NHIF Kenya National Hospital Insurance Fund Kenya

NHIF Act

National Hospital Insurance Fund is a State Parastatal that was established in 1966 as a department under the Ministry of Health. The original NHIF Act of Parliament that set up this Fund in 1966 has over the years been reviewed to accommodate the changing healthcare needs of the Kenyan population, employment, and restructuring in the health sector. Currently, an NHIF Act No 9 of 1998 governs the Fund.

The transformation of NHIF from a department of the Ministry of Health to a state of the corporation was aimed at improving effectiveness and efficiency. The Fund’s core mandate is to provide medical insurance cover to all its members and their declared dependents (spouse and children). The NHIF membership is open to all Kenyans who have attained the age of 18 years and years and have a monthly income of more than Ksh 1000.

NHIF has 31 fully autonomous branches across the country. Each of these branches offers all NHIF services including payment of benefits to hospitals or members or employers. Smaller satellite offices and service points in district hospitals also serve these branches.

NHIF New Rates 2015

NHIF New Rates – NHIF Monthly Contribution

Below are the New NHIF deductions for NHIF new rates 2015 categorized by various monthly income brackets.

Gross Income (Kshs)    Monthly Premium (Kshs)
♦ 0-5,999                                     150
♦ 6,000 – 7,999                           300
♦ 8,000 – 11,999                         400
♦ 12,000 – 14,999                       500

♦ 15,000 – 19,999                       600
♦ 20,000 – 24,999                      750
♦ 25,000 – 29,999                      850
♦ 30,000 – 34,999                      900
♦ 35,000 – 39,999                      950

♦ 40,000 – 44,999                     1,000
♦ 45,000 – 49,999                     1,100
♦ 50,000 – 59,999                     1,200
♦ 60,000 – 69,999                     1,300

♦ 70,000 – 79,999                     1,400
♦ 80,000 – 89,999                    1,500
♦ 90,000 – 99,999                    1,600
♦ 100,000 and above               1,700
♦ Self Employed (special)       500

♦ 80,000 – 89,999                     1,500
♦ 90,000 – 99,999                      1,600
♦ 100,000 and above                 1,700
♦ Self Employed (special)           500

NHIF Rates – Why the new NHIF Rates 2015?

The old premiums allowed for in-patient cover only. The NHIF new rates 2015 will enable NHIF members to have both out-patient and in-patient covers. Services that our members will enjoy under the out-patient cover include:

♦ General consultation with general practitioners
♦ Prescribed laboratory tests/investigations
♦ Drugs/Medicines
♦ Prescribed X-rays and ultrasound diagnosis

♦ Treatment of Sexually Transmitted Infections
♦ Treatment, dressing or diagnostic testing
♦ Family planning

♦ Ante-natal and post-natal care
♦ Clinical counseling services
♦ Health and wellness education

New NHIF Rates – Why should one have two insurance covers e.g NHIF and AAR?

There are products tailored for the public good and those that are meant to be enjoyed by a few people. NHIF provides products that are for the public good. Besides, it is the government’s obligation to provide healthcare to its people and it is doing it through NHIF. NHIF does not discriminate on any illness (whether pre-existing or otherwise) and age group, unlike the other insurance companies. The private cover is meant to cover the few who will afford it.

NHIF Forms

NHIF Registration Form

NHIF registers all eligible members from both the formal and informal sectors. For those in the formal sector, it is compulsory to be a member. For those in the informal sector and retirees, membership is open and voluntary.

To register with NHIF as a member, fill in the NHIF Members Form. To register as an employer or organized group, fill in the NHIF Employers Form.

NHIF Members Form – NHIF Application Form

NHIF Forms – Member Form Requirements

Who is eligible?

Any person…

♦  Who is a *resident in Kenya
♦ Has attained the age of 18 years. (No age limit after the age of 18 years)
♦  Whose total income from salaried or self-employment is more than Kshs. 1,000 per ♦  ♦  month or Kshs. 12,000 per year.

♦  Drawing an income from Kenya
♦  Working under contract or casual terms of employment
♦  It also includes voluntary contributors
* This includes foreign visitors permitted to work or study in Kenya

What do I need to bring?

