The National Hospital Insurance Fund (NHIF) will offer additional benefits to members who pay above the legally set rates if changes to law that provide for the voluntary top-ups are adopted.
The government-backed NHIF (Amendment) Bill 2021 will allow workers in corporate Kenya to increase contributions above the set range of between Sh150 and Sh1,700.
The current set-up has seen many Kenyans exhaust their NHIF benefits, especially outpatient and costly diseases such as cancer, diabetes and kidney failure.
The National Hospital Insurance Fund (NHIF) will offer additional benefits to members who pay above the legally set rates if changes to law that provide for the voluntary top-ups are adopted.
The government-backed NHIF (Amendment) Bill 2021 will allow workers in corporate Kenya to increase contributions above the set range of between Sh150 and Sh1,700.
The current set-up has seen many Kenyans exhaust their NHIF benefits, especially outpatient and costly diseases such as cancer, diabetes and kidney failure.
Now, contributors, including those from the informal sector that pay Sh500 monthly, will get a widow to raise their NHIF monthly premiums for enhanced benefits.
“Subject to such guidelines as the (NHIF) board may from time to time issue, a person who wishes to receive an enhanced benefit may make additional voluntary contributions to the scheme,” reads the Bill.
This means that the Bill leaves it to the NHIF board to decide the criteria of deciding how much one should top up for the enriched benefits.
Contributors to the State-run NHIF are covered for outpatient and inpatient services such as consultation fees, laboratory tests, drugs, dental healthcare, surgery, radiotherapy, physiotherapy and midwifery services.
The NHIF requires all contributors to seek pre-authorisation for some inpatient services such as surgery, CT scan, ultra sound or MRI.
The limits of the bill paid from the cover are determined by factors such as level of hospital and complexity of the procedure.
For instance, the NHIF cover for chemotherapy, radiotherapy, and brachytherapy for cervix and prostate cancer caters up to 10 sessions in a year. Kidney dialysis is covered up to twice per week.
There are benefits that NHIF seeks to enhance in the quest to match the model offered by private insurance firms.
The caps on the benefits were introduced to cushion the State-run Fund from losses on costly medical bills.
NHIF received Sh60.81 billion in the year to June from 8.98 million members and paid out Sh54.3 billion to hospitals in claims.
The fund had in 2015 raised the alarm that cost per illness in some hospitals was as high as 25 times more compared to what others were charging.
It rolled out pre-authorisation in 2017, citing the need to manage access and control benefits to curb fraud.
NHIF had 8,189 accredited health providers at the end of June, nearly double the 4,281 it had in 2017 as it seeks to enhance accessibility.
Every adult will soon make an annual compulsory Sh6,000 contribution to the NHIF if Parliament adopts the Bill in race to offer medical cover for all.
The Bill seeks to make it compulsory for every Kenyan above 18 years to contribute and be a member of NHIF.
They will be required to pay Sh500 monthly in a remodelled universal health coverage (UHC) scheme for outpatient and inpatient services, including maternity, dialysis, cancer treatment and surgery.
The planned mandatory NHIF membership will be an upgrade of the scheme where only workers in the formal sector are compelled to join.
The fund will also only pay hospital bills after patients have exhausted the limit from private insurers.
The proposed law wants NHIF to only step in as a last resort for contributors who also have private covers.
INSURERS, COTU
The proposal is a shift from the current practice where the fund makes the first payment — usually a small portion of the total bill — leaving the rest to private insurers.
The Association of Kenya Insurers and Central Organisation of Trade Unions (Cotu) opposing the Bill.
“The rationale behind the initiators and supporters of this Bill is full of ulterior motives considering the mandate of the NHIF should not be maximising on the amounts they are collecting but it should be to effectively use the collected amounts,” said Cotu yesterday.
Due to low insurance penetration, a quarter of all Kenyans’ healthcare bills are paid out of pocket, according to the World Bank.
This exposes families to debt and donations or disposal of assets to pay for the high medical bills.
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