National Hospital Insurance Fund (NHIF) In Kenya
National Hospital Insurance Fund (NHIF) In Kenya

National Hospital Insurance Fund

Overview

NHIF is a social health insurance program established by the government in 1967. The insurance fund aims at providing quality, sustainable and affordable healthcare for its members and their beneficiaries. The fund is regularly revised to maximize the benefits towards the Kenyans. Some of the improvements since its creation include the inclusion of persons in the informal sector, the addition, and expansion of outpatient services, the inclusion of private hospitals in the list of accredited facilities and recently the ability of outpatients to visit any NHIF certified facility countrywide.

Statutes

The National Hospital Insurance Fund Act chapter 255 of the Laws of Kenya regulates NHIF. The Act of parliamentwas first established in 1998 and last revised in 2012. The Act has five sections and two schedules. The National Council for Law reporting publishes the Act with authority of the attorney general.

Requirements

NHIF is open for all Kenyans both in the formal and informal sector who are at least 18 years old and earn a monthly salary of 1000. It is compulsory for employees in the formalindustry to enroll for NHIF membership. However, membership is open and voluntary for those in the informal area. Members in the formal and informal sector may enlist their spouses and children as beneficiaries.

Contributions

Members contribute different amounts depending on their income levels as determined by NHIF at different times. Those in the informal sector are expected to pay a monthly fee of KSH 500. All contributions should be submitted by the ninth of every month.

Benefits

The benefits enjoyed by NHIF contributors are stipulated in the Benefits Package of November 2015. The package includes the totality of the health services to which members are entitled and the extent to which NHIF provides funding. The packageincludes services such as consultation, laboratory, drugs administration and dispensation, dental services, radiological examination, nursing and midwifery services, surgical, radiotherapy and physiotherapy services.

How it works

NHIF, like other insurance policies, operates by risk. Money from all the contributors is pooled and used to finance medical care for those who fall ill at a particular period. Since not all people fall sick at the same time, the fund can cater for the needs of those who fall sick.

Challenges

NHIF faces several challenges in its running including the management of funds and their allocation to various patients and hospitals. While making efforts to improve the services to their members, NHIF sometimes finds itself limiting these services. For instance, the recent improvement to allow outpatients to use their card at any accredited facility has led to propositions of reducing the number of times NHIF pays for medication in a year. Also with the improved services, members are likely to pay more to sustain the program.

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