Kenyan Residents

♦  Copy of National I.D (including spouse if applicable)
♦  Copy of Employer Appointment/Introduction Letter (excludes self-employed/voluntary contributors)
♦   Colored passport photo (including spouse & dependents if applicable)
♦  Original & copies of Birth Certificate(s) for dependants

Foreign Residents

♦  Copies of passport, alien certificate or work permit (including spouse if applicable)
♦  Colored passport photo (including spouse & dependents if applicable)

Foreign Students

♦ Copy of passport
♦  Colored passport photo
♦ Submit the required amount under the Voluntary/Self Employed Category

Where can I drop off my NHIF application form?

♦ At any of our branches located countrywide.

To Download The NHIF Members Form Click Here: NHIF Members Form

NHIF Employers Form

NHIF Employer Requirements

♦ Certificate of Registration
♦ PIN Certificate

To Download The NHIF Employers Form Click Here: NHIF Employers Form

Other NHIF Forms

Other NHIF Forms can be downloaded from NHIF Website: http://www.nhif.or.ke/

NHIF Kenya – NHIF Registration and Membership

NHIF Kenya  – Who is eligible to apply for membership and what is the requirements/procedure?

Any person…

♦ Who is a resident in Kenya
♦ Has attained the age of 18 years. (No age limit after the age of 18 years)
♦ Whose total income from salaried or self-employment is more than Kshs. 1,000 per month or Kshs. 12,000 per year.

♦ Drawing an income from Kenya
♦ Working under contract or casual terms of employment
♦It also includes voluntary contributors.

NHIF Kenya – NHIF Registration Procedure

♦ For the employed persons, the employer is required to apply for the employee’s registration upon employment by completing Registration Form (NHIF 2) and submitting the same to the Fund for issuance of a card.

♦  Self-employed persons should complete Registration Form (NHIF 2) and submit the same duly completed to the Fund for issuance of a card.

NB. The above categories of contributors are subject to the same terms and conditions on benefits, premiums, and penalties.

NHIF Contributions – Why do both spouses have to contribute and can they use both cards to claim?

Under the law, all person resident in Kenya, over 18 years and whose total income is not less than Kshs. 1,000 in any given month are required to contribute to the Fund irrespective of whether the spouse is a contributor or not. Whereas any card can be used to pay a claim at any given time, both cards cannot be used to pay the same claim at the same time because NHIF policy does not give provision for this.

NHIF Kenya – Is there an age limit for registration?

NHIF has a lower age limit for registration of 18 years but it does not have an upper age limit.

NHIF Kenya – Does NHIF accept traditional marriages?

Yes, however, you are required to produce a sworn affidavit from the Magistrate.

NHIF Kenya – Can we cover children above 18 years waiting to join college?

An individual is eligible to be a member of NHIF once he attains the age of 18 years. However, the individual will benefit from NHIF cover if the said individual has been declared a dependant because:

♦ Is undergoing a full-time course of education at a university, college, school or any other educational establishment. In this case, the contributor is required to produce evidence from the educational establishment as proof of dependence.

♦  Having attained the age of 18 years, he is either mentally or physically handicapped and is wholly dependant on and living with the contributor.

NHIF Kenya – If one has been a contributor for some time and has not received an NHIF card, does it mean that such a person is not properly registered?

Yes. One is only a contributor but not a member if they have not submitted a duly completed NHIF 2 form to NHIF for processing and issuance of an NHIF card. It is the responsibility of an employer to ensure that a contributing member is registered and issued with a membership card.

NHIF New Rates – What happens when one changes employment?

The new employer should inform NHIF for updating of records. Likewise, the old employer should inform NHIF when an employee is leaving.

NHIF New Rates – What should be done with the NHIF card when a contributor retires, is terminated, emigrates or dies?

The card is the property of the Fund and should be returned immediately for record and custody. Other than a contributor who dies, the rest can re-apply if they wish to continue with the membership.

NHIF Contributions – Who is responsible for making NHIF deductions?

The employer is responsible for making deductions and remitting to NHIF by the due date, which is the 9th of every month.

♦ A Penalty of five (5) times amount of contributions due will be levied for late payment payable by the employer

♦ All payments for contributions must be accompanied by payroll information showing individual employee’s contributions paid.

♦ NHIF will only refund contributions which have been paid in error.

♦  Contributions to the informal sector will be done by individual contributors.

NHIF Contributions – What is the procedure for asking for an increase of NHIF rebates?

The increase of rebates is granted on the basis of the improvement of facilities and nursing care provided in the hospital. If such improvements have been made then the proprietor can apply to the Fund for consideration.

NHIF Contributions – Can rebates be decreased?

