Insurance.
Explore policies, coverage and claims context.

One citizen. Multiple protections. One connected life. FCTE tracks every synthetic citizen's insurance relationships as concurrent, real coverage — a government SHA policy and an employer's private plan, active at the same time, on the same person — because that's how real Kenyan formal employment actually works.

Nairobi City Twin™ · 1940–2026

Every capability below is backed by release evidence or certification; the physical design is intentionally generalized.

Insurer and payer context represented as public semantic entities.

Policy — plan tier, copay type/value, deductible, coverage limit, monthly premium, acquisition type, linked to its issuing company.

Coverage — per-citizen enrollment, now modeled so distinct active policy relationships can coexist while duplicate same-policy enrollment is prevented.

Claims context captures amount/outcome/cause and optional care linkage; physical fields and adjudication design are controlled.

Accident and premium-payment context are represented longitudinally; physical relationship fields remain controlled.

Coverage and claim timing is checked against the synthetic resident lifecycle so analytically impossible post-lifecycle records are not treated as valid.

Synthetic by design: FCTE insurance records are analytically representative coverage and claims data. They are not real policyholder records, real claims history, or a substitute for any insurer's or regulator's own data. The public data model claims only the capabilities described here; physical internal methods remain controlled.

Healthcare models the clinical encounter. Employment determines whether employer-provided cover exists. Insurance models the coverage relationship itself — the policy, the enrollment, and what happens when a claim is filed.

Representative semantic rows for the Nairobi insurance model. Synthetic examples; not policyholder records and not the internal data structures.

Explore Coverage Data →

Connections follow the published domain scope. Optional, contextual and planned relationships retain their stated limits below.

The single most important fact about this domain: a real citizen can hold more than one active insurance policy at the same time — and until 2026-08-01, FCTE's own data structure forbade it.

The model supports a public-coverage relationship alongside distinct private or employer coverage where the city context calls for it.

Different active policies can coexist for one synthetic resident while duplicate enrollment in the same policy is treated as invalid. The physical constraint design is controlled.

The release now permits concurrent distinct-policy coverage for one synthetic resident while still preventing duplicate enrollment in the same policy. Exact uniqueness constraints and migration mechanics are intentionally withheld.

Kenya's model emphasizes health-insurance and claims context, while Nigeria's model emphasizes a broader general-insurance market. The distinction is part of the public semantic architecture, not merely a naming change; internal data structures differences remain private.

Real payers span five tiers by establishment date: NHIF (1966), SHA (2023-10-23, replacing NHIF), Linda Mama (2013), long-established private insurers Jubilee (1937), Britam (1965), APA (1979), CIC (1978), plus international entrants Cigna (2000), Allianz Care (2010), Bupa Global (2012), and the M-TIBA mobile health wallet (2016).

NHIF (1966), SHA (2023-10-23), Linda Mama (2013), Jubilee (1937), AAR (1984), Britam (1965), APA (1979), CIC (1978), Madison (1988), Heritage (1976), Resolution Health (2002), Cigna (2000), Allianz Care (2010), Bupa Global (2012), M-TIBA (2016).

Kenya’s public and private coverage can overlap in real life, providing evidence for representing concurrent distinct-policy protection in the synthetic model.

Open Insurance Evidence Catalogue →

Two concurrent employer-provided policies for the same citizen (e.g. from concurrent formal employment at two employers) is a real, disclosed gap — deliberately deferred rather than silently forbidden by an overly broad rule. This is a known and disclosed limitation, not a hidden one.

Employer-sponsored coverage is represented conceptually. This page does not claim a confirmed, verified direct read from Employment's Contract rows into Coverage — that specific cross-domain link has not been confirmed in the data model.

Synthetic citizens and coverage records are not real people and carry no real personally identifiable information. This page makes no claims about compliance frameworks for handling real policyholder data.

Beneficiary and accident-line checks are city-extension checks that are not active in the Nairobi release. They correctly report N/A when the corresponding extension or prerequisite context is absent; N/A is a scoped result, not a hidden certification failure.

Kenya’s fraud-analysis context includes additional claim consistency checks; exact fields and logic are controlled.

Claim amounts, approval rates and premium figures are analytically representative, not sourced from any real insurer's or regulator's actual claims experience. They should not be used for actuarial pricing or real underwriting decisions.

Coverage, Claim, Premium Payment, claim line items and the fraud-workflow queue are all part of the same generation pass and have not yet been (re)run on Nairobi in the current rebuild cycle — those checks report N/A rather than a false PASS or a hidden failure until they run.

View All Insurance Limitations →

Insurance certification evaluates release-level structural, temporal and lifecycle consistency across payer, policy, coverage and claims context. Public results show the outcome and current data-availability state; physical constraints, deployment history and recovery mechanics are intentionally withheld.

Open Insurance Realism Report →

N/A is used deliberately when prerequisite data doesn't exist — never to hide a failure. Coverage and Claims are now live in Nairobi (11 of 15 checks applicable, all passing); the remaining 4 N/A checks depend on later-stage tables (Premium Payments, claim line items, fraud-workflow queue) that are still populating as part of the same generation pass. This page reports the current release state rather than substituting a last-known-good result.

Explore Every Insurance Check →

• Payer context — PASS, 15 companies
• Policy catalogue — PASS, 28 policies
• Coverage relationship integrity — PASS, 0 orphaned rows
• Claim value integrity — PASS, 0 violations
• Premium value & uniqueness — N/A, insurance. PremiumPayment still populating

• Coverage chronology — PASS, 0 violations across policy and claim lifecycle
• Fraud-analysis consistency — PASS, 0 inconsistent rows
• Resident-lifecycle boundary — PASS in the documented release state

28 real Policy rows exist today, naming real Kenyan insurers and products — "NHIF Basic Inpatient Cover," "Britam Afya Imara Basic" among them.

confirmed in the published source: Coverage, Claim, PremiumPayment and AccidentClaim all have 0 rows. The product catalog is real; no citizen-level enrollment, coverage or claim activity has been generated yet.

Employment or scheme enrollment → Policy selection → active Coverage → filed Claim is the designed model — shown as scope, not as a live result.

Risk becomes coverage. One citizen. Multiple protections. One connected life.

Available as Standalone Domain · Multi-Domain Bundle · Full City Twin™