The UHC

Supacover

Universal Health Coverage (UHC) rolled out by the Ministry of Health and National Hospital Insurance Fund (NHIF) presents an opportunity to ensure that the people of Kenya have access to the health services they need without suffering financial hardship. The key mandate of NHIF is to mobilize and register members, collect contributions, and pay health insurance benefits based on the various packages that NHIF has developed for Kenyans.
We Cushion Kenyans from

Financial Hardship

NHIF is working under the guidance of the Ministry of Health (MoH) in the UHC scale-up, which presents an opportunity to secure Kenyans access to quality health services without suffering financial hardship. The spirit of UHC is that every Kenyan, regardless of who they are or what they have, can access a hospital and get treatment without suffering financial hardship. However, this means that Kenyans need to equip themselves with health insurance to avoid paying out of pocket, which would lead to poverty.

Old Man Roasting Maize by the Roadside
Unpackaging The

UHC Supacover Benefits Package

The benefits package Kenyans can access under UHC is dubbed the “UHC Supacover” Benefits package. The principle of UHC is that those who can pay should pay and those who cannot be identified and supported. The Government of Kenya has supported the initial 1 million vulnerable families of those identified in the first rollout phase. Members can access the following packages under the UHC Supa Cover:

01.

Our Inpatient Cover under the National Scheme Cover dubbed ‘The UHC Supacover‘ is available to all eligible Members with their dependants. The benefit package includes: hospital stay with health care diagnosis, procedure and treatment including Consultations and specialist doctor’s fees, bed  charges, Nursing care, diagnostic  laboratory & radiology investigations, prescribed medications and dressings.

General Consultation

Daily Hospital Charges

Nursing Care

Physician’s, surgeon’s, anesthetics’ or physiotherapist’s fees

Operating theatre charges

Prescribed drugs/medications and dressings

Specialist consultations or visits

Prescribed diagnostic laboratory or other medically necessary services

Any active NHIF member will be required to visit any hospital empanelled by NHIF that offers the inpatient benefit package.

02.

Our Inpatient Cover under the National Scheme Cover dubbed ‘The UHC Supacover‘ is available to all eligible Members with their dependants. They include: Consultation with a GP, laboratory and radiological investigations including X-rays and ultrasounds, day-care procedures, drugs & dispensation, health education, mental and behavioural health services, counselling, physiotherapy services, Antenatal & Post Natal care, immunization/vaccines as per KEPI schedule, anti snake venom and anti rabies.

General Consultation

Laboratory and investigation including X-rays and ultrasounds

Diagnostics and treatment of common ailments

Drugs & dispensation

Management of chronic ailments (HIV/AIDS, Diabetes, Asthma, Hypertension, cancer)

Health and wellness education/healthcare counselling such as Screening for conditions e.g Cervical and prostate cancer.

Anti snake venom and anti rabies.

Physiotherapy services

Family planning,midwifery,ante-natal and post-natal services

Physiotherapy Services

Referral for specialized services

Immunization/vaccines as per KEPI schedule

Any active NHIF member will be required to visit any hospital empanelled by NHIF that offers the outpatient benefit package.

03.

Caters for pregnancy related health services: facilitation of labour, delivery through Normal delivery or caesarean section and the aftercare for the mother together with the new-born. 

Consultation and treatment for both mother and child

Child birth through normal and caesarian section deliveries

Family planning services

Operating theatre charges

Prescribed drugs/medications and dressings

Specialist consultations or visits

Prescribed diagnostic laboratory or other medically necessary services

Any active NHIF member will be required to visit any hospital empanelled by NHIF that offers the maternity benefit package.

04.

Covers Haemodialysis including specialist review, nursing & dialysis services, intra-care & dispensed medications, routine laboratory tests, nutrition, counselling & follow up care.

Specialists’ reviews

Nursing and dialysis services

Intra-care and dispensed medications

Nutrition

Routine laboratory tests

Counselling and follow up care

Any active NHIF member will be required to visit any hospital empanelled by NHIF that offers the renal dialysis benefit package.

05.

Includes treatment for cancer patients using radiotherapy, brachytherapy, chemotherapy, immunotherapy, Pet Scans and other interventions as guided by the Ministry of Health (MoH).

Radiotherapy

Brachytherapy

Chemotherapy

Immunotherapy

Pet Scans

Other interventions as guided by the Ministry of Health (MoH)

Any active NHIF member can access the surgical benefit package in any hospital empanelled by NHIF.

06.

All surgical procedures including transplants are covered. Cosmetic surgeries are excluded. Cosmetic surgery is where a person chooses to have an operation, or invasive medical procedure, to change their physical appearance for cosmetic rather than medical reasons. The surgical procedure benefit package includes:

Pre-operative reviews

Operations Costs

Surgeon’s and Anaesthetist fees

Nursing care

Bed charges

Prescribed medication during hospital stay and discharge

Any active NHIF member will be required to visit any hospital empanelled by NHIF that offers the surgical benefit package.

07.

Includes diagnostic imaging services for MRIs and CT scans

NOTE: X-Rays & Ultrasounds are covered under inpatient and outpatient packages. 

CT-Scan

MRI

Any active NHIF member will be required to visit any hospital empanelled by NHIF that offers the radiology benefit package.

08.

The Mental & Behavioural Health Benefit Package covers common mental disorders (including depression and anxiety), severe mental disorders (including psychosis, schizophrenia and bipolar disorder); Neurological disorders (such as epilepsy and dementia), childhood disorders, and drugs and substance abuse disorders.

Common mental disorders (depression and anxiety)

Severe mental disorders (psychosis, schizophrenia and bipolar disorder); Neurological disorders (such as epilepsy and dementia)

Childhood disorders

Drugs and substance abuse disorders

An active NHIF member will be required to visit any hospital empanelled by NHIF that offers the mental & behavioural health benefit package.

09.

This covers road ambulance services via the Kenya Red Cross E-Plus ambulances. It caters for on-site evacuation and transfer of a sick member or their declared dependents for treatment to nearest NHIF declared hospital. 

An active NHIF member will be required to contact E-plus through the telephone numbers 1199 (Toll-Free) or 0700395395 or 0738 395395 or the NHIF toll free line – 0800 720 601.

10.

This benefit package covers for treatment costs pertaining to medical and surgical interventions and PET Scan Imaging, arising from a condition that warrants treatment that’s not available in Kenya.

Member or their declared dependant must be cleared by the Ministry of Health for travel.

Call for Comments & Invitation for Public Participation on the Draft National Health Insurance Fund (NHIF) Amendment Act Regulation