The establishing of the National Health Insurance fund has dispatched a ray of hope to a considerable number of Kenyan needy patients. For a nation, where fertility rate averages 4.26 births for every woman and private sector commands the medicinal services sector, meeting doctor’s visit expenses is dependably among top stresses for families. NHIF, in this way, seems to be the best medical coverage for the common mwananchi as it is reasonable and solid. This exclusive article brings to you all of the necessary information about the national medical coverage assistance so you can completely understand and use this service.
NHIF Kenya. What is National Hospital Insurance Fund?
NHIF Kenya was founded in 1966 as a department under the Ministry of Health. Nevertheless, the parliamentary Act that saw the corporation of this Fund had undergone numerous changes are revisions to customise it as per to the needs of Kenyans, profession statuses, and restructuring in the health sector. At now, the Fund is under the governance of the Act No. 9 of 1988.
The NHIF was reconstructed from being simply a department in the Ministry of health to a state corporation in order for it to optimise its effectiveness and efficiency. The fund currently administers medical insurance to all registered members besides their dependents. Anybody at the age of 18 and above is qualified to register for this medical support system as long as they get a minimum of ks 1,000 each month. The corporate has since grown, and presently it holds 31 fully independent branches and remote offices in hospitals across the country. You can now obtain all services through these branches.
Thanks to NHIF medical cover, Kenyans can now obtain medical services in time of need, regardless of whether they have the cash to cover the cost or not. It is one of the means that the government uses to administer health care services to all Kenyans. Presently they cover inpatients and outpatients in NHIF accredited hospitals and facilities all over the country. Though they have a long way to go, they have made some well-known improvements towards the goal of offering comprehensive medical coverage to all Kenyans.
Services covered by NHIF Kenya
- Inpatient services health cover NHIF
- Civil Servants schemes health cover NHIF
- Outpatient services health cover NHIF
- NHIF Supa/Super cover
- Linda Mama services health cover NHIF
NHIF urges Kenyans to take two insurance covers if possible. This is because, in the health care division, there are products tailored for the common good and those that are only attainable by a few people. NHIF covers only for those stocks that can be obtained by the general public. Thus, if you require more specialized services, you can enrol for a supplementary private cover from private insurance companies.
i. Who can register at NHIF Kenya
You are qualified to register for NHIF Fund if you are 18 years and above and earn a monthly salary of ks, 1,000 and over. Both formally employed and informal employees can enrol for the Fund. For those individuals who are employed officially, registration as an NHIF member is mandatory. Those persons in casual employment and retirees have a decision either to register or not to register.
Eligible persons include:
- Kenyan citizens including both foreigners permitted to study or work in Kenya
- Attained the minimum age of 18 years. There is no upper/overhead age limit for NHIF.
- Earns an income from Kenya (employed/or self-employed)
- Earns an income of more than ks.1000 in any given month or ksh,12,000 per year
- Works under a lease/contract or casual basis. It also includes the voluntary contributors.
- Volunteer contributors
ii. How to register to NHIF. Step-by-step NHIF registration pattern
a) NHIF registration as self-employed
The Kenya national hospital Insurance fund has made it simple for people to register for membership. Kenyans can now enrol online through the NHIF portal online and experience the perks that come from its coverage. During the NHIF online registration Self -employed personalities will fill in the Self-Employed Application Form.
- As a willing member, you will be required to present the following documents during your NHIF online registration method.
- A copy of your national ID
- Your employers NHIF code (i.e. if you are employed)
- A copy of your spouse’s national, ie ID where applicable
- Original prints of your birth certificate (including your spouses or dependents that is, where applicable)
- A coloured passport size photo. It is likewise necessary to attach passport photos of your spouse or dependents where applicable
Foreign citizens will also be expected to provide copies of their passport or an alien certificate, and work licenses and copies of passport sized photos. Insert other dependents if it is applicable. This also connects to international students learning in Kenyan institutions.
