Beneficiaries of the National Hospital Insurance Fund (NHIF) and those that hope to join should be prepared for a total overhaul of the terms and conditions on the health cover.
The changes to the terms and conditions were reached upon in a meeting held on 17th December 2019.
Below is a Breakdown of the Changes
The number of dependents has been reviewed to a maximum of five children and one spouse for the national scheme form the previous 10 members of the same family for National Scheme Members.
If a member defaults on payment for 12 consecutive months, the membership will be revoked and they would have to start payments afresh.
Please note that for a managed scheme, it will be capped at M+6 and M+1 for normal and retiree schemes respectively.
Dependents can also be only increased at an increased premium by the NHIF member after evaluation.
In the case of default for 12 months and above, the affected member will start payment afresh and be eligible for benefits after 90 days from the date of resumption of payment in addition to a one-year upfront payment, payable within the waiting period while observing due dates.
The waiting period for new Voluntary members is now from 60 days to 90 days and will be also required to make a one-year upfront payment before they can be eligible for any benefits.
Initially, voluntary category members used to pay 500 shillings per month which total to 6000 shillings per year while those in formal employment make contributions as per their income.
In a memo addressed to NHIF’s Regional Managers, Branch Managers, and other senior officers, the National health fund noted that the changes would be put to effect on 1st January 2020.
For both maternity and specialized services, any dependent declared after initial registration shall be subjected to a 6-month waiting period after such declaration.
Newborns will be considered eligible for benefit provided they are declared within six months from the date of birth.
The changes will not in any way affect the following:
Health Insurance subsidy program
Free Maternity Program (Linda Mama)
Elderly Persons with Severe Disabilities
Inua Jamii Program
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