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The State health insurer has introduced stringent requirements likely to lock out millions of poor Kenyans seeking subsidised medical cover.
The National Hospital Insurance Fund (NHIF) has introduced a one-year advance payment system for current contributors.
New self-contributors will also pay Sh6,000 upfront and wait for 90 days before they can benefit from the NHIF health cover.
Voluntary scheme
Under the current voluntary scheme, individuals were required to pay Sh500 a month to get covered after a 60-day waiting period.
The new NHIF changes, which have already been communicated to all branch managers and senior officials, became effective on January 1.
“In order to align the organisation towards attainment of the sustainable Universal Health Coverage and purpose for enhancing member retention, the special full board meeting on December 17, 2019, resolved that the changes be effected in member management module with effect from January 1, 2020,” reads the memo dated January 7, 2020.
The memo signed by NHIF acting Head of Registration and Compliance Robert Otom is also addressed to all healthcare providers.
At the same time, defaulters will be required to pay a penalty of Sh250 for 11 months and pay for another year in advance before waiting for 30 days before the cover is reactivated.
“In case of default for 12 months and above, the affected member will start payment afresh and be eligible for benefits after 90 days from the date of resumption in addition to a one year (12 months) upfront payment, payable within the waiting period while observing due dates, otherwise the rule above will also apply,” reads the memo.
Maternity services
If the voluntary member is accessing maternity services, the benefit will be restricted to six months after the card matures for principal members or spouse declared during registration.
Newborns, however, are exempted from this provision, provided they are declared within six months from the date of birth.
“For inpatient and medical outpatient, additional dependents shall be eligible for benefit after 30 days’ waiting period. This waiting period of 30 days will also apply in case of change of spouse,” it adds.
Eligibility to access specialised services shall be restricted to six months’ waiting period following maturity for new members while defaulters will have to pay up the fine and the advance one year upfront, with a 30-day waiting period.
Other changes communicated are that the number of dependents per card has been limited to a maximum of one spouse and five children.
The changes, however, do not affect the state sponsored programmes, which include the Health Insurance Subsidy programme, Linda Mama, elderly persons with severe disabilities, and Inua Jamii programme.
In October 2019, while releasing a task-force report on NHIF, the Health CS Sicily Kariuki hinted at some changes on the scheme on grounds that it was bleeding financially.
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