NHIF surgery cover set to ease members’ healthcare burden

National Hospital Insurance Fund headquarters in Nairobi. NHIF says scaling up of the insurance premiums will ensure that the poor access affordable medical services. Photo/FREDRICK ONYANGO
National Hospital Insurance Fund headquarters in Nairobi. Photo/FREDRICK ONYANGO 

The National Hospital Insurance Fund (NHIF) has introduced a surgical benefits package that will see it cover minor, major and specialised surgeries to ease the financial burden for members undergoing the procedures.

It will cover a maximum Sh500,000 for specialised surgeries, Sh130,000 for major surgeries and Sh40,000 for minor surgeries. Surgery costs were previously not covered.

The surgical package is the latest addition to procedures covered after dialysis and cancer treatment following the increase of premiums payable by members by the national health insurer.

“This package will deal with major, minor and specialised surgeries including cancer surgeries,” Mohamud Ali, the NHIF board chairman said on Monday.

He added that this will now allow for NHIF members to be covered for surgeries like heart and brain procedures.


Many households resort to holding fund-raisers to cater for the major and specialised surgeries and the after-care expenses. Mr Ali said the benefits will become applicable once they are put on the Kenya Gazette.

“The letter (for gazettement) will go out tomorrow (today) to the Attorney- General’s chambers and we expect that to come out in the Gazette as soon as possible. Immediately they are gazetted,” he said.

The package is value for money for more than two million NHIF members, whose monthly contribution rose by up to 1,000 per cent with a thin range of benefits accruing to them.

The NHIF in April gazetted new rates for procedures like cancer therapy, MRI diagnostic services and kidney dialysis which saw large private and mission hospitals agree to start offering these services.
The April rates were set after negotiations with the hospitals which had refused the initial rates arguing they were too low.

The hospitals are however yet to start offering outpatient services to NHIF members as they differ on the pricing.

Members remain confined to medical care from public hospitals and small private facilities that have agreed to the lower capitations.

This is despite an increase in workers’ monthly contributions to the fund from Sh320 to between Sh500 and Sh1,700 in April based on their pay scale with the promise of enhanced outpatient benefits in both public and private hospitals.

Private hospitals have rejected the Sh1,200 allocation that the NHIF has offered to pay as annual fee (capitation) for every beneficiary, saying it is too little.

This has meant that patients visiting the outpatient facilities in hospitals like Nairobi, MP Shah, Aga Khan and Mater pay out of pocket or through their private insurance.

The statutory medical scheme collects up to Sh1.9 billion a month.