Ensure that the information you provide is correct. Don’t forget to save your work. Lastly, you will get a notification from the website or through text message informing you of the status of your registration.
b) NHIF registration as an employer
Employers registering for NHIF will present the following documents.
- Certificate of registration
- PIN certificate
They can then fill in the data on the NHIF employer registration form and then submit it along with the document attachment above. Following successful submission, you will get an information from the website and through SMS informing you of your registration status.
All NHIF forms can be easily downloaded from the official nhif.or.ke website.
Requirement for Foreign Residents
- Photocopies of passport, alien certificate or work permit (including spouse if applicable).
- Coloured passport photo (including spouse & dependents if applicable).
- Registration Requirement for Foreign Students.
- Photocopy of passport.
- Coloured passport size photo.
iii. Waiting Period for NHIF
After successfully finishing your registration you will have to wait for some time depending on the nature of Membership you are subscribed to. Those in formal employment will be expected to wait for thirty days before accessing NHIF services. Voluntary members self-employed individuals can wait up to 60 long days to start accessing their services.
a) NHIF new rates 2018
In the beginning, NHIF used to cover for in-patient services only. Nevertheless, after the standards were revised, the Fund now covers for both in-patient and out-patient services for registered members. Out-patient protection services included in these NHIF new charges include:
- General consultation with general practitioners
- Directed laboratory tests/investigations
- Ante-natal and post-natal care
- Clinical counselling services
- Prescribed X-rays and ultrasound diagnosis
- Treatment of Sexually Transmitted Infections
- Treatment, dressing or diagnostic testing
- Family planning
- Health and wellness education
Before NHIF new premium rates were accomplished, self-employed Kenyans were paying ksh 160 monthly. These days, NHIF rates for self-employed Kenyans are ks 500 per month. Premium charges for those working in the formal sector pay different amounts of contributions depending on the salary they earn. These are the present premium NHIF rates for formal workers and are also available on the NHIF official website
The NHIF current rates increase was purely for the good of the public. The Government proposed these rates aiming to cover all services for the Fund registered members including minor surgeries, labs and drugs. These rates are just a picture of how the cost of health care in Kenya keeps climbing. The Kenyan government is now able to fulfil their responsibility of providing health care to all its residents.
b) How to pay your NHIF contributions
All NHIF beneficiaries can pay their contributions through Mpesa or online repositories. This Medical cover is engaged in helping Kenyans access medical services at affordable costs. With the NHIF monthly rate contributions you make, NHIF will recount for the entire bill in private hospitals and the public and mission hospitals under the contract.
i. Paying NHIF via M-PESA. NHIF M-PESA pay bill number is 200222
Self-employed and the voluntary Kenyans can now make their NHIF contributions via the NHIF M-Pesa Paybill number. This alternative has made it more comfortable for Kenyans to make their monthly contributions as well as check their standings. The Safaricom Mpesa pay bill number for NHIF payment is 200222. You can further access it on the NHIF online portal.
M-Pesa payments are, without any doubt the most straightforward option available. You can pay for your NHIF cover at home, in the office or on the go. Thanks to this discovery, you do not have to face the pressure and time wastage of lining out to make payments in an NHIF office. Also, this can be in a matter of minutes.
If you want to make the payment via M-pesa, you can use the following procedure. Only make sure you had a listed Safaricom line with an active Mpesa account and placed with the total amount you want to pay for plus the transaction charges.
- Go to the M-pesa menu and select ‘Pay Bill‘ option
- Key in the official NHIF M-pesa business number which is 200222
- Now Key in your Account number which is your Kenyan National ID Number
- Key in the amount you want to contribute- the least is ks 500 per month, but you can pay in advance for any number of months you want.
- Enter your M-Pesa PIN.
