Members
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Members
The National Health Scheme (NHS) dubbed “UHC Supacover” is the primary health insurance cover for all members and their declared dependants as provided in the Amended NHIF Act of 2022. The membership is both statutory (employed) and voluntary (self-employed) to all Kenyans who are ordinarily residents in Kenya and who have attained the age of 18 years. Members enjoy inpatient, outpatient services and special benefits packages. Voluntary contributors pay Kshs. 500 every month for the principal members and their declared dependants.
The Enhanced Scheme (ES) is a negotiated comprehensive cover between a procuring entity and NHIF. It is an enhancement from the National Health Scheme (NHS). covers include Civil Servants, National Police and Prison Service (NPS/KPS), County Governments, Parastatals, Pension Schemes for Retired Public officers e.g. The Kenya Association of Retired Officers (KARO), Water & Sewerage Companies, Public Universities among others.
Linda Mama is the Government’s expanded free maternity programme administered through NHIF that covers:
Edu Afya is a comprehensive medical scheme for all public secondary students covering all students captured under the National Education Management Information System (NEMIS) and registered with NHIF.
One can check the scheme they are in by sending a text message with the format [ID {space} Your ID Number] e.g. (ID 12345678) to 1550, by dialing *155#, using the ‘My NHIF‘ App which can be downloaded from Google Play Store or Apple Store or the NHIF online Selfcare Platform.
All Kenyans above 18 years are eligible to register for NHIF membership. One can apply for a single membership or family membership which allows them to include their declared spouse and children below 18 years of age. NHIF doesn’t check for pre-existing conditions.
Self-employed members can register online by using the NHIF Selfcare Platform, by dialing *155# or by using the ‘My NHIF‘ App which can be downloaded from Google Play Store or Apple Store. After registering online, members are required to visit the nearest NHIF office or Huduma Center for finger biometric registration. They can also visit any of our nearest offices or Huduma Centres countrywide with the following documents:
Employed persons can also register using the process outlined above or they can physically visit any of our branch offices or Huduma Centres countrywide with an introduction letter from the employer or with the registration form stamped by the employer.
Afterwards, they will send their NHIF member numbers (which they will get on the platform they register from) to their employers for monthly remittance.
It takes 60 days for self-employed persons to access services and 30 days for those in formal employment. NHIF faced out the use of physical cards and one can now access services from hospitals using finger biometrics.
Principal members will be required to present their National Identification Card to access services in hospitals. Hospitals will then do a finger biometric identification to verify the member. In case finger biometrics do not work, hospitals will send a One-Time-PIN (OTP) to the member’s declared phone numbers for verification.
Declared dependants will be required to present the Principal Member’s National Identification Card. Hospitals will then send a One-Time-PIN (OTP) to the principal member’s declared phone numbers for verification.
NHIF covers the nuclear family which includes the principal member and legally declared spouse and children. One can not include other relatives apart from your legally declared spouse and children. One can only add one spouse to their cover. Additional spouses will require individual covers. One can add orphans and/or adopted children to their cover by obtaining proof of legal guardianship/adoption letter from the children’s department at the county offices.
You will be required to physically visit our offices or any Huduma Centre countrywide to add a child to your cover. You will need to present the following documents:
One will be required to physically visit any NHIF office or any Huduma Centre countrywide to add a spouse to their cover. The following documents will be required:
*The newly added spouse will enjoy the benefits of the cover after 28 calendar days.
One will be required to physically visit any NHIF office or any Huduma Centre countrywide to remove a spouse from their cover. One will need to present the following documents:
One will be required to physically visit our offices or any Huduma Centre countrywide to change their spouse. One will need to present the following documents:
*The newly added spouse will enjoy the benefits of the cover after 28 calendar days.
National Health Scheme (NHS) members can access various benefit packages under the “UHC Supacover” They include:
*Dental and optical services are not covered under the Supa Cover
The scope of cover for inpatient benefit package includes:
The scope of cover for outpatient benefit package includes:
Preauthorization is a type of legal restriction placed on certain health services, medications and tests by NHIF. This obliges the hospital to check and take permission from the NHIF first, before providing certain services to determine if the patient’s plan covers the cost of the said service or not.
*Emergencies are acted upon as per the constitution and the contract between NHIF and the hospital.
Turnaround for response is up to a minimum 24 working hours or a maximum of 48 hours once all relevant information has been received.
Comprehensive hospitals offer all-inclusive services of all the packages to members of the National Health Scheme (NHS) without pay (walk in and walk out). The scope of service covered without out-of-pocket payment.
Non-comprehensive hospitals allow a members seek treatment however the member may incur co-payments for services.
One can only choose one hospital for the principal member and one for each of the declared dependants depending on their locality. One can choose a hospital that is nearest to them. Hospital changes are done every quarter.
One can change their outpatient facility using the NHIF Selfcare Platform,by dialling *155# or by using the ‘My NHIF’ App which can be downloaded from Google Play Store or Apple Store.
Members of the National Health Scheme (NHS) can only access hospitals under
comprehensive contracts. They can however access non-comprehensive hospitals only on referral when undergoing specialized surgeries.
Click here to get a list of hospitals that can be accessed by the National Health Scheme (NHS).
Members of the Enhanced Scheme (ES) can access hospitals under comprehensive or non-comprehensive contracts depending on their individual allocations.
Click here to get a list of hospitals that can be accessed by the Enhanced Scheme (ES).
For the convenience of our members, we have adopted several payment modes to make it easy for members to remit their contributions. One can pay through:
Every registered self-employed member is required to make a monthly contribution of KES 500 to their accounts. Existing members are required to pay on or before the 9th of the following month to avoid penalties.
If payments are made after 9th of the following month, then a penalty of 10% (KES 50) of the voluntary monthly contribution will be surcharged. A member will be required to pay outstanding arrears and/or penalties to access services.
The following steps are used to make monthly contributions through MPESA.
*Please note that you are supposed to use your National Identification Number as your Account Number and not your NHIF Member Number. You have to pay premiums up to the current month for your cover to be active. Safaricom’s Terms and Conditions Apply
The following steps are used to pay for penalties through M-PESA.
*Please note that you are supposed to use your National Identification Number as your Account Number and not your NHIF Member Number. You have to pay premiums up to the current month and pay all penalties for your cover to be active. Safaricom’s Terms and Conditions Apply
If one makes an error during the process of payment, for example, if one inputs their NHIF Member Number as the M-PESA Account Number instead of their National Identification Number, they can visit our Accounts Department at any of our offices with a copy of their National Identification Card with the M-PESA message they received from Safaricom capturing the erroneous transaction they made and they will get assistance.
If a member defaults for more than 12 Months, they will be treated like a new entrant/member in the scheme. They can reactivate their NHIF cover by paying KES 1,500 which will act as their three months’ contribution. They will then have to wait for 2 months (60 days) from the date of payment for their cover to be active. One is advised to subsequently make monthly payments to avoid penalties.
One can get their NHIF account statement by:
NHIF Building, Community Area, Ragati Road
P.O. BOX 30443-00100, Nairobi, Kenya
Toll Free Telephone:
0800 720 601
NHIF Branch Network
