This archive report was first published on 10 January 2020.
January 10, 2020 - The National Health Insurance Fund (NHIF) has made significant changes to its scheme, which will impact voluntary members who pay Sh500 monthly. The changes, which took effect on January 1, aim to boost attainment of sustainable universal health coverage and enhance member retention.
One of the key changes is the introduction of a six-month waiting period for maternity services. This means that members will have to wait for six months after registration to access maternity services at any hospital. The fund has also restricted access to maternity benefits to post-card maturity for principal members or spouses declared at the point of registration.
Additionally, the scheme has introduced a 12-month upfront payment for new members. This means that those joining the scheme will have to pay for a year upfront. The fund's management has indicated that this change will help to enhance member retention.
Another change is the restriction on dependants. With effect from January 1, a member can include only one spouse and five children as dependants. Additional dependants can be included subject to payment of additional premiums to be communicated after actuarial valuation.
Members who default for a year or more will have to 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; they will be subjected to six months period after such declaration. The rule does not apply to newborns.
The changes exempt programmes that target vulnerable people, including the free maternity, elderly persons with disabilities, and health insurance subsidy programmes. The fund increased its principal contributors by 13 per cent to 7.7 million last year, with most new members coming from the informal sector.
