NHIF INSURANCE COVER

 

Information is power as always said but in contrary “inadequacy or lack of information can lead to under-utilization of available and necessary resources that we deserve”

I have had a chance at some point to work with NHIF and had various field events. This gave me a clear overview of perception of the people in both rural and urban setups about this organization and the services that it offers.

Some of the issues to be looked into cut across both the self-employed and employed persons. I have complied them into two and I`m going to start with the self-employed.

 

Self-employed/organized groups.

This is a volunteer membership. Anybody without any formal employment and is above 18 years is eligible to become a member. After registering, one is supposed to be paying sh. 160 per month but can pay for the months ahead if he/she is in a position to.

Principal member, his/her children below 18 years of age are covered by this membership. They are eligible to inpatient services in all government, private and faith-based hospitals for all medical conditions apart from cosmetic procedures.

However, failure to comply with this payment leads one to pay some penalty fee. For a month penalty is 160 x 5 = 800 + monthly contribution amounting to sh. 960.

Payment dateline for any month is date 9th of the next month. Say January would be 9th of February.

Employed persons.

These are the civil servants and disciple services (Kenya police, Administration police and Prison service). All employees are supposed to register to become members. Employer will deduct NHIF contributions from all employees and remits the same to NHIF with a payroll by-product.

Members will therefore be in a position to access both in-patient and out-patient services.

  1. In-patient cover.

This will be on referral basis from the selected out-patient health-care facility, selected by the principal member. It cover medical and surgical conditions which require admission. It include:

  1. Nursing care
  2. Rehabilitation service
  3. Radiology services
  4. Operating theatre services
  5. Diagnostic, laboratory or other medically necessary services
  6. Pre-hospitalization procedures i.e. x-ray, laboratory.
  7. Specialist consultations.

To access this cover, member is supposed to produce: a copy of NHIF card and a copy of principal`s id.

  1. Out-patient cover.

It includes the following:

Consultation, optical care, dental care, annual medical checkup, day care services such as surgery, radiological examinations, laboratory investigations, drugs administration and dispensing, nursing and mid wifery.

To access this cover one is supposed to produce the following:

  • A copy of NHIF card or
  • A copy of national identification card or staff identification card.

For more explicit information on the employed check out for my next blog post./ I welcome any correction on any mistake, mistyped or misquoted context.

For more clarification visit any nearest NHIF office or visit NHIF website

 

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