Details of police Sh4.5 billion medical cover

More than 122,000 police officers, their spouses and children will from today enjoy Sh4.5 billion comprehensive medical cover under the National Hospital Insurance Fund (NHIF).

Up to five children and one spouse of the employees of National Police Service and Kenya Prison Service will be covered under the medical scheme that officially starts today.

Dependent children will be eligible for cover up to 21 years or to the age of 25 if enrolled in full-time education.

Terror injuries

Details of the cover indicate that officers who may be caught up in acts of terrorism will be adequately covered.

Those who may lose limbs or parts of their body that require replacements will also be covered under the scheme.

“Prosthetic devices needed as part of treatment, which includes external artificial body part, such as prosthetic limb or prosthetic ear are included,” read the details of the cover.

In addition to these, members who suffer from an occupational injury, illness or disease will access any NHIF accredited hospital regardless of job group and medical bills shall be paid in full.

Worth noting is that all pre-existing, chronic, congenital, HIV Aids, sexually transmitted diseases (STDs) will be covered up to full limits.

NHIF Chief Executive Officer Geoffrey Mwangi termed the scheme as “the best they could get in the market”.

“It will take care of the family and we will give them a comprehensive medical cover,” said Mwangi.

Mwangi said the police service and the Kenya Prisons signed a contract with NHIF for provision of comprehensive medical cover.

He said the officers’ cover is bigger and superior to that of civil servants.

An NHIF internal memo seen by Sunday Standard requests all staff to accord the beneficiaries of the scheme support to ensure seamless access to benefits.

Finer details of the cover show that all police and prisons officers in grades PG1 to PG8 will get unlimited inpatient and outpatient cover.

Also falling under this category will be civil servants under job group A to L.

Mwangi said civil servants within the police service and the Kenya Prisons will also benefit from the cover.

There are 121,268 officers under this category.

Officers under grade PG8 to PG10 will have an inpatient cover of Sh2.75 million and an outpatient cover of Sh300,000. Civil servants under job group M and N will also fall under this category.

PG10 to PG11 and civil servants under job group P will enjoy an inpatient cover of Sh3 million and an outpatient of Sh400,000.

Civil servants of job group Q and officers under PG12 will have an inpatient cover of Sh3.25 million and an outpatient cover of Sh450,000.

And all civil servants under job group R-T and officers under PG 13-15 will enjoy an inpatient cover of Sh3.5 million and an outpatient cover of Sh500,000.

Optical needs

All beneficiaries will have optical cover of Sh100,000 flat rate and Sh60,000 for dental cover.

The out-patient optical cover provides for the cost of lenses and frames, prescription for ophthalmic treatment and eye lenses.

“The out-patient dental cover provides for cost of consultations, x-rays, root canal, extractions and scaling accident related dental treatment,” reads the document.

Medical check-ups are allowed once a year for a member and declared spouse.

An analysis of the scheme details shows that officers will largely attend public hospitals.

Access to the hospitals will be based on three categories.

Category one will include job groups A-L, PG1-PG7 for police officers and PG1-PG8 for prison officers.

Category two will include officers in job groups M-Q, PG8-PG10 for Police Officers & PG9-PG12 for police officers.

And category three will include members in job group R-T, PG11-PG12 for Police Officers and PG13-PG15 for prison officers.

Other details show that emergency caesarean section will be covered up to a limit of Sh200,000 as stand-alone benefit.

“Last expense rider of Sh200,000 per principal member and Sh50,000 for one spouse at no additional cost,” the document reads.

Treatment costs arising from a condition that warrants treatment overseas will be covered in full.