Our story began 54 years ago when National Hospital Insurance Fund (NHIF) was established as a department in the Ministry of Health to provide health insurance exclusively for those in formal employment. In 1972 an amendment was made to allow for inclusion of membership in the informal sector.
The Fund was then transformed into a State Parastatal through an Act of parliament, NHIF Act No. 9 of 1998. In July 2015, we commenced Outpatient services together with the Benefit packages that ease the financial burden of our members suffering from chronic illness that include Cancer, Chronic Kidney Disease (CKD) among others.
Today, we provide both In and Outpatient health Insurance to over 9 million households all over the Country.
We endeavor to provide medical insurance cover to all our members and their declared dependants (Spouse and children), by facilitating access to quality healthcare through strategic resource pooling and healthcare purchasing. The Fund's vision is "A world-class universal social insurer." To be achieved through its Mission, 'To contribute towards Universal Health Coverage through the provision of affordable, accessible, sustainable and quality health insurance through strategic resource pooling and healthcare purchasing in collaboration with stakeholders.'
CORE VALUES We commit ourselves to observing the highest ideals of customer responsiveness, ethics and professionalism, team spirit, partnerships and collaborations, innovation and creativity, and corporate social sustainability.
- Increase the numbers of principal members from 7 million in 2018 to 19 million by 2022
- Enhance revenue inflow and its utilization
- Enhance compliance to good governance
- Enhance synergies in information and resource sharing with stakeholders and partners
The governance and management structure is organized as per the recommended international best practice for Semi-Autonomous Insurance Funds. The Board of Management (BoM) is the governing body of NHIF, as set out in the NHIF Act.
We offer health insurance coverage for both In and Outpatient visits at the over 8000 private and public NHIF contracted hospitals countrywide. These services are under the National Scheme dubbed 'SUPA COVER' for those registered and, remit monthly contributions. Rates for the informal sector are at a fixed amount of KES. 500 a month and for those in the formal employment the rates are at graduating scale between Kes150-1700 monthly.
- The Outpatient benefits include consultation, lab investigations, daycare procedures, drugs and dispensation, health education, wellness and counseling, vaccines immunization as per the KEPI schedule.
- We further cover specialized treatment for renal dialysis, radiology and chemotherapy for cancer treatment, surgical procedures, maternal care and reproductive health services, emergency road evacuation, overseas treatment and rehabilitation for drug and substance abuse.
- We cater for the disadvantaged in the society through government-sponsored programs.
These programs include:
- Linda Mama Program, a health insurance cover for expectant mother and their newborn children with no other form of insurance. The program offers ante-natal, delivery care, postnatal care, referral, and infant care.
- Edu-Afya the Secondary School Cover whereby the government launched and rolled out a free comprehensive medical cover for all students in public secondary schools.
- Health Insurance Subsidy Program which covers the poor, orphans and vulnerable children (OVC).
- Health Insurance Subsidy Program which targets the old and persons with severe disabilities (OPSD).
OUR CUTTING EDGE
- Our cover has no upper age limit
- No filtering for pre-existing illnesses on enrollment
- Family based
OUR ACHIEVEMENTS SO FAR
- NHIF's membership has steadily grown over the years to 9Million FY 2019/2020
- NHIF has increased coverage of the informal sector from less than 200,000 in 2005 to Over 3.2M in 2019/2020
- The total contribution revenue has increased from KES 3.1 billion in FY 2006/07 to around KES 55B in projected for FY 2019/2020
- The pay-out ratio has increased to 90% in FY2017/18 from 32% in FY06
- Increased investment in ICT; claims notification, revenue collection (EFT payments, MPESA)
- NHIF on average pays claims within 14 working days
- Revision of hospital rebates to a maximum of kshs.4,000 up from kshs.2,400 depending on category.
- The Fund has contracts with over 8,000 accredited health facilities (Inpatient & Outpatient) and connected to the Fund's system
- Reduced the average length of stay in hospitals from 12 days in FY2003/04 to the current 4 days
- Improved public Image
- Introduction of the self-care portal in 2020 whereby members can select their preferred outpatient hospital, check their status and dependants remotely using the USSD *155#, MY NHIF APP, and the self-care portal on our website. This has helped in enhancing the synergy in information and resource sharing with stakeholders.
- Enhancing accessibility by having 95 fully autonomous branch and satellite offices and our presence in the 47 Huduma centers countrywide.
NHIF'S IMPACT ON THE SOCIETY
In the financial year 2019/2020 NHIF managed to pay for a total of 4.44 million hospital visits, thus 1.43 Million cases for inpatient and 3.01 Million cases for Outpatient services. This in turn has gone into saving millions of Households catastrophic financial losses brought about by health-related issues.
Besides shelter, food, clothing, and education having a health insurance has proven to be a basic need that keeps millions of families from losing their properties, and livelihoods due to unexpected illnesses.