rather than focusing on loss ratios alone.

Largest observed adverse product gap: HINDU COUNCIL has the largest positive observed claims-minus-earned-premium gap (KES 67.64m). This shows where the largest recorded gap arises, but does not explain its cause.

Positive bars indicate recorded claims above estimated earned premium, before operating costs, expenses, IBNR or further adjustments. They are not the final underwriting result. Products with no positive earned premium cannot be ranked on this basis and remain disclosed in the product register.

3. Which Community benefits account for the most claims?

We have identified the Community benefits accounting for the largest claims amounts. The chart shows where the costs arise, but not necessarily why.

Benefits are source classifications and may not be comparable in coverage or cost structure. Provider names and tiers remain in the underlying analysis. A separate provider chart is omitted because classification alone does not support a distinct conclusion about efficiency.

4. Conclusions and data required for a fuller review

Frequency and severity. We also examined claim events relative to estimated covered member-years and average payable amount per event. The figures are retained in the technical appendix rather than charted because the exposure and event counts are indicative. They do not establish whether senior-member experience is driven mainly by claim frequency or severity.

Conclusion. We have completed our review of the Retail and Community products using the information available. Community has recorded an adverse earned loss ratio, which raises concerns about renewing senior products at existing rates. While most senior members are understood to fall under Community, we cannot verify or quantify their separate experience from these records. We therefore cannot support a specific senior premium adjustment or change in underwriting terms based on this analysis alone.

Observed result: Earned loss ratio 109.6%, compared with written loss ratio 90.6%. The primary metric uses estimated earned premium; the written basis is a supplementary comparison. The difference reflects the premium denominator, not a different set of claims.