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Paying for Health Insurance

Health insurance is important because it can pay for your hospital bill when you do not have cash. You can choose between public health insurance or private. Public health insurance in Kenya is provided by National Hospital Insurance Fund – NHIF and private is by individual medical insurance companies or a product of bigger insurance companies. The public insurance is open to all Kenyans and covers all conditions. Private health insurance companies are choosy, charge higher rates and may not cover people with conditions like HIV/Aids, Diabetes or other chronic conditions. Before you sign up with any private health insurance make sure you understand fully what they are offering. Learn how you can join NHIF.
 
National Hospital Insurance Fund - NHIF
This is a public medical insurance cover for Kenyan citizens and their declared dependants (spouse and children). NHIF provides an in-patient medical cover and partial cover for surgical cases in some of these hospitals. To qualify; you must become a member and make monthly contributions. It is open for both the employed and the unemployed. There are 23 branches of NHIF country wide and in every district hospital you will find a service point. Formal sector employees’ contribution is deducted by employer and submitted to the fund. Those not formerly employed can pay directly to NHIF Ksh. 160 per month. Any person earning Ksh. 1000 and above is eligible.
 
These are the benefits of registering with NHIF
  • An inpatient cover of up to Ksh 396,000 per year for the contributor, spouse and children.
  • A comprehensive medical cover in certain hospitals across the country.
  • NHIF works with a network of over 400 accredited government, private and mission health providers spread across the country.
  • NHIF reimburses hospital claims as per agreed daily rebates.
  • Covers maternity cases.
  • NHIF does not exclude any disease.

How to claim hospital payment

The hospital can submit the claims directly to NSSF after the contributor has been discharged from the hospital. If there is no query on the claims, NHIF pays within 14 days. If a member opts to pay the bill directly to the hospital, they can launch a general claim to NHIF for reimbursement.
 
NHIF Accredited Hospitals
NHIF has divided the accredited hospitals in to 3 categories:
  • Category A - Government Hospitals. Members enjoy full and comprehensive for maternity and medical diseases including surgery. Therefore, if you are a member, you do not pay anything to be admitted.
  • Category B - Private and Mission. Members get a full comprehensive cover but if surgery is required, the member pays for that.
  • Category C – Private. NHIF only pays for specified daily benefits and the member pays everything else.

 

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