Frequently Asked Questions
NB. The above categories of contributors are subject to the same terms and conditions on benefits, premiums and penalties.
For those in formal employment the contributions are based on the total income earned per month. A standard fee has been set for those in informal sector and voluntary contributors as indicated below:
|Gross Income||Monthly contribution|
|Less than 5,999||150|
|6,000 - 7,999||300|
|8,000 - 11,999||400|
|12,000 - 14,999||500|
|15,000 - 19,999||600|
|20,000 - 24,999||750|
|25,000 - 29,999||850|
|30,000 - 49,999||1,000|
|50,000 - 99,999||1,500|
|Self Employed (Special)||500|
For verification of the information provided to NHIF.
Under the law, all persons resident in Kenya, over 18 years and whose total income is not less than Kshs. 1,000 in any given month are required to contribute to the Fund irrespective of whether the spouse is a contributor or not. Whereas any card can be used to pay a claim at any given time, both cards cannot be used to pay the same claim at the same time because NHIF policy does not give provision for this.
NHIF has a lower age limit for registration of 18 years but it does not have an upper age limit.
Yes, however you are required to produce a sworn affidavit from the Magistrate.
An individual is eligible to be a member of NHIF once he attains the age of 18 years. However, the individual will benefit from NHIF cover if the said individual has been declared a dependant because:
A policy is being designed which once in place, will address this issue.
Yes. One is only a contributor but not a member if they have not submitted a duly completed NHIF 2 form to NHIF for processing and issuance of an NHIF card. It is the responsibility of an employer to ensure that a contributing member is registered and issued with a membership card.
The new employer should inform NHIF for updating of records. Likewise, the old employer should inform NHIF when an employee is leaving.
The card is the property of the Fund and should be returned immediately for record and custody. Other than a contributor who dies, the rest can re-apply if they wish to continue with membership.
The employer is responsible for making deductions and remitting to NHIF by the due date, which is the 9th of every month.
The increase of rebates is granted on the basis of improvement of facilities and nursing care provided in the hospital. If such improvements have been made then the proprietor can apply to the Fund for consideration.
Yes. If the standards laid down by the Board of Management for a given hospital deteriorate then the rebates can either be decreased or the hospital degazetted.1
The company will be required to fill form NHIF 33 and attach certificate of registration and the PIN certificate. A compliance check will then be carried out by NHIF.
A letter advising the Fund of the said changes will be required. You will also be required to fill an amendment form.
No, this will not be possible because the code is the account number that enables payments to be made.
There is no set time frame of how long this should take, but ideally it shouldn’t take more than two days because NHIF has assigned inspectors to cover specific regions.
The resident is required to apply for the registration by completing a Registration Form (NHIF 2) and submitting the same to the Fund for issuance of a card. He will also be required to present original and attach copies of passport, alien certificate or a work permit. If the said foreigner has dependants, he will be required to attach documents such as birth certificates, spouse’s passport or alien certificate and their current passport size photos.
Since NHIF also covers residents, the student will be covered under the self employed category. The student should complete a Registration Form (NHIF 2), present original and attach copies of passport, passport size photo and the required amount and submit the same duly completed to the Fund for issuance of a card.
Urgent cards take 24 hours to be printed. Normal cards will take up to 14 days. A member can go to the nearest NHIF office to inquire if the card has been printed once the set deadlines have elapsed.
The contributor is at liberty to apply for a card for his second or other wives not named in his first card. The children of a contributor irrespective of their mother or father are eligible to benefit so long as they are dependant on the contributor.
A member wishing to make amendments for purposes of updating records should complete an amendment form indicating the desired change.
|1.||In case of change of spouse one will be required to produce one or more of the following depending on each case-
|2.||For change of ID details, one will be required to produce a copy of the National ID.|
|3.||For updating of dependant’s records (child), one will be required to produce birth notification / certificate/immunization (Child Health Card) and/also the necessary documents supporting adoption or fostering of a child and coloured passport size photo(s)|
|4.||For updating of dependant’s records (spouse), one will be required to produce copy of ID, a sworn affidavit from the Magistrate or marriage certificate and coloured passport size photo(s)|
The Fund is not a Social Security Scheme or Provident Fund where members who retire from employment are paid their savings plus interest. The Fund is a social health insurance scheme which pays only when the contingency assured against occur i.e. contributor or a member of his family is hospitalized. Retirees are encouraged to continue with membership to NHIF as voluntary members.