Yes. If the standards laid down by the Board of Management for a given hospital deteriorate then the rebates can either be decreased or the hospital degazetted

NHIF Membership Number and Card

NHIF Membership Card – How long does it take to print a card?

Urgent cards take 24 hours to be printed. Normal cards will take up to 14 days. A member can go to the nearest NHIF office to inquire if the card has been printed once the set deadlines have elapsed.

NHIF Membership Number – What does one have to do to obtain the card for the second or of the wives? Are children of another spouse (s) beneficiaries?

The contributor is at liberty to apply for a card for his second or other wives not named in his first card. The children of a contributor irrespective of their mother or father are eligible to benefit so long as they are dependant on the contributor.

NHIF Mpesa Contributions – NHIF Pay Bill Number ( NHIF Business Number)

To pay via your mobile phone (enabled with Mpesa service) follow these simple steps:

♦ Select the Pay Bill option
♦ Enter Busines no. – Type in 200222
♦ Enter a/c no – Type in contributor’s National Identity Number

♦ Enter amount  – Type in the amount you wish to contribute
♦ Enter pin – Type in your Mpesa Pin
♦ Confirm all details are correct then press OK

Mpesa New Rates – Transaction charges are as follows:

You will receive a confirmation SMS from Mpesa immediately.

Min. Amount (Ksh)	Max. Amount (Ksh)	Charge (Ksh)
10	49	3
50	99	5
100	499	22
500	999	22
1,000	1,499	22
1,500	2,499	22
2,500	3,499	33
3,500	4,999	33
5,000	7,499	33
7,500	9,999	33
10,000	14,999	33
15,000	19,499	33
20,000	24,999	33
25,000	29,999	33
30,000	34,999	33
35,000	39,999	44
40,000	44,999	44
45,000	49,999	44
50,000	70,000	55

NB: This option is only available to voluntary contributors & the self-employed. It cannot be used by companies

 NHIF Kenya Claims

What are the procedures for making an NHIF claim?

There are two types of claims for NHIF namely:
Hospital Claim: A claim submitted by a hospital after allowing NHIF benefits to a contributor. For a hospital claim attach:

♦  Completed and signed admission and claim Form NHIF 8.
♦ Hospital statements/invoices.
♦ NHIF members’ cards.
♦ Certificate of contributions paid where applicable.

♦ Photocopies of both sides of a contributor’s NHIF card.
♦ Photocopies of both sides of a contributor’s identity card. And that of spouse if she is the patient.
♦ Cash receipts/invoices must have a hospital seal.
♦ Case summary

General Claim: A claim lodged directly with the Fund by a contributor after paying his bills at the hospital. This includes foreign claims. For a general claim attach:

1. Duly completed claim form
2. Original invoices and cash receipts from the hospital (these should be stamped/sealed depending on the type of hospital)
3. Copy of national id for the contributor
4. Copy of national id for the spouse or copy of a birth certificate for a child in the event that a dependant was hospitalized
5. Discharge summary
6. Certificate of contributions paid where applicable

NHIF Kenya – Why are claims not paid within the stipulated time?

The Fund strives to pay claims within 14 working days upon receipt from the hospitals. Members who opt to clear the bills with the hospital may launch a general claim directly to NHIF for reimbursement. Once a claim is submitted, it is examined by the Fund to ensure validity before payment. A claim can, however, be rejected and the hospital/member informed accordingly to incorporate either the missing documents or to address the abnormalities identified. This process may delay payments.

NHIF Kenya – How and when does a claim become a late claim?

A claim that is submitted or lodged with the Fund 90 days after the date of discharge.

NHIF Kenya – Who should sign the claims presented to the Fund in the absence of the Contributor?

Only the contributor is allowed to sign the claim form, but in cases where the contributor is unavailable, either because of death or is incapacitated, the spouse or the legal representative of the contributor may sign the claim form. However, in such circumstances, a letter explaining the reasons thereof should be attached.

NHIF Kenya – Does the Fund cover treatment received outside the country and to what extent?

Yes, the Fund covers treatment obtained outside the country. The rate currently is Kshs. 1,700 per day.

NHIF Kenya – In the case where the patient is a contributor and he happens to die, who is entitled to lodge a claim on his behalf and how?

The claim can be lodged by the next of kin who will be required to attach the death certificate. However, payment will be made to the Public Trustee or Legal Representative (administrator of the estate).

NHIF Kenya – If a credit card is used for settlement of medical bill what would be the procedure for claiming benefits?