- Check again to assure that you have input the right information
- Wait for a confirmation message
ii. Paying NHIF contributions using Jambo pay
Voluntary members can additionally pay for their NHIF cover through Jambopay. Jambopay is an authorised service in Kenya that allows Kenyans to make payments through their official site www.jambopay.com or Jambopay App. NHIF is amongst the companies listed on Jambopay and to make payments simply select NHIF and complete the payment.
iii. Make NHIF Payment Online
A different method of making your NHIF contribution is by utilising their www.nhif.or.ke website. Visit the site http://www.nhif.or.ke/healthinsurance/registeronline/
- On the menu, click on self-employed
- Enter your passport/National ID or Alien ID
- Fill all the information upon system ID verification
- Attach the scanned copy of your passport/ID or Alien
- Attach your passport photo
- Attach your marriage certificate if married
- Submit upon conclusion of the form
- You will then get an SMS in your bearer contact number.
These payments systems have cut long lines and improved the accessibility of Medical services across the country today. Equity Bank Kenya is among the pathfinder banks which now allow regular NHIF contributions. NHIF is also on its way to start an e-payment system in an aim to better health insurance services for all its clients. One thing to note, though, is that the amount of NHIF payment made after getting medical services depends upon the hospital you are admitted in. Various hospitals have different terms of contract with NHIF which in turn decides the compensation.
NHIF M-Pesa transaction charges
b) Who is responsible for making NHIF deductions?
Deductions are solely made from the salaries of Kenyans who are formally employed. The employer is accountable for making these deductions and submitting to NHIF by the 9th of each month. Should the employer neglect to remit the contribution by the scheduled date, they will be levied with a fine of two times the amount of contributions due. All the contributions must likewise contain the salary of each employee and the amount paid to NHIF. Should a contribution be given in an error, NHIF will fully refund the money. If an employee changes employment, the latest employer is obligated to inform the NHIF so that their records can be updated. The former employer should also inform NHIF that the employee has gone.
ii. NHIF rebates
You can be granted a rebate advance if you prove the improvement of facilities and the level of care rendered in your hospital. Once you are sure of the developments, you can apply to the Fund for recompense.
Nevertheless, if in any case, your hospital fails to meet the standards laid down by the Board of Management, NHIF can decrease your rebates, or the hospital may be degazetted altogether.
iii. Spousal contributions and claims
The law of Kenya demands that every person residing in Kenya and earns a minimum amount of ks 1,000 in any given month has to contribute to the Fund. This is irrespective of whether they are wedded and the spouses are contributors too. Nevertheless, if both spouses make contributions, they can utilise either of their cards to pay a claim. They, however, can’t use both their cards to make the identical claim and at the same time.
iv. What if You Break the Contribution?
Should you breach or miss to make the contribution, you have two choices. You can either pay the principal amount of fee and be restricted from accessing the services for 60 days, or you can remove all the penalties and arrears accrued and continue to enjoy NHIF services as usual.
v. How to check NHIF contributions
You can check your NHIF account via one of two ways, as follows:
Text your Kenyan National ID or Passport number, depending on the document which you used to register to the shortcode that is 21101 in this format of, “ID * your ID number*” for instance ID 33852617. This method can only be practised by individual members. It just takes a few seconds, and you will get a reply containing; NHIF membership number, full name; ID/Passport number; your year of birth; employer name (if you are employed) and date of the last NHIF contribution. This service costs only kshs 10 per SMS.
NHIF statement. NHIF contribution statement online
You can additionally check your contribution status online via the NHIF self-service portal. Nevertheless, to do this, you should have a Jambopay eWallet for individuals or for corporate. If you do not have one, you can easily access and create it through the NHIF portal by logging in with your credentials . In addition, you can additionally request for and view your NHIF contribution statement online.
After you successfully register with NHIF Kenya, you will receive an NHIF card. The card comprises an NHIF membership number which is essentially your Membership number. You will be asked to provide this number before you can make any transactions, for example, paying hospital bills or making your monthly cover contributions. If you have registered but haven’t got the card, that means you are yet to be a member. For the Urgent cards, it can take up to 24 hours to be published. Standard cards take up to 14 days. To get your card picked, visit any nearest NHIF branch office.
i. Wives and children
As a member of the cover, you can list the dependents are beneficiaries of your NHIF cover. In the case of marriages, you will want to prove that the dependent is your partner. NHIF further accepts traditional marriages but only after you provide a sworn affidavit from a magistrate.
