This archive report was first published on 10 January 2020.
As of January 1, 2020, the National Health Insurance Fund (NHIF) has implemented new rules that will impact voluntary members who pay Sh500 monthly.
One of the key changes is a six-month waiting period for maternity services at any hospital, which applies to new members who register after January 1.
According to a memo dated January 7, 2020, the fund restricts access to maternity benefits to post-card maturity for principal members or spouses declared at the point of registration.
However, the changes exempt programmes that target vulnerable people, including the free maternity, elderly persons with disabilities, and health insurance subsidy programmes.
The fund's management stated that the reviews aim to boost attainment of sustainable universal health coverage and enhance member retention.
Under the new rules, affected members will have to wait 90 days, up from the current 60, to enjoy the benefits.
Additionally, a member can include only one spouse and five children as dependants, with any additional dependants requiring payment of additional premiums after actuarial valuation.
If a member defaults for a year or more, they will start paying afresh and be eligible to benefit after 90 days from the date of resumption of payment, with a year's upfront payment.
Any dependant declared after initial registration will not benefit from the maternity and specialised package, subject to a six-month waiting period after such declaration, except for newborns.
