Maternity Medical Insurance Cover On NHIFPosted on 2016-10-04
Each time our office phone rings or a online inquiry comes in, one of our insurance customer advisors gets ready to answer one of these kinds of questions from concerned and caring mothers to be in this beloved country. To set the record, there is no retail/individual/family medical insurance scheme in Kenya that will cover an expecting mother without a mandatory waiting period. A pregnancy can never be classified as an accident in the insurance world (although for many young couples, it often comes about in a most unplanned manner). Therefore, once a woman is already expecting, it beats the logic of insurance trying to purchase insurance for a risk, which has already occurred. Understandably, no insurer will accept to collect an insurance premium of circa Kshs.15, 000 in return for a maternity insurance bill of Kshs. 120,000 in the next 8 or less months. Even in the other parts of the world for example in the United Kingdom, leading medical insurers also have simular conditions and waiting periods for pregnancy e.g. BUPA maternity
This begs the questions, what should I do if I am already pregnant? What are my options? What advice can you give me? This can be a source of worry and stress for young/first time mothers, trying to find the right information to make sure that they have a smooth pregnancy and safe delivery for themselves and their child.
National Hospital Insurance Fund (NHIF) is a government run medical insurance service, developed with the eventual goal of offering universal healthcare for all Kenyans. All citizens in the formal and informal sectors in Kenya are required to be members of the fund. The fund is the main source of medical insurance for Kenyans after the demise of the Linda Jamii medical cover in 2015. It is very important to be a paid up member of NHIF because of the comprehensive medical insurance benefits this membership affords you as a member and declared spouse and children. It is advisable to pay an upfront lump sum amount for the membership instead of paying monthly, as the system may take some time to reflect the payments, which may inconvenience you at the time of seeking treatment. The NHIF monthly contributions are pocket friendly for all income brackets, you can use this KRA PAYE calculator to find out how much the premiums for your monthly income bracket will be.
Every Kenyan should consider NHIF membership because it subsidizes cost of treatment especially for those without a personal or corporate medical cover. The NHIF has recently expanded its scope of coverage, range of benefits and medical provider panel. While it previously only covered the expenses for hospitalization of members at listed medical providers and hospitals, the NHIF now takes care of costs associated with outpatient services, the treatment of cancer and the cost of dialysis, surgeries as announced in the NHIF new benefits report. This means you get access to comprehensive care i.e. walking in and out of any hospital under category A and B without paying a single cent as a negotiated amount is already set between the hospital and NHIF. But note that it does not apply to surgical cases in Hospitals under contract B where members do co-pay. Whether these services are really free is a subject of discussion in another forum. What exactly is covered by NHIF? I also don’t know.
I have my own reservations about the effectiveness of the NHIF comprehensive benefit package. You can’t depend on it fully; it can let you down when you need it the most as from my most recent experience. I recently visited one hospital in Westlands in Nairobi. I have been using my AAR insurance and First Assurance cards on outpatient; this time I decided to use NHIF since I contribute a good chunk of my monthly wages to this scheme. I was ushered to a separate waiting bay, billing section, consultation and pharmacy, which are deliberately set for universal/NHIF patients. I was treated like an individual seeking free services. The doctor prescribed benzoyl peroxide, which goes for at most Ksh. 800. According to the pharmacist at the NHIF section, this medication is not covered. I was instructed to either pay in cash for the medication or go to seek the services from a government hospital!
With this sour experience I felt like am being conned out of my hard earned Kshs.1, 700 NHIF monthly contribution. My questions to CEO Simeon ole Kirgotty and Chair Mohamud Ali; Do I really need NHIF? What are you doing to ensure Kenyans are getting VALUE for their MONEY?
Maternity on the NHIF
Luckily for many Kenyans, the NHIF will cover maternity insurance even if the member joins the scheme when they are already expecting, this is unlike the retail medical insurance products we have in Kenya.
For maternity, normal delivery NHIF covers up to Ksh.10, 000 and Caesarean Section patients will get up to Ksh. 30,000.
