NHIF sets Oct 1 as start date for surgical covers

The National Health Insurance Fund (NHIF) will start covering surgical procedures from October 1 in a move expected to ease cost burden on Kenyans undergoing specialist treatment at the local facilities.

The NHIF chief executive officer, Geoffrey Mwangi said the national insurer is finalising on guidelines to govern the new benefits.
Mr Mwangi said that beneficiaries will access the new services from all level three and above hospitals that are accredited with the NHIF.

“Besides finalising on the guidelines, we are also signing contracts with over 2,000 facilities that are accredited with us,” Mr Mwangi told the Business Daily yesterday during a phone interview. “Kenyans who access the other over 4,000 low-end facilities will also benefit from this package.”

The insurer had initially announced the surgical benefits last month stating that it had embarked on setting up guidelines for gazettement.
Surgery were initially not covered by the NHIF.

Kenyans accessing minor procedures from health centres and other low-end facilities will enjoy between Sh30,000 and Sh40,000 cover of their medical bills.

Major and specialised surgeries done in level three, four and five hospitals will be catered for their bills to the tune of Sh80,000 and Sh500,000, respectively.

READ: NHIF surgery cover to ease medical burden for patients

The increased benefit comes a few months after the NHIF increased premiums payable by members. It has since introduced special packages including; foreign treatment, specialised lab test, chronic disease, oncology and radiology. Other newly introduced packages include drug and substance abuse, kidney transplant and renal dialysis package.

The NHIF previously only covered maternity, inpatient and outpatient medical costs.

Enhanced benefits

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

The workers’ monthly contributions to the fund were increased 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.

The new benefits will now allow for NHIF members to be covered for cancer surgeries and others 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.

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