- Upon admission in hospital an NHIF member is accorded services and the hospital makes a claim to the Fund for reimbursement
- An in-patient cover for the contributor, declared spouse and children
- Provides comprehensive medical cover in majority of over 400 accredited Government facilities, Mission health providers and some private health providers across the country
- Provides in-patient services in private and high cost hospitals on a co-payment basis
- Comprehensive maternity and CS (Caesarian) package in government hospitals, majority of mission and some private hospitals
- Dialysis at Kenyatta National Hospital & Moi Teaching & Referral Hospital at a rebate
- Family planning – Vasectomy and Tubal Ligation
- NHIF does not exclude any disease.
- Proposed Benefits
Contributions & Deductions
Formal sector employees' contributions are deducted and remitted to the Fund by their employers. This is done by Cheque or through E-banking.
For members under the voluntary category, they pay Kshs.500 per month (Kshs.6000 per annum). For those in formal employment, contributions are made as per their income.
Payment of Claims
Claims are submitted by hospitals directly to NHIF after the contributors have been discharged from the hospitals. The claims are examined by the Fund to ensure validity before payment.
A claim can however be rejected and the hospital informed accordingly to incorporate either the missing documents or to address the abnormalities identified.
The Fund strives to pay claims within 14 days upon receipt of the claim from the hospitals. Members who opt to clear the bills with the hospital may launch a general claim directly to NHIF for reimbursement.
|NHIF seeks to establish partnership with individuals and/organizations to finance health insurance for indigents including orphans & vulnerable children, poor older persons, persons with disabilities and destitute families. The indigents shall be identified by NHIF or the sponsors.|
Enrolled indigents and their dependants shall have access to the current benefit package of inpatient cover in any of the health providers accredited to NHIF countrywide.
Accrediting & Contracting Hospitals
- The Fund strives to accredit as many hospitals as possible so as to ensure all members access NHIF benefits whenever they are across the country.
- NHIF has an objective accreditation criteria and guidelines that aim to encourage hospitals towards quality improvement.
- Accredited organizations are those recognized by the Fund and allowed to offer services to NHIF members and claim reimbursements thereof.
- Accreditation of a health provider takes into account the services, personnel, infrastructure and equipments among other issues that the institutions have. The level of rebate therefore corresponds to the grade after scoring the various aspects.
- The Fund, further contracts the health facilities to ensure they provide services comprehensively. This means that NHIF members walk in and walk out of the facilities fully treated at the cost of NHIF without making additional payments.
- The contracts spell out the obligations of the health provider and NHIF.