These maternity limits are not sufficient even for category A hospitals leave alone category B. For category C hospitals, the likes of Nairobi Hospital, Aga Khan, Ksh.10, 000 is not even sufficient for a single day bed limit in a category C. Category C are the most desired medical facilities, with internationally trained and qualified staff, top quality equipment and technology and great service, these are the facilities where each and every mother wants to bring her child to this world in. If you thought NHIF is sufficient, you should think again. An average normal delivery cost in Kenya is around Ksh.37, 500, for the same normal delivery in Category C hospital like Agha Khan, the advertised rates for this package start at a minimum of KSh. 99, 000.
In a nutshell, what am I saying? The NHIF maternity cover may be good news for an expectant mother but it is not sufficient even for normal delivery in a Category A hospital. It leaves a large gap, which needs to be filled with either cash payment or a private medical insurance plan. Ideally, one should have an additional medical plan to cushion these expenses. The joy of a newborn baby may be short lived when the hospital presents a very big medical bill for the maternity expenses.
Many Kenyans may not want to register for privately funded medical health insurance plans because of the perceived high cost. When you buy a commercial medical insurance policy from a local healthcare provider such as First Assurance, AAR Insurance, JUBILEE Insurance, RESOLUTION Insurance, APA Insurance, UAP and other medical insurance providers in Kenya, your insurance is calculated net of the NHIF contribution to your hospitalization. Since membership in NHIF is mandatory for employed persons, health insurance companies assume that everyone who buys additional insurance from them is actually buying ADDITIONAL insurance. The policy benefits are therefore calculated net of the amount NHIF should pay. If you do not keep your NHIF contributions current, you may have to foot an amount equivalent to what NHIF should pay, depending on the insurance company you are with.
Maternity cover is usually included as an enhancement of a basic health insurance policy. It has a waiting period meaning the member cannot enjoy the benefits immediately they are accepted on cover. The waiting period varies from 10 months up to 24 months for some providers. Maternity insurance in Kenya usually meets the costs of ante, postnatal care, hospitalization, including delivery and any eventualities such as congenital illnesses that may result from the pregnancy. Due to its nature as an “assured risk”, the maternity cover in many ways is a customer retention element used by insurance companies.
Good health is such a foundational matter in life, without it, it becomes difficult to live and enjoy life, achieve any important life goals. Medical insurance plans in Kenya are very affordable, there are a variety of economy packages with affordable premiums of under KSh 10, 000 per adult. You do not need to take on a cover of limit KSh 10 million, for most people, limits of KSh 1 million are more than sufficient to meet in patient medical bills. In addition, it is possible to enroll on one of the cheapest family medical insurance plan for less than KSh 15, 000 per annum. One needs to look at their needs, budget, and benefits and compare medical insurance plan quotes available in the market before finding the best compromise.
My advice to the young generation; as you constitute that wedding committee, don’t forget to put a health plan in mind since you are about to start a family. Medical and education are sure expenses in any family set up. Kids will bring joy, but planning for them you must.
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Update 21st July 2017
Following the continuing improvement of the NHIF scheme, expectant mothers are entitled to a maternity cover of up to KSh 10,000 for normal delivery while a C-section delivery is covered up to KSh30,000.
Update August 2018
Linda Mama Scheme
On top of the standard maternity cover for expectant mothers under the NHIF, there is a special scheme for expectant mothers. The only requirement is that the expectant mother has to be registered with the NHIF. The cost for this is absolutely free of charge, a big relief for expectant women especially those in less well to do areas.This will ensure that mothers and infants have access to healthcare nationwide A multitude of services are covered on this scheme including :
- Antenatal profile e.g. screening for TB, HIV, etc
- Preventive services e.g. vaccines for Tetanus Toxoid, deworming etc
- Prevention of Mother to Child transmission of HIV
- Post Natal care for the mother and child for a period of time up to 6 months after both
Registration is free of charge and can be done using a mobile phone by dialling *263#. The expectant mother is required to be an NHIF registered member to enjoy these services.
By Raymond Momanyi
The writer is the General Manager, PESABAZAAR.com. A leading insurance aggregator in Kenya