In the event of second or other wives, the subscriber can apply for another card to incorporate for them if they were not named in the first card. Children are all eligible for the cover irrespective of the mother and father as long as their subject on the contributor.
ii. Children over 18 years and waiting to join college
Once kids accomplish the age of 18, they are separated from the parents’ NHIF cover. Still, they can benefit from the cover only if;
They are full-time learners in a learning institution, e.g. university, college or any other training establishments. The contributor will have to provide evidence from the educational institution as evidence of dependence.
They are either physically or mentally disabled and entirely depends on and living with the contributor.
iii. How to Retrieve your NHIF Number When You have Lost your Card
Should your NHIF card get lost or something, you can still retrieve your cover number and submit it for transactions.
a) Call NHIF customer care desk on their toll-free numbers 0800720601, (020) 2714793,(020) 2723255/56, and (020) 2722527. Present them with your ID or passport number depending on the one which you used to register. They will check the number and present it to you.
b) Send a text message to the shortcode 21101. You will get a message showing your account status and your membership number.
iv. NHIF Card Replacement
After the loss of your card, it is vital to replace it instantly. The replacement process is straightforward and easy. Deposit ks 100 to any NHIF bank account at any National Bank of Kenya, Kenya Commercial Bank, or Cooperative Bank. Then, visit the nearest NHIF office to you or Huduma centre. Show your deposit slip to the clerk, and you will be issued with another NHIF card.
NHIF Kenya Claims
For NHIF to cover for any member’s medical bills, a claim needs to be made. The NHIF claims can be done either by the hospital or the contributor. These claims could be lodged still if the member received treatment out of the country.
i. Hospital Claim:
This occurs when the hospital is the one presenting a claim after offering medical services to an NHIF contributor. In this situation, you go to the hospital, get treatment and provide them with your NHIF information. It is the obligation of the hospital to make sure they receive the funds due to your medication.
For a hospital to submit this form of claim, they should provide
- An admission application form NHIF 8, properly completed and signed.
- Present the hospital invoices or statement of treatment accorded to the patient.
- NHIF member’s card.
- Certificate of contributions paid where appropriate.
- Photocopies of all the sides of a contributor’s NHIF card.
- Photocopies of both sides of a contributor’s official identity card (ID). And that of the spouse if she is the patient in this case.
- Cash receipts/slip/invoices must have hospital seal.
- Case summary of the patient.
ii. General Claim:
This is a claim presented by the contributor after he has paid the bill for his treatment at the hospital. This occurs when you go to the hospital, get medication then ask for NHIF Fund to compensate the money. This too includes the foreign claims.
To lodge a general claim formally, you need to provide
- Properly completed general claim form
- The Original invoices and cash receipts from the hospital (these should be stamped/sealed depending on the nature of hospital)
- Copy of national ID for the contributor
- Copy of the national ID for the spouse or copy of the birth certificate for a child in the incident that a dependent was hospitalized
- Certificate of contributions paid where it is applicable.
- Evidence of payment in case you used a credit card.
Typically, the Fund will pay for these claims within 14 days after they receive it from the hospital. Nevertheless, if you lodged a general claim, you can do it directly at the NHIF office for reimbursement. After the claim is formally submitted, the Fund examines it to guarantee that it is valid before they make the payment. In the event of any abnormalities in the claim or abstaining documents, the Fund rejects the claim and notifies the hospital or the member to submit the missing documents or correct the abnormalities before they make payments. If a claim is presented after 90 days have passed since the patient was discharged, the Fund recognises it a late claim and may not be compensated. It is consequently wise to lodge claims as soon as one is discharged.
