NHIF members will no longer choose outpatient hospitals

Written By: Margaret Kalekye

Kenyans can now get out-patient treatment in any facility from all designated health facilities provided by the National Hospital Insurance Fund (NHIF) countrywide.

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NHIF members were previously required to select hospitals that they can easily access for outpatient services.

According to the national insurer, the changes allow for portability of services and will apply to both members of the national scheme and the various managed schemes.

Hospitals that have not yet signed the new contract with the insurer that took effect Wednesday (November 1st) should not offer services until they do so.

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In a statement, NHIF says it is responding to needs of beneficiaries while adapting to changing market dynamics.

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“The funds is responding to the needs of its beneficiaries and at the same time adapting to the changing market dynamics while promoting the aspiration to universal health care coverage with a view to facilitate access to affordable, sustainable, equitable and quality social health insurance” said NHIF chief executive Geoffrey Mwangi.

Another relief for contributors is the scrapping of co-pay.

“In line with these changes, members will no longer co-pay as was the case previously and will continue enjoying the same benefit package,” added the CEO.

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Members can now access a designated list of contracted and declared healthcare facilities in all NHIF service points, its website and social media pages.

Chronic diseases

Early this year NHIF introduced an enhanced cover that came as a big relief for low-income households that were unable to access treatment for chronic diseases in private hospitals.

The NHIF pays up to Sh500,000 for a kidney transplant and Sh10,000 per dialysis session.

Records show dialysis is the single-largest driver of claims, highlighting the growing cases of kidney ailments among Kenyans.

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The NHIF paid hospitals Sh839.9 million in the six months to December, up from Sh139.8 million in a similar period a year earlier.

It received 86,776 claims for dialysis sessions in the first half compared to 37,177 in the same period a year ago.

Cancer patients are entitled to a Sh25,000 cover for chemotherapy session and Sh18,000 for radiology.

Expectant mothers are entitled to a maternity cover of up to Sh10,000 for normal delivery while a C-section delivery is covered up to Sh30,000.


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