No. At the moment the service is only available to self-employed members.
There are two types of claims for NHIF namely:
Hospital Claim: A claim submitted by a hospital after allowing NHIF benefits to a contributor. For a hospital claim attach:
General Claim: A claim lodged directly with the Fund by a contributor after paying his bills at the hospital. This includes foreign claims. For a general claim attach:
The Fund strives to pay claims within 14 working days upon receipt from the hospitals. Members who opt to clear the bills with the hospital may launch a general claim directly to NHIF for reimbursement. Once a claim is submitted, it is examined by the Fund to ensure validity before payment. A claim can however be rejected and the hospital/member informed accordingly to incorporate either the missing documents or to address the abnormalities identified. This process may delay payments.
A claim that is submitted or lodged with the Fund 90 days after the date of discharge.
Only the contributor is allowed to sign the claim form, but in cases where the contributor is unavailable, either because of death or is incapacitated, the spouse or the legal representative of the contributor may sign the claim form. However, in such circumstances a letter explaining the reasons thereof should be attached.
Yes the Fund covers treatment obtained outside the country. The rate currently is Kshs. 1,700 per day.
The claim can be lodged by the next of kin who will be required to attach the death certificate. However, payment will be made to the Public Trustee or Legal Representative (administrator of the estate).
The contributor will be required to complete all necessary claim documents and attach proof that the hospital has been paid.
Yes, the Fund is pursuing this issue. Talks with St. Mary’s management have already been initiated.
Yes, every member shall have an opportunity to visit a facility of their choice as long as it has been accredited.
The organization has an elaborate system of performance management that ensures we continuously improve our services.
All interested hospitals that meet the accreditation standards as set by NHIF will be contracted to provide services to our members.
NHIF does not discriminate against any illness.
The contract that NHIF enters into with the accredited facilities ensures that the facilities continuously have enough drugs supply. There is also a Quality Assurance program to be undertaken by the contracted facilities and this is regularly monitored by NHIF.
No. The principle of insurance calls for "pooling of Funds" from many insured members in order to pay for relatively uncommon but severely devastating losses which can occur to them. The protection is offered through a premium which is non refundable.
The validity of the NHIF card ceases with the death of the contributor, subject to it having been paid up to the date of death. However, if the deceased had paid for the entire period of the financial year, the contributors spouse may apply for membership and will be eligible for cover for the period already paid for. At the end of such period, the spouse will continue to contribute as the principal member.
The old premiums allowed for in-patient cover only. The new rates will enable NHIF members to have both out-patient and in-patient covers. Services that our members will enjoy under the out-patient cover include:
Ideally the rates took effect in July 2010 when they were gazetted. But due to a court case, implementation has been delayed until the court makes a ruling.
There are products tailored for public good and those that are meant to be enjoyed by a few people. NHIF provides products that are for the public good. Besides, it is the government’s obligation to provide healthcare to its people and it is doing it through NHIF. NHIF does not discriminate on any illness (whether pre-existing or otherwise) and age group unlike the other insurance companies. Private cover is meant to cover the few who will afford.
Yes, extensive social dialogue took place between NHIF and all stakeholders who are also represented in the Board.
The employer is liable to pay penalties on late contributions .In the case of self employed persons, the contributor himself/herself is liable.
No. However, contributions for this period must be updated where one wishes to claim NHIF benefits.
No. An employee is not expected to pay arrears of contributions and penalties where the employer has failed to do so. The law has clearly placed responsibility of deducting and remitting contributions to the Fund on the employer.
A self-employed person earning an income of Kshs. 1,000 or above per month or 12,000 per year is required by law to pay a monthly contribution of Kshs. 160 by the 9th of every month. Failure to do so will attract a penalty of 5 times the contribution due. However, due to earning fluctuations, self employed persons are allowed to make upfront payments in quarterly, half yearly and on annual basis.
Still have an unanswered question? Then feel free to contact us for any further enquiries.