Moreover, the claim should be signed by the contributor. However, an event that the contributor is not possible or is not in a position to sign, their brides or their legal representatives is entitled to sign on his behalf. The claim should then be duly accompanied by a report explaining why the contributor could not sign the claim by themselves. If the parent/guardian was the contributor and they befall to die, the next of kin can start the claim and attach the death certificate. Nonetheless, the payment for the treatment will be made to the Public Trustee or the Legal Representative.
i. NHIF Penalties for Late Payment
NHIF payment scheduled date is usually on the 9th of every month. Going beyond any NHIF payment due date draws huge penalties which must ultimately be cleared for the insurance cover to remain valid. It is important to learn how to check NHIF payments to avoid unnecessary penalties for you and your employers. When the employer avoids a payment, they are legally required to make double principle payments. For informal members of the cover, failure to make NHIF payments will draw an extra fee of 50% the NHIF payment rates. For instance, Ks. 250 on top of Ks. 500 to make a total of Ks. 750.
For those people whose employers are responsible for remitting their NHIF contributions to the Fund, the employers take the load in case of any penalties. Normally, they are fined two times the amount due for contribution due to late remissions.
The voluntary members, though, are directly responsible for any penalties. Nevertheless, since the income for this category of people keeps shifting, they are allowed to make upfront payments in quarterly, half yearly or on an annual basis. Contributors whose releases to the fund are scheduled when they are abroad are assumed to start paying them on the day they return home to avoid penalties.
In the event that no revenue was earned in a particular month, the contributors are not required to pay for the NHIf payments. However, in order to demand NHIF privileges, the arrears during this period must be updated first.
NHIF Kenya has really made it simple for Kenyans to access medical attention when they need it. Currently, members can attend any hospital of their choice to get treatment as long as it is accredited by the Fund. This is a piece of excellent news since the Fund has a list of over 2,000 accredited hospitals countrywide.
The Fund is constantly on its toes to provide continually advancing services to all its members. It does not distinguish any illnesses from their cover meaning that patients with any sort of illness can access medical care. A year ago, the Fund introduced NIF enhanced benefits that observed patients with chronic diseases get even better deals, where they would look for treatment for diseases such as cancer at almost no extra cost. With the new cool benefits, the Fund pays for chemotherapy and radiotherapy sessions for many needy patients.
The contract that the NHIF registers into with the accredited facilities guarantees that the hospital continually has enough drugs supply. It also goes ahead to strictly monitor the Quality assurance program that makes sure these hospitals adhere to this requirement. Hence, if you are under an NHIF medical cover, you are qualified to get drugs that are prescribed by the doctor from the same hospital even if it is just a painkiller drug like Panadol.
The Fund similarly abolished the co-payment requirement for its members. Additional pay for full treatment has been abandoned, and the Fund now caters for the entire treatment charges. This is applicable and is equal to all their members despite of whether they are formal or informal members. Even though it is voluntary for the informal sector, it is greatly advisable that self-employed Kenyans too partake in these benefits by becoming members. The project is said to have more than 24,000,000 beneficiaries. The organisation provides medical cars for evacuation to every member. This service is accessible for people who need instant help and treatment at home or road traffic events. You only require to use Red Cross’ free of charge hotline.
In the event that a contributor departs, the validity of the NHIF card discontinues with their death if he had handled remissions for up to that every month only. However, if they had settled their contributions for the whole period of the financial year, their surviving spouses can then apply for membership and will be qualified for the NHIF cover for the duration of the year that was paid for. If the period expires, then the spouse can continue making the contributions and enjoying all of the NHIF benefits.
NHIF Accredited Hospitals
NHIF has more than 2,000 certified hospitals across the country today. The hospitals are classified into three categories. The Hospitals in category A include all government or the public hospitals. NHIF incorporates the entire bill for the treatment of people in these hospitals. The Category B hospitals cover Private and mission hospitals. NHI members received in these mission hospitals get a fully comprehensive cover also. Category C is for private hospitals. Earlier, patients needed to co-pay for these services, but after the new bill, patients inquiring treatment in accredited private hospitals likewise enjoy a comprehensive cover. On the portal, they have listed a full list of all accredited hospitals.
Inpatient hospital list
Civil servant Hospital list
Outpatient hospital list
Linda mama hospital list