Your health is your world. Being in good health is the most valuable treasure. No amount of wealth can compare to good health, and no amount of money can buy good health. Being healthy helps us to enjoy life better, create memories with our loved ones, enjoy our hobbies, and stare into the beautiful sunset as we plan our future on how to bring our dreams into reality. 

Isn’t it a beautiful feeling to wake up in great health and enjoy the beautiful breeze? Sometimes, even after eating healthy, exercising, and getting enough sleep, we still fall sick and need to access medical care. There are various medical insurance plans available in the market which you can choose from depending on the limits you may require and your budget (we shall discuss them in another forum).

What is NHIF?

The National Hospital Insurance Fund is a state corporation with the directive to provide affordable medical insurance coverage to all registered members, including their dependents. It covers both inpatient and outpatient services, but the limits depend on your type of cover.

What are the plans available under NHIF?

There are two categories of contributions:-

  1. Employed- Mandatary deductions from payroll
  2. Self-Employed- Voluntary payments

Who Is Eligible for NHIF?

  • All Kenyan Citizens
  • All persons aged 18years and above
  • Persons with a minimum monthly income of Kshs. 1,000 

What are the services covered by NHIF?

  • Doctors, nurses, and clinical officers’ consultation
  • Dispensation of drugs
  • Laboratory Examinations
  • Radiology investigations
  • Dental services
  • Optical services
  • Surgical services
  • Radiotherapy
  • Physiotherapy
  • Specialist services (Depends on the cover)

What is NHIF Supa Cover?

It is the most reliable and accessible cover for you and your family and affordable too at Kshs. 500 per month for you and your dependents. It covers both inpatient and outpatient services.

Outpatient services

  • Medical consultations
  • Laboratory investigations
  • Drug administration
  • Counselling &Wellness
  • Daycare procedures
  • Physiotherapy services
  • Health education
  • Immunizations & Vaccines as per KEPI guideline
  • Vaccines

Inpatient Services

  • Maternity services- Normal Delivery & C-Section
  • Family planning
  • Surgical services including transplant
  • Renal Dialysis
  • Rehabilitation – Drugs & Substance Abuse
  • Specialized Overseas surgeries 
  • Emergency Road Rescue services
  • Cancer services
  • CT-Scans, MRI & X-Rays

What are NHIF medical cover limits?

The limits for various services may be capped depending on the cover. These are:-

Civil Servants

  • Job group A-K Unlimited cover inpatient and outpatient services
  • Job group L-T Limits range from inpatient- Kshs.1M to 2.25M, outpatient Kshs. 100,000 to Kshs. 350,000

Maternity Services

  • Normal Delivery-Kshs. 10,000
  • C-Section- Kshs. 30,000
  • Ultrasound- Kshs. 3,000

The maternity limits may not be sufficient to cover maternity costs in Private hospitals. Please work with a good agent to source for a medical cover that will cover for costs in your hospital of choice.

Surgical Procedures

  • Minor-Kshs. 10,000 to Kshs. 30,000
  • Intermediate- Kshs. 40,000 to Kshs. 80,000
  • Major- Up to Kshs. 130,000
  • Specialized- Up to Kshs. 500,000

Cancer services

  • Radiotherapy- Maximum 20 Sessions @ Kshs. 3,600 each or up to Ksh. 18,000 weekly in a government facility. E.g. KNH
  • PET diagnostic scan in private hospitals- Up to Kshs. 69,500
  • Chemotherapy in private hospitals –upto Kshs. 25,000 per session
  • Oncology clinics- 24 sessions per year from Kshs. 25,000 to Kshs. 150,000

The NHIF may not be sufficient to cover all the cancer treatment costs since there is a limit on the costs incurred. You will need to pay out of your pocket for the extra costs or source for medical insurance cover that has wider coverage.

Chronic Diseases

These include Kidney failure, hypertension, and high blood pressure among others.

  • Monthly check-up – Max. Kshs. 5,000
  • CT scan- Max. Kshs. 8,000
  • Kidney Dialysis- Max. Kshs. 10,000
  • MRI Scans- Max. Kshs. 15,000
  • Radiology- Max. Kshs 18,000
  • Kidney Transplant- Max. Kshs 500,000

Dental Services

The limit per family is Kshs. 50,000.  You will be able to access the below services 

  • Filings
  • Consultations
  • Dental X-rays
  • Dentures
  • Extractions
  • Orthodontics
  • Dental Anesthetics fees
  • Surgical fees
  • Root canal

Optical services

The limit is Kshs.40, 000 per family per year, services to be obtained from accredited service providers.

Which are NHIF healthcare providers?

  • Contract A Facilities- Government Hospitals
  • Contract B Facilities- Mission and Faith-based Hospitals
  • Contract C Facilities- Private Hospitals

What are the exclusions under NHIF?

  • Cosmetic treatments
  • Costs are redeemable from WIBA.
  • Massages (except for physiotherapy)
  • Costs are recoverable from other insurance plans.
  • Costs from un-authorized hospitals/service providers or traditional herbalists
  • Vaccines not listed under KEPI guidelines
  • Weight-loss treatments
  • Other treatments not authorized by NHIF (Check with your employer)

NHIF coverage may not provide wider coverage, but due to its affordability, it is important to have it and also include it in your other medical insurance plans. 

Do you have any medical insurance in place? What would you like to know?