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NHIF is vital to Kenyans but using it is a challenge

Thursday April 30 2015

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As a worker, you have 12 payments a year deducted from your salary as your contribution to the National Hospital Insurance Fund, and this goes on for many years.

You never get to see your statement because there is no way to readily check your status – until you’re in hospital and want to make a claim.

NHIF reimburses the hospital up to Sh1900 per night, which will cover your payments at a rural hospital and represents a fractional reduction of your bill at a Nairobi hospital.

The hospital will run a check on your card but if there’s one payment missing from your statement, such as in January 2008, your entire membership is invalidated and you have to pay a penalty of up to five times the missing payment.

It doesn’t matter whether you or your company was responsible for making the payment which is missing from your statement - you simply can’t benefit from the NHIF.

At this stage, you can make the missing payment of Sh160 or Sh320 to the hospital, which is empowered to receive the payment and a penalty of five times this amount on behalf of NHIF, but the hospital cannot change your NHIF status. You have to go to an NHIF office and adjust it.

Besides hospitals, the same pattern is seen in other NHIF payment channels. You can conveniently  pay your contributions by M-Pesa, call the NHIF call centre or visit their desk at a Huduma Centre, but you will find that while staff at the Huduma Centre or NHIF call centre are able to confirm your membership status, they are not empowered to do things like change your status or membership. For that you still have to visit a NHIF office or headquarters.

It could be something as simple as inputting your NHIF number instead of your national ID number when making an M-Pesa payment, but this can only be fixed at the NHIF office

This month, Kenyans get to start paying new rates to the NHIF. The Cabinet Secretary for Health gazetted the new NHIF rates that will now be effective April 1, 2015. In the new plan, workers’ monthly contributions to the NHIF are set to rise from the current Sh320 to Sh1,700 per person for the highest contributors, who earn salaries of above Sh100,000.

Despite some contributions going up almost five times, there will be no increase in the daily bed compensation that NHIF pays to hospitals.

Also, while the new contributions are said to come with more benefits like meeting costs of some  laboratory tests, drugs, X-rays and ultrasound, doctor consultation, and even family planning, it seems NHIF is yet to formally communicate these outpatient benefits to service providers like hospitals, where patients still have to pay cash or though their medical insurers.

NHIF is a vital institution, but one which does not inspire much public confidence. This is because, like its sister NSSF, it is often mentioned in the news for procurement scandals, a revolving door of directors and executives, and court wrangles that always burden the taxpayer further.

It also did not help when a former health minister said Kenyans should not hesitate to pay for NHIF as the amount was still less than what he paid for lunch.

But using the NHIF is challenging, and this is sad because they are really the medical insurance options for groups like Kenyan retirees. Once you are 55 or 60 years or older, you have almost no local medical insurance options in Kenya besides NHIF.

The NHIF should empower both its staff and its members to create a better experience. They can send expiry notices by SMS. Members should also be able to view, query and reconcile missing payments without having to visit NHIF offices. Hopefully, these new contributions will lead to a better experience in future.

Twitter: @bankelele