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National Hospital Insurance Fund – NHIF

National Hospital Insurance Fund was established in 1966 as a department the Ministry of Health. Today the Fund is governed by  the NHF Act 1998. The transformation NHIF from a department in corporation was aimed at improving effectiveness and efficiency. The Fund’s core mandate is to provide  medical insurance cover to members and their dependants (spouse and children) in Kenya.

NHIF membership is open to Kenyans 18 years and above who have a monthly income of Sh 1,000 and above ($13.3). NHIF  has 23 branches across the country. Each offers NHIF services, including payment of benefits to hospitals members or employers. Smaller satellite offices and services points in district hospitals also serve the branches.

In the financial year 2008-2009, the NHIF had 2.3 million members (1.9 million in the formal sector and 376,000 from the informal one),up from 2.07 million in 2007-2008.In 2008-2009, the NHIF collected sh5.3 billion(466.25 million) from members, up from sh4.8 billion ($60 million) the previous financial year.

The NHIF provides provides an inpatient cover of up to Shs396,000($5,280) a year for the contributor, spouse and children. It provides an inpatient  medical cover in certain hospital across  the country. It works with more than 400 accredited Government, private and mission health providers. The fund reimburses hospital hospital claims according to daily rebates. It accredits as many hospitals as possible to ensure members access NHIF benefits whenever they are. It has objected accreditation guidelines that encourage hospital to improve service. The accredited organizations are those NHIF recognizes and allows to offer service to members and claim reimbursements. Accreditation takes into account a hospital service, personnel, infrastructure and equipment. The level of rebate corresponds to the grade scoring the various aspects.

•Category A: (Government hospitals); Members will enjoying comprehensive cover for maternity and diseases, including surgery, They will not pay on admission provided they are full paid members.

• Category B: Private and mission hospitals. Members enjoy comprehensive cover but co-pay for surgery.

• Category C: Private hospitals. NHIF pays specified daily benefits.

NHIF covers those in formal and informal employment. Those leaving formal employment (retirees) could update their membership records and pay Sh1, 920 ($25.6) a year or Sh160 ($2.1) a month to enjoy uninterrupted NIHIF benefits.

The NHIF has proposed to increase the monthly contributions. It is proposed that employees who earn less than 5, 999 ($74.9) pay Sh150 ($1.875) a month. Those who earn between Sh6,000 ($75) and 7,999 ($99.9) Sh300 ($3.75), Sh8,000-Sh 11,999 (Sh400), Sh12,000 to Sh14,999 (Sh500), Sh15,000-Sh19,999 (Sh600), Sh20,000-Sh24,999 (511750), Sh25,000 to Sh29,999 (Sh850). For those who earn between Sh30, 000 ($375) and Sh49, 999, it is proposed they pay Sh1, 000 ($12.5) a month, Sh50, 000 ($625) to Sh99, 999 Shs, 500 and more than Sh100, 000 ($1,250) Sh2000 ($25). The self-employed will pay Sh500 ($6.25) a month, and voluntary contributors Sh300 ($3.75) a month. However, the matter has gone to court

The health facilities NHIF contracts provide services comprehensively. This means that members walk in, are treated and walk out at cost of NHIF without additional payments. The fund covers maternity expenses and does not exclude any disease.