NHIF – what you need to know
3 years ago
The National Hospital Insurance Fund (NHIF) is a State Parastatal that was established in 1966 as a department under the Ministry of Health. Currently, the NHIF Act No. 9 of 1998 governs the Fund.
The Fund’s core mandate is to provide medical insurance cover to all its members and their declared dependants (spouse, child and other named dependants).
NHIF membership is mandatory for everyone who is (i) ordinarily resident in Kenya (ii) is over 18 years old and (iii) has a monthly income of more than Kshs. 1,000/= whether derived from employment or self-employment.
Rates of the contribution
These are set out in the National Hospital Insurance Fund (Standard & Special Contributions) Regulations, 2003. The rates are graduated as follows: –
|Gross Income (Kshs.)||Proposed Premiums (Kshs.)|
Once a person becomes a member of the fund, he is required to make monthly contributions to the fund in order to enjoy the services offered.
For those who are employed, their employers are responsible for deducting and remitting the payments monthly to the Fund (Section 16(3) of the Act).
The payments should be made by the 9th of the month failing which a late payment penalty of 25% of the amount of that contribution, for micro and small enterprises, or two times the amount of that contribution, for all other cases, is payable.
If an employer fails to make payment on time, the penalty accrues to them and not the employee.
For those who are self-employed, the penalty is five times the amount of the contribution. Failing to pay is also a criminal offence for which one is liable, on conviction, to a fine equal to four times the amount of that contribution.
There is also the option of voluntary membership by which a person may apply to be a voluntary contributor so as to cover such other dependants who would otherwise not be entitled to the benefits under the standard or special contributions paid by the contributor. Limited details are available about this option.
The relationship between NHIF and the Employment Act
Section 34 of the Employment Act, 2007 places an obligation on an employer to ensure ‘the provision of sufficient and proper medicine for his employees during illness and if possible, medical attendance during serious illness’.
This obligation is fulfilled if the employee is able to secure medical treatment through the employee’s NHIF membership.
If, as a result of a late or delayed payment by an employer, an employee is unable to claim or obtain the NHIF benefits, the employer shall be liable to the employee to the extent of the denied benefit and any other injury or inconvenience arising therefrom.
Benefits of NHIF
One must be a fully paid-up member to enjoy the NHIF benefits. The benefits are enjoyed at NHIF accredited hospitals.
The services currently offered by NHIF include;
- Inpatient services – NHIF has contracted hospitals under three Categories; A, B & C, to provide inpatient medical cover and partial cover for surgical cases. According to the NHIF website, under Category A (government hospitals), members would be able to enjoy full and comprehensive cover for maternity and medical diseases including surgery. Members admitted under contract Category B (private and mission) hospitals will enjoy full and comprehensive cover but where surgery is required, the contributor may be required to co-pay. Those visiting facilities contracted under Category C (private) will continue with the current system where NHIF pays specified daily benefits under the current arrangements.
- Outpatient services – Limited to expenses incurred in respect of drugs, laboratory tests and diagnostic services, surgical, dental or medical procedures or equipment; physiotherapy care and doctors’ fees, food and boarding costs, subject to such limits as may be prescribed.
- Civil servant scheme – Available to civil servants. The benefits include inpatient cover, outpatient cover, maternity cover and reproductive health, exgratia payment, Group life cover and last expense cover.
- Linda Mama services – Provides free maternity services – antenatal and postnatal – at accredited public and private hospitals and faith-based hospitals. All pregnant women who are Kenyan citizens are eligible to join.
- EduAfya Service – Is a comprehensive medical insurance cover for public secondary schools students.
- Supa cover services – Is said to be an advanced cover with the following benefits: –
- Outpatient services – Consultation, Laboratory, investigations, daycare procedures, drugs and dispensation, health education, wellness and counselling, physiotherapy services, immunization/vaccines as per the KEPI schedule;
- Inpatient services;
- Maternal care – Antenatal and Prenatal care and deliveries (Normal delivery and caesarian section);
- Reproductive health services including family planning;
- Renal Dialysis;
- Overseas treatment for specialized surgeries not available locally;
- Rehabilitation for drugs and substance abuse;
- All surgical procedures including transplants;
- Emergency road evacuation services;
- Radiology imaging services (X-rays, CT Scan, & MRI);
- Cancer Treatment.
The supa cover looks quite impressive. A CT scan, for example, costs up to Kshs. 30,000/= in some private hospitals, I note that it is one of the benefits of the supa cover. I wonder whether the supa cover implementation has been successful.
See the NHIF website for more information and for a list of the accredited hospitals.
NHIF is a mandatory deduction. From the look of things and a bit of personal experience, it is quite beneficial.
The information on this website is for general guidance on your rights and responsibilities and is not legal advice. If you need more details on your rights or legal advice about what action to take, please contact a lawyer.
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