Introduction

On 10th January 2022, H.E President Uhuru Kenyatta signed into law the NHIF (Amendment) Act, 2022 with a commencement date of 28th January 2022. This was to notify members (Both employers and Employees) that the title of the Principal Act had now been amended to read the National Health Insurance Fund which establishes a Management Board.

Further to this, the term employer was expanded to include ANY “company” that has entered into a contract of employment with an individual.

Highlights and key areas to note:

1. Beneficiaries

Under the amended Act, beneficiaries now include a person who has not attained the age of 21 years and has no income or has attained the age of 25 years but still undergoing a full-time course, persons with disability, a spouse and a contributor.

 2. Matching of Contributions.

National and County Governments will be required to match contributions equal to that which the employee is legally responsible to pay. However, the law allows the exemption of employers who have a private medical cover in place that provides equal or better benefits for employees to those contained in the Act.

The Cabinet Secretary for Health is supposed to come up with regulations for implementation of the matching on contribution by employers.

3. Procedure for exemption

For any exemption from matching contributions, an employer is required to submit an application to the NHIF Management board with a certificate from the Insurance Regulatory

Authority certifying that their respective employees have been insured, provide details of the benefits of the cover and its validity period. The NHIF Board shall then consider and determine such an application within 30 days.

4. Private Insurance

Members who have a private health insurance cover are therefore encouraged to obtain a certificate from the Insurance Regulatory Authority specifying the details of the cover, benefits and validity period and thereafter submit the same to the NHIF Board to be granted exemption.

5. Enhanced Benefits

An employee wishing to receive enhanced benefits will be required to make additional contribution. However, there is no requirement for the employer to match the additional contribution made by the employee.

6. Private cover

The Fund will only pay for the costs of medical attention after the private Health cover has been exhausted. This will also be subject to the funds limit for that particular benefit.

7. Enhanced Penalties

The Tableau Below Shows the New Penalties:

How can I register For NHIF?

For new members , you can dial *155# on any phone toll free and register as an NHIF member. After registration you will get NHIF member number by SMS. You will now be able to access NHIF self-care services which include Payment of Monthly contributions, Payment of Penalties and Arrears.

NHIF Outpatient and Inpatient Covers

NHIF covers outpatient services including consultation fees, physiotherapy services, drugs dispensation, laboratory examinations, wellness and counseling, health education, and immunization.

The insurer also covers bed charges, consultation, nursing care, medication, surgery, physiotherapy, laboratory services, specialist consultation, and accompanying treatment.

Others include accident fractures and blood transfusion procedures.

The applicable limits (bed charges) as follows:

  • Low-cost government hospitals: From shs.1200.00 daily.
  • High-cost private hospitals: The maximum coverage is Sh.4, 000 per day.

Limits for the other services depend on the hospital category.

Civil servants cover limits: Inpatient and Outpatient Services

For public servants, the cover is limited for both inpatient and outpatient services in some job groups.

Take a look.

In our subsequent publication we look at oncology, Radiotherapy, Diagnostic Tests, Chronic diseases, Imaging services, dental care and surgeries. We shall also highlight services that are not covered by NHIF.

How do you find the new scheme, will it improve provision of Healthcare? Will it improve Healthcare access to wananchi? Please leave your comments in the comment section.

Lawquery Team.

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