Unashig ~ NHIF's New Terms and Conditions for Enhanced Health Insurance Cover

NHIF released to Unashig today the tabulated details of a new set of Enhanced Health Insurance benefits and limits, as well as the premiums associated with them. This is a major step in our push to launch our group cover this July. Here below are the details as received [You will notice that the new package is a dramatic departure from the details that we were given in the draft contract almost two years ago]:

1. There is no set, or minimum, number of Unashig members who must subscribe before we can launch the cover. Very importantly, this is because the premium to be paid by any Member (+ Dependents) is not going to be averaged over the total number of participating Unashig Members. Each family will be given a chance to choose the package it wishes to have and can afford. 

2. NHIF will not accept applications from individual families for the Enhanced Cover. Only members of a group, such as Unashig, qualify; and all payments must be made as an annual lump sum amount through Unashig. Unashig will not get any commission for this.

3. Members can join the scheme only at the beginning of cover -- for example, July 2019; or halfway into the year, for example, February 2020. Whether a member joins at the beginning or at the half-way point, the year of cover will end on the same date for everyone covered – for, example, a date in June 2020. However, those who join in mid-year will pay a prorated premium – not the whole premium for the year. How this will be calculated is not yet clear.

4. The packages offered are based on the broad age-group of the principal Member and Spouse, and of course the ages of the children. 

5. Principal Members are divided into two basic categories: Those under 60 years of age, and those aged 60 years or more. Those aged 60 years or more will be asked to pay significantly more than those aged below 60 for any package of benefits and limits that their respective families may choose for themselves. Three basic tables are given that capture:

a) A range of "Benefit Limits" (in KES) for specified Benefits (i.e. Inpatient, Maternity, Outpatient, Dental and Optical): Here, the benefits related to Inpatient Cover, for example, range from KES 500,000/- to KES 10,000,000/-, while Outpatient benefits range from KES 50,000/- to KES 300,000/-. Dental and Optical benefits range from KES 5,000/- to KES 30,000/-, respectively. Maternity cover is also provided for, with benefits running from KES 50,000/- to KES 250,000/-. How maternity cover will benefit those past the child-bearing age remains unclear.

b) Annual Contribution Rate for those under 60 years of age: Here, we notice that only those below 60 years of age, and in the category of M+0 to M+3, have the opportunity to choose a LIMITED number of benefits that do not require the payment of any additional sum over-and-above the KES 66,000/- already paid as premium. 

c) Annual Contribution Rate for those aged 60 and above: All those aged 60 years and more will be required to pay additional premiums beyond the KES 66,000/- for any of the benefits options that they may choose.

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In addition to the foregoing, NHIF requires that each Member intending to be participate in the Enhanced Insurance cover must provide in advance, through Unashig, the age of each named dependent to be included. Such details should be sent by email to unashig.kenya@gmail.com. Always remember to include your Unashig Membership number in all written communication with Unashig Kenya PLC. Also take note that pre-existing conditions must be confidentially notified by the Member in writing to NHIF prior to the commencement of cover.

Unashig’s own requirement is that Members to be covered should have paid the Membership Application Fee (KES 2,000/-), the Insurance Processing Fee (KES 1,200/-), one CB share if a Full Member (KES 2,000/-) and at least 2 CB shares (KES 2,000/- each). It is noted that most of those who have paid the KES 66,000/- premium have also paid the other amounts indicated above.

READ: Three Basic Tables for the Revised Enhanced Health Insurance Cover

READ (and pay particular attention to the Benefits Schedule): Full Dossier of NHIF's Enhanced Health Insurance Benefits, Limits and Premiums for Below 60 and 60+ Clients, Year 2019

Letter to NHIF's CEO Concerning New Tabulations/Options for Enhanced Health Insurance Cover

[Reproduced below is the substance of a letter mailed by the Unashig CEO this afternoon to NHIF's Ag. CEO]

You will recall that two members of the Unashig Board joined me in a meeting in your office in April this year. Our purpose was to find out how soon Unashig Members could launch their Enhanced Health Insurance cover. You advised us that a new policy would be in place by mid-June 2019, and that new contracts reflecting the new policy might be signed to take effect in July 2019.

Unashig Kenya PLC is a company established by current and past academic and non-academic staff of the University of Nairobi, as well as other shareholders who are Kenyan citizens, to leverage our group size to meet enhanced health insurance costs. We believe that  group-funding should bring down the premiums to a more affordable level for every participating family. Some 165 members have already contributed over KES 11 million toward the Enhanced Health Insurance. The money is in the Unashig bank account at KCB awaiting remittance to NHIF depending on the requirements of your new policy. The money was collected on the basis of a premium rate (indicated to us in a draft contract with NHIF in 2017-18) of  KES 66,000/- per family size of up to M+3. Depending on the affordable options available, the number of Unashig members paying tor the cover could easily rise to 350 or more, in response to the continuing breakdown of University Health Services.

Quite obviously, the times have since changed. Consequently, we are interested to know if any of your newly available benefits-packages and related limits and premiums might be attractive, and affordable, to our members within the premium ceiling of KSH 66,000/- per M+3. Alternatively, we would like to consult with our members concerning the package to opt for even if it should

require an additional premium over and above the KES 66,000/- previously set for a family of 4 (that is, or M+3).

An early response from your office would be greatly appreciated. We are not asking for a grant. We simply wish to have NHIF cover fully paid for by us, with the first year of cover beginning in July 2019.