KENYA: Current Benefits under NHIF's Basic Insurance Cover ~ w.e.f. May 2016

INTRODUCTION

The great majority of Kenyans, including University lecturers, have no clear idea of the range or magnitude benefits that they are entitled to under the National Hospital Insurance Fund (NHIF). This realization, made more challenging by on-going negotiations with a private insurer, finally prompted a delegation from the University of Nairobi Health Insurance Group (UNASHIG) to visit NHIF offices at Upper Hill, Nairobi, last Friday (July 7th 2017). 

The officers whom UNASHIG officials met at NHIF informed the delegation that all contributors to NHIF’s Basic or Standard cover enjoy (with effect from May 2016) the same benefits equally, whether they pay KES 1,700/-, 500 or only 150/- per month. Concerning Inpatient treatment, NHIF pays a daily rate towards all aspects of care, not a bed rate. The daily Inpatient rate ranges from a minimum of KES 1,500/- to a maximum of KES 4,000/-, depending on the hospital you choose. This daily rate is payable for a total of 180 days (or 6 months) only, in any given year. The daily rate at Nairobi Hospital, for example, is KES 4,000/-. Thus, the maximum that NHIF can pay for 180 days at Nairobi Hospital is KES 720,000/-.

The purpose of an enhanced group cover, such as UNASHIG seeks, would be to bridge the gap between the expenses billed by the patient’s combined service providers and the amounts that NHIF is obliged to pay under the provisions of the Basic Inpatient cover, as specified below. In our quest for enhanced group cover, the big question which we must collectively answer is: How high do we want to go above the respective components of the Basic Cover specified below, and can we afford it all?  READ MORE

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