KENYA: Contents of a Letter Dated July 23rd to NHIF's Acting CEO Referencing the Initial List of Unashig Members Who Have Paid Up for the Recently Revised Enhanced Health Insurance Cover

Further to our letter to you of June 18^th 2019, and further to the Excel Tables attached to a June 19^th email from Fardosa Abdi, we are pleased to send you the attached list of Unashig Members who are ready for the immediate launch of our Enhanced Health Insurance cover. The list contains family details of 87 Unashig Members, as well as the benefits and limits which each family is paying for.

Those included on the list have raised a total of over KES 8,500,000/-. The final numbers are likely to rise to around KES10 million in premiums deposited in the bank by between 95 and 100 Members, depending on how Unashig and NHIF finalize the details of the insurance contract. We wish to have the launch in very early in August 2019, since a July launch seems impossible now.

This is how we at Unashig have interpreted NHIF’s new Enhanced Health Insurance policy – and the summary Excel Tables and the ten more disaggregated tables which actualize the policy: Each family is first classified by the Unashig Member’s age into two age-groups – as either Below 60 or 60+.  The summary and detailed tables are likewise designed, respectively, for those aged below 60 and those aged 60 or over. We understand and accept that each family must stick to its age-group, and that each is required to pay the aggregate premium specified for the age-group in terms of each Benefit Layer and any of the 5 more specific benefits that it actually chooses and wishes to enjoy – taking into account its size such as M+0.... or the like). 

In the view of Unashig’s Board, the tables are a menu (with each ‘item’ fully-priced) from which each Member/Family is free to pick what to pay for, and what not to. Thus, a family which is no longer in the child-bearing age will not see the need to pay for Maternity cover, and should not be compelled to do so. That is the common view of our Members as well. Likewise, those who think that they already have adequate Outpatient cover through NHIF’s mandatory Basic Cover and/or the University’s (or other employer’s) Staff Clinic – or some other aspect of Universal Health Care – should not have to pay for it under the Enhanced Cover as well, or to come up with an alternative benefit or ceiling outside of the set menu. As we understand it, Dental and Optical covers are for the same reason also optional.

Due to cost implications, about 30 of our Members – each of whom had prepaid a premium of KES 66,000/- by April 2019 – are hesitant to join the scheme until there is greater clarity about how a family’s age-group is to be determined. More specifically, they wait to know whether a family’s age-group is to be determined by the age of the individual who is officially a Unashig Member, or by the age of the oldest family member. Our own computations are based on the age of the Unashig Member in any given family. If NHIF is of another view, it will affect the number in the Final Version of our list of Members to be covered.

Some of our members, discouraged by the sudden increase in premium amounts, now wish to take the opportunity offered by NHIF to join the Enhanced Health Insurance scheme half-way through the first year of our Enhanced Cover. We would appreciate knowing how NHIF proposes to compute the prorated premiums for the half-year.

Finally, we ask you to let us know the specific team at NHIF with which three or four of us should start meeting to iron out the relevant contract details and the modalities for launching our Enhanced Cover in early August. We propose that the first meetings be held later this week and early next week.

(Sgd). Mauri Yambo
Unashig CEO

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.