New National Health Insurance Fund announces new rules, penalties

Friday, January 10th, 2020 00:00 | By
National Hospital Insurance Fund headquarters in Upper Hill, Nairobi. Photo/File

New National Health Insurance Fund (NHIF) members will have to wait for three months and pay a full year’s contribution before being eligible for any benefits.

This is one of the new rules that has been introduced in a memo sent by Head of Compliance Registration Richard Otom to senior NHIF officials.  The waiting period has been reviewed upwards from two to three months.

“Revision of the waiting period for new voluntary national scheme members from the current 60 days to 90 days and to introduce a -year 12 months upfront payment, payable within the waiting period while observing the due dates, before one can be eligible for any of the benefits,” said Otom in a circular seen by People Daily yesterday.

The same rule will apply if a member does not pay contributions for a whole year and they will have to start afresh.

 “In case of defaulting 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, payable within the waiting period while observing due dates,” said the circular.

Previously, this was not the requirement, as one would just be enjoying the services after waiting for two months and paying the monthly contributions for the period.

Monthly contributions

Secretary-General Kenya Association of Private Hospitals (KAPH) Timothy Olweny yesterday confirmed hospitals have received the circular. He, however, said the main problem facing the scheme is sustaining the scheme because many members don’t make monthly contributions.

“I however feel that they should have consulted members before introducing the new regulations,” said Olweny.

The circular said that the penalty on defaulting beneficiaries has been retained at 50 per cent of their monthly contribution for each month paid late, up to 11 months, coupled with requirement to pay for one year in advance and a restriction of 30 days before being eligible for benefits.

 NHIF has also reviewed its dependents’ terms by reducing the number of dependent children to five from the current 10.

 The national scheme will also be limited to one spouse, with NHIF adding that all with additional dependents would only be included subject to payment of additional premiums which will be communicated after actuarial evaluation is done

The reviews which were agreed after special full board meeting in December last year also agreed to introduce one year upfront period payment which will be payable within the waiting period.

For the voluntary members access to maternity benefit will be restricted for six months post card maturity for principal members or spouse declared at the point of registration.

“Both maternity and specialised services, any dependent declared after initial registration shall be subjected to a six month waiting period after such declaration with exception of newborns who shall be considered eligible for benefits,” the statement says.

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