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NHIF rejects unaccredited providers

Wednesday September 11 2019

NHIF cover

President Uhuru Kenyatta (back row, centre) and members of the Executive during the signing of a contract on implementation of comprehensive medical cover for secondary school students between the Ministry of Education and National Hospital Insurance Fund at State House, Nairobi, on April 13, 2018. PHOTO | SAMUEL MIRUNG'U | PSCU  

FAITH NYAMAI
By FAITH NYAMAI
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Thousands of secondary school students are unable to access the National Health Insurance Fund’s (NHIF) EduAfya medical services. This came after the fund said it will not pay for services offered by unaccredited health facilities in schools.

OUTREACH PLANS

With school administrators in a quandary over the directive, a crisis meeting is set for Wednesday between the Ministry of Education and NHIF officials to unlock the impasse.

In a September 5 letter to the health service providers, NHIF said it will not pay for services offered to students by the unaccredited facilities stationed in schools. “It has been noted with great concern that some facilities are generating EduAfya claims from non-accredited facilities especially from school clinics or sanatoriums,” read the letter.

The Nation has learnt that the most affected facilities are those that previously offered services to schools before the government launched the students medical scheme. NHIF said some schools breached the service contract and engaged facilities that are not recognised by NHIF.

“You are advised not to submit any claims that may have been raised from the above mentioned arrangements,” the hospitals have been told.

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The health facilities have been advised to refer to their contracts for the definition of accreditation or accredited facilities. The insurer has further said all claims from hospitals offering services to schools will be subjected to audit verification and if found unsuitable for payment, necessary actions will be taken against them.

“No claim should arise from medical camps or outreach treatment plans,” read the letter.

COMPREHENSIVE

On Tuesday, NHIF acting Chief Executive Officer Nicodemus Odongo said the insurer had written to all hospitals cautioning them against offering services to patients without accreditation.

“We are doing a precautionary exercise to ensure only accredited health facilities are offering services to patients,” he said. 

In a June 24 circular from Education Principal Secretary Belio Kipsang’ to regional and county directors, schools were advised to choose service providers who are able to offer services at the institutions. The schools were advised to work with NHIF local branches before contracting any health services.

Schools with functional sanatoriums were asked to submit them to the ministry to facilitate NHIF accreditation.

“All students are expected to benefit but cases of some experiencing challenges have been reported,” he said.

The Education ministry rolled out the student medical cover in May 2018 to enable students in public secondary schools to access comprehensive medical services.

The scheme was further enhanced in January this year. The government pays Sh1,350 for each student.