Inpatient cover doubled as NHIF unveils new benefits

Friday January 29 2016

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The medical cover for expectant mothers and cancer patients has been increased by up to 300 per cent.

The National Health Insurance Fund announced new rebates which become effective on Monday.

The improved benefits come just months after the insurer increased the amount that members have to pay each month from a flat rate of Sh200 to a graduated contribution capped at Sh2,000 for the highest paying members earning over Sh100,000 a month.

Fund Chairman Mohamud Ali said that the new benefits would start immediately once they are approved by the Cabinet Secretary for Health, Mr Cleopa Mailu and are gazetted by attorney-general, Githu Muigai.

The benefits for inpatient services have been doubled in both public and private hospitals.

The insurer will now pay a minimum rate of Sh1,200 a night for patients who will be admitted in any public hospital and up to Sh4,000 a night for those admitted in private hospitals.

This is an increase from the previous Sh600 and Sh2,100, respectively.

The insurer will also pay up to Sh3,500 for patients who will be admitted in faith-based hospitals.

Speaking while releasing the new rebates structure, Mr Ali said the new rates and benefits were meant to help the country attain universal health care, and therefore “all Kenyans ought to enrol as members of the fund to enjoy these health benefits”.

“We expect these adjustments to take effect latest Monday,” said Mr Ali. “We think that by tomorrow it should be in place.”

The insurer had for a long time come under pressure from health stakeholders who argued that despite enforcing new rates on contributors that saw its collection increase threefold, from Sh800 million to Sh2.3 billion monthly, its members were not enjoying enhanced benefits.

The fund, in a new category of specialised radiological and diagnostic services benefits, will pay Sh25,000 per session for cancer patients who will access the services in any accredited hospital.

The national medical insurer will also pay Sh18,000 per session for those accessing radiotherapy, while footing up to Sh5,000 for clinical reviews monthly.

For those who need specialised laboratory tests like magnetic resonance imaging and computed tomography scans (CT-Scan), the insurer said it would offset a bill of up to Sh15,000 and Sh8,000, respectively.

However, reacting to the news on Thursday evening, some union representatives argued that if NHIF intended to provide a universal health cover, it should do so unconditionally.

The Kenya Medical Practitioners, Pharmacists and Dentists Union Secretary General, Dr Ouma Oluga said: “From a simplistic view, it looks like a very nice thing. However, this will make it spend more money trying to respond to a sub-sector of people without necessarily offering universal health care.”

The Secretary-General of the Union of Kenya Civil Servants, Mr Tom Odege, said that if the insurer wanted “to be fair”, it would offer services without pegging a rate, and therefore Kenyans would be able to “walk in and out of hospitals without paying a dime because as long as there are rates, people will never enjoy the services.”

In the new plan, patients suffering from kidney ailments, who were scarcely catered for under the old scheme, will enjoy up to a 300 per cent increase in specialised care cover.

Those requiring dialysis, for instance, will get up to Sh10,000 per session, a fivefold increase from the Sh2,000 the insurer used to pay.

At the same time, the fund will pay Sh500,000 for surgery for those who need kidney transplants, which is equal to what the Kenyatta National Referral Hospital charges patients who go for transplants.

The insurer also increased maternity cover and will now pay up to Sh10,000 for normal deliveries and Sh30,000 for Caesarean sections.

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

The benefit, however, will be limited to only those patients with diseases that cannot be treated locally.

While announcing the new benefits yesterday, the fund’s chief executive, Mr Simeon ole Kirgotty, said that the heavily contested outpatient service introduced last year would remain unchanged, with contributors only accessing the service from accredited hospitals.

“We now have 1,400 facilities providing the outpatient service and expect that the hospitals that were contesting the rebate can now come on board,” he said.