The contributor will be required to complete all necessary claim documents and attach proof that the hospital has been paid.

NHIF Benefits

NHIF Benefits – Will I visit the hospital of my choice?

Yes, every member shall have an opportunity to visit a facility of their choice as long as it has been accredited.

NHIF Benefits – Will NHIF improve their services?

The organization has an elaborate system of performance management that ensures we continuously improve our services.

NHIF Benefits – Which hospitals will cover outpatient?

All interested hospitals that meet the accreditation standards as set by NHIF will be contracted to provide services to our members.

NHIF Benefits – Will NHIF cover chronic illnesses?

NHIF does not discriminate against any illness.

NHIF Benefits – Will there be enough drugs in hospitals?

The contract that NHIF enters into with the accredited facilities ensures that the facilities continuously have enough drug supply. There is also a Quality Assurance program to be undertaken by the contracted facilities and this is regularly monitored by NHIF.

NHIF Benefits – Does NHIF refund a contributor who never utilizes his/her contributions?

No. The principle of insurance calls for “pooling of Funds” from many insured members in order to pay for relatively uncommon but severely devastating losses that can occur to them. The protection is offered through a premium which is nonrefundable.

NHIF Benefits – Can the NHIF card continue to be used by the beneficiaries after the death of the contributor?

The validity of the NHIF card ceases with the death of the contributor, subject to it having been paid up to the date of death. However, if the deceased had paid for the entire period of the financial year, the contributor’s spouse may apply for membership and will be eligible for cover for the period already paid for. At the end of such period, the spouse will continue to contribute as the principal member.

NHIF Penalties

NHIF Penalties – Who is liable to pay penalty for late contributions?

The employer is liable to pay penalties on late contributions. In the case of self-employed persons, the contributor himself/herself is liable.

NHIF Penalties – Is a contributor required to pay contributions for the period where no income has been earned?

No. However, contributions for this period must be updated where one wishes to claim NHIF benefits.

NHIF Penalties – Is an employee expected to pay arrears of contributions where an employer has failed to remit the contributions to the Fund?

No. An employee is not expected to pay arrears of contributions and penalties where the employer has failed to do so. The law has clearly placed the responsibility of deducting and remitting contributions to the Fund on the employer.

NHIF Penalties – What is the obligation of a self-employed person under the Act?

A self-employed person earning an income of Kshs. 1,000 or above per month or 12,000 per year is required by law to pay a monthly contribution of Kshs. 160 by the 9th of every month. Failure to do so will attract a penalty of 5 times the contribution due. However, due to earning fluctuations, self-employed persons are allowed to make upfront payments in quarterly, half-yearly and on an annual basis.

NHIF Accredited Hospitals

This comprehensive in-patient health cover has been introduced for NHIF contributors and their dependents. The actualization of this package is a culmination of continued reforms at NHIF. Such reforms include efficiency, arising from the decentralization of NHIF services and continued partnership with health providers on enhanced quality services to all members. To enhance these benefits, NHIF has contracted hospitals under three Categories; A, B & C, to provide this in-patient medical cover and partial cover for surgical cases in some of these hospitals. Our members are at liberty to attend hospitals under any category.

NHIF Accredited Hospitals – Category A (government hospitals)

Under Category A (government hospitals), members would be able to enjoy full and comprehensive cover for maternity and medical diseases including surgery. In short, they will not need to pay for anything on admission provided they are fully paid up members of NHIF.

NHIF Accredited Hospitals – Category B (private and mission)

Members admitted under contract Category B (private and mission) hospitals will enjoy full and comprehensive cover but where surgery is required, the contributor may be required to co-pay.

NHIF Accredited Hospitals – Category C (private)

Those visiting facilities contracted under Category C (private) will continue with the current system where NHIF pays specified daily benefits under the current arrangements. NHIF will continue to negotiate with other health providers not appearing in the list below to determine which category of the contract they will sign. Members will be informed of additional hospitals as and when they sign the contracts.

For a comprehensive list of Hospitals, the Number of Beds and Contracts covered by NHIF visit the NHIF Website here: http://www.nhif.or.ke/ Under Hospitals.

