NHIF Explains Paying Only Ksh3,000 for Patient With Ksh87,000 Bill

A photo of  the NHIF building in Nairobi
A photo of the NHIF building in Nairobi's Upper Hill taken on March 4, 2020.

A debate ensued after several Kenyans lamented about the National Health Insurance Fund (NHIF) remitting either one or two per cent of their hospital bills despite always paying the monthly contributions.

In particular, a situation was highlighted where an online user identified as Abdul indicated that his wife's delivery cost Ksh87,000.

He wondered why the Fund only offered to pay for three days' bed - which amounted to Ksh3,000.

In response, NHIF clarified that they offered two categories for hospital bills comprising comprehensive and non-comprehensive covers.

NHIF acting CEO Samson Kuhora (centre) in Kisumu on Tuesday May 23, 2023
NHIF acting CEO Samson Kuhora (centre) in Kisumu on Tuesday, May 23, 2023

"In the comprehensive facilities, we cater for your bills wholly whereas in non-comprehensive facilities, we cover on a rebate basis. That is between Ksh2,500 and Ksh4,000 for each day of admission. This is why we advise that before a procedure, you check in so that we can effectively advise," the statement read in part.

In another situation, the conversation drifted to the Fund only paying premium services to civil servants and excluding other Kenyans. 

In particular, Governance Adviser Omore Osendo highlighted that his father was asked if he is a civil servant to access certain services despite paying contributions for over three decades. 

"My mother has been a contributor for the last 40 years or whenever NHIF was instituted - whichever came first. My dad is also a contributor. He can use either his or hers. When my father was taken ill late last year, the nearest hospital asked us if he is a civil servant. I am tired of these public services and benefits that we pay for but they are designated for particular citizens," Osendo enquired.

In a rejoinder, NHIF clarified that relevant ministries or employers pay extra for civil servants to enable the Fund to provide premium services.

"Do note that the civil servants are being paid for an extra amount by their relevant ministries or employers to enable us to offer these services to them at an extra cost that is in the form of a negotiated scheme," the statement read in part.

NHIF Cover

Hospitals are grouped into National Health Scheme (NHS) and Enhanced Scheme (ES) members. NHS, better known as Universal Health Care Supercover, is the primary health cover for all members and their dependents.

It includes employed and self-employed Kenyans who have attained the age of 18 years.

On the other hand, ES covers civil servants, National Police, County governments, parastatals and pension schemes for retired public officers.

How to Check List of all Hospitals That Cover Comprehensively and Non-comprehensively

Head over to NHIF official page: nhif.or.ke

Click the Members icon and click the hospital listing category.

Choose between NHS and ES and click any of the icons to view the respective category of hospitals.

Under the scheme, click on the respective icon or title of hospital categories to open the table list. 

An image on NHIF headquarters in Upperhill, Nairobi County.
An image on NHIF headquarters in Upperhill, Nairobi County.