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Members can still choose their preferred health facilities, NHIF clarifies

Health & Science

The National Health Insurance Fund has clarified that the window for its 5.6 million members to choose their preferred health facilities before accessing outpatient health care has not been closed.

Speaking on Tuesday in reaction to an article by The Standard, NHIF’s Director of Strategy, Planning and Marketing Nicodemus Odongo said NHIF members can still choose health facilities they prefer but will only access outpatient health services from April when NHIF pays capitation funds to the selected facilities.

“We often pay capitation money to health facilities every three months and that depends on the number of NHIF members who have chosen the facilities they prefer,” he said.

He added: “So Kenyans can still continue choosing the facilities they prefer and their names will be included when we make our next payout at the end of March. “

It has emerged that it is only 945,640 principal members of NHIF and their 1.3 million dependents who can access the NHIF outpatient cover after choosing their preferred facilities within the NHIF deadline of January 15 this year.

This means that the rest, including 4.5 million principal members and over 20 million dependents will not access outpatient services for failure to choose their preferred health facilities despite making contributions.

“Kenyans should not wait until April to choose their facilities. They should continue doing so even now since that window is still open. If they don’t do so, they will not access outpatient medical services,” said Mr Odongo.

The NHIF outpatient cover is run under the capitation model in which NHIF provides Sh1, 200 per year to accredited facilities for every principal member together with their five dependents.

The insurer pays the funds to health facilities according to the number of its members who have chosen them as their preferred facilities to receive outpatient healthcare.

NHIF CEO Simeon Ole Kirgotty on Monday indicated that many of its members have not chosen their preferred facilities for the outpatient cover despite aggressive public and media campaigns by the insurer.

“Many NHIF members may not realise that to access outpatient cover, they have to choose their preferred facilities. We will scale up our public campaigns even further to raise awareness among our members.”

He added: “Outpatient cover is not the same as the NHIF inpatient cover where members don’t have to choose facilities before accessing services.”

Among the benefits in the outpatient NHIF cover include general consultations with doctors, laboratory tests, drugs, x-ray and ultrasound diagnosis , treatment of chronic diseases like cancer  and sexually transmitted infections, family planning, antenatal and post-natal care, clinical counselling services, health and wellness education among others.

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