NHIF Kenya – NHIF New Rates

NHIF Contacts

National Hospital Insurance Fund
P.O. Box: 30443 – 00100, Nairobi, Kenya
Phone: 0800 720 601, (020) 2723255/56,
(020) 2714793/94, (020) 2722527
Fax: (020) 2714806
Inquiries: customercare@nhif.or.ke
Complaints: complaints@nhif.or.ke
Liaise: info@nhif.or.ke
Fraud: fraud@nhif.or.ke or (020) 2714803

NHIF Website – www.nhif.or.ke

The NHIF Website is www.nhif.or.ke

NHIF Branches

NHIF Branches in Nairobi

NHIF Offices in Nairobi

Building: Nairobi NHIF Building
P.O Box: 30443, Nairobi (020)
Telephone: 2723255 / 2723256 / 2714820

NHIF Industrial Area Branch

Building: Devcon Building
P.O Box: 143, Nairobi (020)
Telephone: 550768 / 550776 / 2538871

NHIF Westlands Branch

Building: Bandari Plaza
P.O Box: 719 – 00606, Nairobi (020)
Telephone: 4449922 /4452462 /4440019

NHIF Satellite Offices in Nairobi

1. Ruaraka
2. Ongata Rongai
3. Buruburu
4. Kenyatta National Hospital
5. Eastleigh

NHIF Branches in Central Province

NHIF Kiambu Branch

Building: Mapa House
P.O Box: 254, Kiambu (066)
Telephone: 2022137 / (020) 8055793

NHIF Limuru Branch

Building: Njengi Plaza
P.O Box: 1250, Limuru
Telephone: (066) 72544 / 72424

NHIF Nanyuki Branch

Building: Laipha House
P.O Box: 673 – 10400, Nanyuki
Telephone: (062) 31400 / 31406

NHIF Nyeri Branch

Building: Lwale Building
P.O Box: 658, Nyeri
Telephone: (061) 2032899 / 2030957

NHIF Thika Branch

Building: Nellion Plaza
P.O Box: Private Bag, Thika
Telephone: (067) 22271 / 31446

Satellite Offices in Central Province

1. Nyahururu
2. Muranga
3. Othaya

NHIF Branches in Coast Province

NHIF  Malindi Branch

Building: Barani Plaza
P.O Box: 1423, Malindi
Telephone: (042) 31269 / 31270

NHIF  Mombasa Branch

Building: NSSF Building
P.O Box: 84101, Mombasa
Telephone: (041) 224360 / 2227460

NHIF Voi Branch

Building: Haji Building
P.O Box: 471, Voi
Telephone: (043) 30052 / 30547

NHIF  Ukunda Branch

Building: Ali Mubarak House
P.O Box: 1665 – 804000 Ukunda
Telephone: (040) 3202904

NHIF Satellite Offices in Coast Province

1. Taveta
2. Kibwezi
3. Mariakani
4. Lamu
5. Kilifi
6. Hola

NHIF Branches in Eastern Province

NHIF Embu Branch

Building: Eastern Emporium Building
P.O Box: 1315, Embu (068)
Telephone: 30546 / 30062

NHIF Kitui Branch

Building: Zein Building
P.O Box: 1466, Kitui
Telephone: (044) 22919 / 22920

NHIF Machakos Branch

Building: KCB Building
P.O Box: 2017, Machakos
Telephone: (044) 22919 / 21686

NHIF Meru Branch

Building: Nhif Building
P.O Box: 2193, Meru
Telephone: (064) 30137 / 30629

NHIF Satellite Offices in Eastern Province

1. Makueni
2. Kajiado
3. Loitoktok
4. Makindu
5. Kangundo
6. Matuu
7. Kerugoya
8. Mwea
9. Chuka
10. Marsabit
11. Maua
12. Moyale
13. Isiolo
14. Mwingi
15. Mutomo

NHIF Branches in North Eastern Province

NHIF Garissa Branch

Building: Northern Site Building
P.O Box: 107, Garissa
Telephone: (046) 2020 / 2049

NHIF Satellite Offices in North Eastern Province

1. Mandera
2. Wajir
3. Moyale

NHIF Branches in Nyanza Province

NHIF Homa Bay Branch

Building: Sonyaco Plaza – 1st Floor
P.O Box: 412, Homa Bay
Telephone: (059) 22030

NHIF Kisii Branch

Building: Ouru Gardens
P.O Box: 3466, Kisii
Telephone: (058) 30426 / 30458

NHIF Kisumu Branch

Building: Reinsurance Plaza
P.O Box: 231, Kisumu
Telephone: (057) 2020638 / 2020028

