The plan seeks to end delays that have lasted since 2015 when the fund introduced outpatient cover entitling members to healthcare at both private and public facilities.
Unlike civil servants who can access both outpatient and inpatient cover at both public and top private hospitals, private sector employees are limited.
The NHIF in 2015 introduced outpatient cover and enhanced benefits for cancer and kidney dialysis after raising the amount that workers contribute to the fund.
Private sector and informal workers will start accessing outpatient medical treatment at top private facilities like Aga Khan, Mater and Nairobi Hospital under an arrangement in which the NHIF will pay part of their bills.
The National Hospital Insurance Fund (NHIF) is in discussion with the premium hospitals to roll out a co-payment scheme for the insurer to pay a portion of the bills with the remainder footed by private sector employees.
The plan seeks to end delays that have lasted since 2015 when the fund introduced outpatient cover entitling members to healthcare at both private and public facilities.
But the top private hospitals opted out of the outpatient deal, denying NHIF’S 6.1 million members premium services associated with these facilities. The hospitals rejected the Sh1,200 cash allocation that the NHIF offered for each member and their family to access out-patient services for a year, saying it is too little.
MP Shah Hospital in Nairobi is the only top private facility that currently accepts private sector workers under the NHIF’s outpatient programme.
“A deal with the remaining top hospitals is in sight. We plan to roll out a co-payment scheme where the NHIF will pay for members up to a certain level while the patient will cover the balance,” NHIF chief executive Geoffrey Mwangi told the Business Daily.
Unlike civil servants who can access both outpatient and inpatient cover at both public and top private hospitals, private sector employees are limited to inpatient services at facilities like Aga Khan, Mater and Nairobi Hospital.
The NHIF in 2015 introduced outpatient cover and enhanced benefits for cancer and kidney dialysis after raising the amount that workers contribute to the fund from Sh320 to a graduated scale of between Sh500 and Sh1,700 per month.
Private sector workers also cannot access referral hospitals like Moi Teaching and Referral Hospital in Eldoret and Kenyatta National Hospital.
“We are having talks to bring them on board as well,” said Mr Mwangi.
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