NHIF boss defends payment of Sh200m excess cover for police
Mercy Mwai @wangumarci
The National Health Insurance Fund (NHIF) paid Sh200 million to police and prisons officers who exceeded their cover limit without the approval of the Interior Ministry.
NHIF Chief Executive Officer Peter Kamunyo told the Public Accounts Committee (PAC) of the National Assembly that those who enjoyed the excess cover were 1,832 officers and their beneficiaries.
Kamunyo said they made a decision on who can enjoy the cover based on the laid down procedures as at that moment there was no provision requiring approval from the insuring entity.
Kamunyo further explained that those who enjoyed the cover were mostly cases of referrals from various hospitals.
“Yes we do need approvals but the reason why we did not ask for it at that time was because this provision was silent on this. We, however, followed all the terms and conditions in the original contract,” he said.
Out of Sh200 million paid as excess cover, Kamunyo told MPs that only Sh157 million was spent leaving a balance of Sh43 million that was carried over to the 2018/19 financial year.
Kamunyo appeared before the committee to respond to queries raised by Auditor General Nancy Gathungu on the procurement of a comprehensive medical cover for a period of two years from October 1, 2017 to September 30, 2019 through direct procurement method.
Gathungu in her 2017/18 audit report said there was no evidence of any employee exceeding the limit, hence the money should have been refunded.
Interior Principal Secretary Karanja Kibicho, who last month appeared before the committee, said they had no option but withhold subscription as NHIF had refused to refund them their money.
On claims the insurer was still holding on to the money which was an excess payment on the National Police Service comprehensive medical cover, Kamunyo said the issues were sorted out after a meeting between them, the Interior Ministry, the Kenya Police Department and the Inspector General of Police.
“Indeed there was utilisation of the excess funds. But we went through the documents and we segregated all the data and we only left a balance of Sh5 million,” he said.
The Ministry of Interior paid the Sh200 million for excess loss of cover to cushion members who might exhaust their limit over and above the original two-year contract that ran from 2017 to 2019 of Sh4.5 billion that was to benefit 122,708 beneficiaries.