What national insurer can do for you now

The National Health Insurance Fund (NHIF) has historically attracted scepticism from both health care providers and contributors.

This, the insurer says, is due to lack of understanding of the benefits package, which it revamped last year via an expanded outpatient cover and a revamped inpatient scheme. To go the extra mile, it also introduced a package for patients with chronic diseases such as diabetes, hypertension and cancer, which had previously been excluded. Here, some of the new benefits offered by the cover:

1. Maternity:

The medical cover for expectant mothers and cancer patients has been increased by up to 300 per cent. This means normal delivery will get a new rate of Sh10,000, up from the previous Sh6,000. Caesarean Section patients will get Sh30,000, which has been increased from Sh18,000.

On top of the NHIF cover, the government has expanded the Sh4.2 billion-a-year free maternity services programme to faith-based hospitals in a bid to cover more pregnant women from low-income households.

The scheme has in the past three years been confined to public hospitals but under its new Linda Mama, Boresha Jamii programme, the ministry, through an NHIF-run programme, will pay Sh6,000 per woman.

Expectant mothers are entitled to at least four antenatal, delivery and post-natal checkups. This cover will also cater for the welfare of the newborn. The package further includes both outpatient and in-patient management for conditions and complications that may arise during pregnancy and after delivery. 

2. In-patient:

The insurance cover will cater for Sh1,200 per night for the lowest-level government hospitals. This is a 100 per cent increase, up from the old rebate of Sh600. The highest level of government hospitals will give a cover of Sh4,000, a 233 per cent increase from the previous Sh2,400. The insurer will also pay up to Sh3,500 for patients who will be admitted in faith-based hospitals. 

3. Chronic diseases:

Those requiring dialysis will get up to Sh10,000 per session, a five-fold increase from the Sh2,000 the insurer used to pay, while patients undergoing a kidney transplant will get a Sh500,000 cover, from the current Sh200,000.

The Fund will also pay Sh25,000 per session for chemotherapy for cancer patients treated in any accredited hospital, Sh18,000 per session for those accessing radiotherapy, and Sh5,000 for monthly clinical reviews. For those who need specialised laboratory tests like magnetic resonance imaging (MRI) and computed tomography scans (CT-Scan), the insurer will offset a bill of up to Sh15,000 and Sh8,000, respectively. 

4. Surgeries:

Major surgeries in Level 3 and 4 hospitals will be covered up to a maximum of Sh80,000, and in Level 5 and 6 facilities up to a maximum of Sh130,000 on pre-authorisation basis. Specialised treatment is covered up to a maximum of Sh500,000.

In December, the fund announced that its members would be able to use their cards to get treatment abroad, under its new Chronic Disease Fund, which will pay up to Sh5 million.