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Private health insurance is crucial for healthcare financing, but its uptake remains suboptimal, with many still relying on out-of-pocket expenses. Statistics indicate Kenya's informal sector comprises 83.3% of the population, with only 2% of employees having national hospital insurance and 20% having public health insurance. Therefore, this study investigated effect of strategic decision on uptake of private health insurance services, specifically, the study examined the effect of level of coverage, cost and affordability, network of health providers and quality of services on uptake of private health insurance services in Nairobi City County, Kenya. The study was anchored using the agency theory, dynamic capability theory and expected utility theory. The study embraced descriptive research design. The target population was sixteen private health insurance in Nairobi city county, Kenya. A sample size of eighty was utilized, employing census. Primary data was collected using a semi-structured questionnaire. The response rate was sixty eight percent. Level of coverage, cost and affordability, network of health providers and quality of services had a significant effect on uptake of private health insurance services. The study recommend, insurance providers should continue to offer diverse plans that cater to different needs and income brackets, ensuring that comprehensive coverage options remain accessible to a broad audience. Additionally, insurers should continue to develop and offer flexible payment plans that cater to different income levels. Introducing tiered pricing models, where customers can choose from a range of premium options based on their financial capacity, can make insurance more accessible. Moreover, the insurer should focus on maintaining a strong commitment to service quality and continually refining their offerings, which can build greater trust and satisfaction among customers, leading to increased adoption of private health insurance services.