NHIF Proposes Changes To OUTPATIENT Medical Insurance Visits

If you are a Kenyan who has reached the employment age, you pay your taxes and no longer live in your parents’ house then you know that the importance of a health insurance cannot be overstated.

Luckily, Kenya like many other countries across the world has a government run medical insurance that allows citizens to access affordable healthcare.

Kenya unlike some countries around the world does not make it mandatory for all its citizens to have health insurance.

How the government run health insurance fund works is that it makes it mandatory for those in formal employment to register and make contributions to the insurance fund on a monthly basis. Those in the informal sector are not required to register or make contributions to the insurance fund but are encouraged to do so if they are to enjoy the benefits.

The National Hospital Insurance Fund (NHIF) has however been a news item quite often this month for both right and wrong reasons.

Earlier this month, NHIF announced that Kenyans who are members of the fund could access outpatient services from any accredited hospital of their choice.

In the past, this was not an option. One had to choose a specific hospital that operates on a 24hours basis in advance to receive outpatient services under the Fund.

This move by the fund earned them points with Kenyans given one can now access outpatient services anywhere in the country. This translates to timely treatment and takes us a step closer to achieving universal health care.

In the same breath however, NHIF also announced that it was limiting the number of outpatient visits to four per year from the initial unlimited visits.

What this means is that if a family of four relies on the same NHIF card then each of them will only receive outpatient services under the card only once a year. In case of more visit then one will be required to pay from their pocket.

If you have a family of more than four on the hand, it means one or more people from your family may be locked out from enjoying even a single outpatient service under the Fund.

The insurance body defended their move saying it would help them in curbing healthcare fraud, wastage and abuse of health financing resources.

Other circles are defending the fund saying that despite this move, NHIF has come a long way over the years from a time when none of its members could access outpatient services as recently as 2010.

Over the years the insurance fund has seen a lot of changes all in a bid to make it more inclusive and more universal and this led to an increase of the contribution rates going up in 2012.

For the longest time minimum NHIF contribution was Sh320 per month but that rose to Sh2,000 for those earning a monthly gross salary of Sh100,000 and above. Those earning gross salary of between Sh50,000 and Sh99,999 now had to contribute Sh1,500 per month. Those who earn less than Sh5,000 would contribute Sh150 and those who are self-employed would remit Sh500.

Most of the changes that the insurance fund has made including increasing the contribution rates has been met with resistance but overtime has proven to be for the better. For example, in early 2016 the Fund announced a new package that would cover patients with chronic diseases such as diabetes, hypertension and cancer.

In the past this was nothing but a dream for these patients who often incur high costs for treatment but had to pay from their pockets despite being under the insurance fund.

So this new change that the insurance fund recently announced begs the question, is it indeed for the better? We can only wait and see if it will be beneficial in the end though it is however important to note that there are many other options in the market for those who feel that the insurance fund does not quite cut it for them.

There are many companies out there offering health insurance and most of them if not all can be complimented by your NHIF card.

UAP Insurance for example has what they call Afya Imara County Family cover with an inpatient limit cover of Sh1 million per member a year and once has to pay a premium amount of Sh31,928 for the cover for a family of four.
The cover covers acute and chronic conditions, accidents, hospitalization costs, doctor and surgeon fees as well as drugs and dressings and has a co-pay of Sh100 for outpatient services. Those eligible for the cover should be between 0 to 65 years old.

Jubilee Insurance is another option one might considered when it comes insuring your family. It has family cover that offers an inpatient cover of up to Sh500,000 shared among the family members and those eligible should be between the ages of 18 to 60 years.
It covers pre-existing, chronic, congenital, HIV/AIDS and related conditions with a waiting period of up to 1 year. The premium on this cover is Sh39,617 for a family of four and all inpatient hospital bills are paid in net of NHIF.

First Assurance also offers a family health cover with each member being entitled to an inpatient cover limit of up to Sh1 million.
The premium one needs to pay for the insurance for a family of four amounts to Sh46,424 with an age limit of up to 65 years. Some of the benefits of the cover include prescriptions drugs and dressing upon discharge up to 30 days’ supply. It has a waiting period of up to a year for HIV, chronic and pre-existing illnesses, two years for diabetes and related conditions and one year for maternity among others.

A waiting period is often a set time limit before a new holder of an insurance cover can seek treatment for certain illnesses under the cover.

After all is said and done, despite the controversy that surrounds NHIF and its decisions, the benefits of having a card from the insurance fund outweigh reasons for not having one.

Even those with other insurance covers from private firms take them up to support what the NHIF cards can do.

Whatever insurance cover you choose to take on behalf of your family, make a lot of comparisons first before settling. Choose an insurance cover that best takes care of the needs of your family.

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