NHIF Migori Branch

Building: Kimaiga Annex
P.O Box: 1183, Migori
Telephone: (056) 20927 / 20174

NHIF Satellite Offices in Nyanza Province

1. Mbita
2. Homa Bay
3. Nyamira
4. Kilgoris
5. Siaya

NHIF Branches in Rift Valley Province

NHIF Eldoret Branch

Building: KVDA Plaza
P.O Box: 3091, Eldoret
Telephone: (053) 2030749 / 2061400

NHIF Kabarnet Branch

Building: Town Hall
P.O Box: 310, Kabarnet
Telephone: (053) 21844 / 21484

NHIF Kericho Branch

Building: Koineei Plaza
P.O Box: 1948, Kericho
Telephone: (052) 20518 / 20618

NHIF Kitengela Branch

Building: Milele Centre
P.O Box: 540 – 00242, Kitengela
Telephone: (058) 22303

NHIF Naivasha Branch

Building: Jubilee Mall- 1981,
P.O Box: Naivasha (050)
Telephone: 2020818

NHIF Nakuru Branch

Building: AFC Building
P.O Box: 155, Nakuru
Telephone: (051) 2211118 / 2213136

NHIF Nandi Hills Branch

Building: Nandi Hills Plaza
P.O Box: 302, Nandi Hills
Telephone: (053) 643188

NHIF Narok Branch

Building: Maa Towers
P.O Box: 918, Narok
Telephone: (050) 22132

NHIF Sotik Branch

Building: Bureti Tea Sacco Building
P.O Box: 321, Sotik
Telephone: (051) 8031651

NHIF Satellite Offices Rift Valley Province

1. Kapsabet
2. Lodwar
3. Kapsowar
4. Eldama Ravine
5. Narok
6. Maralal

NHIF Branches in Western Province

NHIF Kakamega Branch

Building: Ambwere Towers
P.O Box: 280, Kakamega
(056) 30408 / 30399

NHIF Kitale Branch

Building: Teachers Sacco Plaza
P.O Box: 3091, Eldoret
Telephone: (054) 31879

NHIF Mumias Branch

Building: Bemark House
P.O Box: 967, Mumias
Telephone: (056) 641005 / 641484

NHIF Webuye Branch

Building: NHIF office, opposite Webuye District Hospital gate C/o
P.O Box: 280, Kakamega
Telephone: (056) 30408

NHIF Satellite Offices in Western Province

1. Webuye
2. Busia
3. Bungoma

NHIF Kenya – National Hospital Insurance Fund Video

NHIF Kenya News Updates

NHIF hands members Sh500,000 surgery cover in a deal with hospitals

Updated: 7.10.2016
Source: Nation.

The National Hospital Insurance Fund (NHIF) has started covering surgical procedures up to Sh500,000 after signing contracts with more than 2,000 hospitals.

Chief executive Geoffrey Mwangi said on Thursday fund members can now undergo surgery at no pay at high-end health facilities such as Nairobi Hospital, Aga Khan Hospital, and MP Shah.

“The surgical package is now on. We have signed contracts with over 2,000 facilities that are accredited with us,” he said.

The NHIF did not initially cover surgeries and the move is expected to ease the cost burden on Kenyans undergoing specialized treatment at the local facilities.

The NHIF members seeking minor procedures will enjoy between Sh30,000 and Sh40,000 cover of their medical bills.

Major surgeries will be covered up to Sh130,000 while those undergoing specialized surgeries for diseases such as cancer would be covered up to Sh500,000.

MP Shah chief executive Anup Das said patients at their facilities have been enjoying the benefits since Monday.

“We started offering surgical benefits this week. Those whose bills surpassed the NHIF cut off would mix and match with covers from their other insurance companies,” he said on Thursday.

Those without private insurance will be expected to top up cash, he added.

The insurer had initially announced the benefits in August and pledged to issue further details on the cover.

“They are our own internal guidelines. For instance, we have a team in Naivasha training on filing for claims and also how to identify patients’ conditions and what package they qualify for, whether minor, major or specialized,” said Mr. Mwangi.

The surgical package is a boon to more than two million NHIF members whose monthly contribution were increased more than three-fold.

Monthly contributions were increased from Sh320 to between Sh500 and Sh1,700 in April based on workers’ pay with the promise of enhanced outpatient benefits in public and private hospitals.

For corporates, the enhanced NHIF cover will ease the burden of rising insurance costs that have seen insurers raise premiums in line with increasing medical expenses.