NHIF Kenya - National Hospital Insurance Fund

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National Hospital Insurance Fund

The National Hospital Insurance Fund is a Kenya government state corporation with a mandate to provide health insurance to Kenyans over the age of 18.

NHIF Registration

NHIF in Kenya registers all eligible members from both the formal and informal sector. For those in the formal sector, it is compulsory to be a member. For those in the informal sector and retirees, membership is open and voluntary.

To register with NHIF as a member, fill in the Members Form. To register as an employer or organized group, fill in the Employers Form.

NHIF Benefits of Health Insurance in Kenya

  • Upon admission in hospital an NHIF member is accorded services and the hospital makes a claim to the Fund for reimbursement
  • An in-patient cover for the contributor, declared spouse and children
  • Provides comprehensive medical cover in majority of over 400 accredited Government facilities, Mission health providers and some private health providers across the country
  • Provides in-patient services in private and high cost hospitals on a co-payment basis
  • Comprehensive maternity and CS (Caesarian) package in government hospitals, majority of mission and some private hospitals
  • Dialysis at Kenyatta National Hospital & Moi Teaching & Referral Hospital at a rebate
  • Family planning – Vasectomy and Tubal Ligation
  • NHIF does not exclude any disease.

    NHIF Proposed Benefits

    In addition to the current benefits, under the proposed out-patient cover, members will enjoy the following benefits:

  • Prescribed laboratory tests/investigations
  • Drugs/medicines
  • Prescribed X-rays and ultra sound diagnosis
  • Treatment of Sexually Transmitted Infections
  • Treatment, dressing or diagnostic testing
  • Family planning
  • Ante-natal and post-natal care
  • Clinical counseling services
  • Health and wellness education
  • General consultation with general practitioners

    Contributions & Deductions

    Formal sector employees' contributions are deducted and remitted to the Fund by their employers. This is done by Cheque or through E-banking.

    For members under the voluntary category, they pay Kshs.160 per month (Kshs.1920 per annum). For those in formal employment, contributions are made as per their income.

    Payment of Claims

    Claims are submitted by hospitals directly to NHIF after the contributors have been discharged from the hospitals. The claims are examined by the Fund to ensure validity before payment.

    A claim can however be rejected and the hospital informed accordingly to incorporate either the missing documents or to address the abnormalities identified.

    The Fund strives to pay claims within 14 days upon receipt of the claim from the hospitals. Members who opt to clear the bills with the hospital may launch a general claim directly to NHIF for reimbursement.

    Sponsored Programmes

    NHIF seeks to establish partnership with individuals and/organizations to finance health insurance for indigents including orphans & vulnerable children, poor older persons, persons with disabilities and destitute families. The indigents shall be identified by NHIF or the sponsors.

    Enrolled indigents and their dependants shall have access to the current benefit package of inpatient cover in any of the health providers accredited to NHIF countrywide.

    Accrediting & Contracting Hospitals

  • The Fund strives to accredit as many hospitals as possible so as to ensure all members access NHIF benefits whenever they are across the country.
  • NHIF has an objective accreditation criteria and guidelines that aim to encourage hospitals towards quality improvement.
  • Accredited organizations are those recognized by the Fund and allowed to offer services to NHIF members and claim reimbursements thereof.
  • Accreditation of a health provider takes into account the services, personnel, infrastructure and equipments among other issues that the institutions have. The level of rebate therefore corresponds to the grade after scoring the various aspects.
  • The Fund, further contracts the health facilities to ensure they provide services comprehensively. This means that NHIF members walk in and walk out of the facilities fully treated at the cost of NHIF without making additional payments.
  • The contracts spell out the obligations of the health provider and NHIF.

    NHIF Rates
    Below are the NHIF rates categorized by various monthly income brackets.

    Gross Income (Ksh) - Monthly Rate
    1,000 - 1,499 30 Ksh
    1,500 - 1,999 40 Ksh
    2,000 - 2,999 60 Ksh
    3,000 - 3,999 80 Ksh
    4,000 - 4,999 100 Ksh
    5,000 - 5,999 120 Ksh
    6,000 - 6,999 140 Ksh
    7,000 - 7,999 160 Ksh
    8,000 - 8,999 180 Ksh
    9,000 - 9,999 200 Ksh
    10,000 - 10,999 220 Ksh
    11,000 - 11,999 240 Ksh
    12,000 - 12,999 260 Ksh
    13,000 - 13,999 280 Ksh
    14,000 - 14,999 300 Ksh
    15,000 and above 320 Ksh
    Voluntary/Self Employed 160 Ksh

    National Hospital Insurance Fund - NHIF Kenya Contacts

    P.O. Box: 30443 - 00100, Nairobi, Kenya
    Phones: 0800 720 601, (020) 2723255/56, (020) 2714793/94, (020) 2722527
    Fax: (020) 2714806
    Enquiries: customercare@nhif.or.ke
    Complaints: complaints@nhif.or.ke
    Liaise: info@nhif.or.ke
    Fraud: fraud@nhif.or.ke or (020) 2714803
    Branches: Located Country Wide

    NHIF Internships in Kenya - National Hospital Insurance Fund

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