Transcript NATIONAL HOSPITAL INSURANCE FUND HISTORICAL …

NATIONAL HOSPITAL
INSURANCE FUND
The Social Health Insurer of Choice
HISTORICAL
BACKGROUND
The NHIF was established
in 1966 under CAP 255 of the
Laws of Kenya to be run by
an Advisory
Council appointed by the
Minister of Health.
The NHIF was established in
1966 under CAP 255 of the Laws
of Kenya to be run by an
Advisory Council appointed by
the Minister of Health.
It catered for salaried
employees earning Kshs.1,000
and above per month, making a
monthly contribution
of Kshs.20/=
In 1972 an amendment was
made to incorporate voluntary
members (self-employed) at a
monthly
contribution of Kshs.60/=
In 1998, Cap 255 was repealed
and replaced by the NHIF Act
No.9 of 1998 which
transformed the Fund
to a State Corporation
managed by an all inclusive
Board representing various
stakeholders and interest
groups: -Permanent Secretary – Health
-Central Organization of Trade
Unions
-
Directorate of Personnel Management
-
Kenya National Union of Teachers s
Director of Medical Services
Kenya national Farmers Union
Federation of Kenya Employers
Association Kenya Insurers
Christian Association of Kenya
-
NGOs
Kenya Medical Association
VISION
To be a world class social
health insurance scheme.
MISSION
To provide accessible, affordable,
sustainable and quality Social
Health insurance through
effective and efficient utilization
of resources to the satisfaction of
stakeholders.
The Fund operates under the
social security principle that
the rich should support the
poor, the healthy support the
sick and young support the
old.
MANDATE
Register and receive contributions.
Make payments to declared
hospitals.
Set criteria for declaration of
hospitals and accredit them.
Regulate contributions payable to
the fund.
MEMBERSHIP
A Kenyan resident.
Has attained 18 years of age and
above.
Drawn from both formal and informal
sector.
Monthly
income of over Kshs.1,000/=
or Kshs.12,000 per annum for selfemployed persons.
Current
membership of 1.5 million
principal and 8 million dependants.
INFORMAL SECTOR/
PENSIONERS
development Goals is to ensure
access to health for all by the year
2015.
To achieve this NHIF has
embarked on a programme to
work with organised groups/
associations so as to
expand informal sector
membership.
 These
groups include:
Retirement groups
Co-operative societies.
Community based organization.
Micro-finance institutions.
Church organizations.
Matatu Sacco’s.
Individual self employed persons.
Pension schemes/Organised
groups facilitate registration of
members.
That in the meantime maintain the
Certificate of Contribution Paid
(CCP)
Maintain members records.
CONTRIBUTIONS
Kshs.160 per month( 1920/= per
year) for pensioners/ organised
groups .
Range from Kshs.30/= to 320/=
based on gross monthly income
for formal sector members.
MODE OF PAYMENTS
Employers effect deductions and
remit to the Fund by cheque or
cash,
E-banking
Members in the informal sector
pay in any of our offices.
Kshs.160 per month for informal
sector members
Members in the informal sector
pay in any of our offices.
All payments should be
th
received by the 9 of the
following month.
For retirees/self employed
persons payment for the year may
be paid upfront; either quarterly,
semi-annually and/or annually.
BENEFITS
COVER
Covers all admission cases with
few exceptions such as
circumcision.
No medical checkup required.
Covers
member, spouse and
children under the age of 18 year.
Children over 18 yrs and in
learning institutions are also
covered
Is for 180 days of hospitalization in a
year.
NHIF pay a daily rebate which ranges
from Ksh.400/= to Ksh.2,200/=
Foreign claims
The number of other spouses is not
limited and depends on the ability to
pay for them
HOW TO ACCESS BENEFITS
Through presentation of the following
to hospital on admission:
Current NHIF Card- both manilla and
photocard.
Certificate of Contributions
Paid.(CCP)/ Receipt.
ID card.
The accredited hospitals deducts the
daily rebate X number of days of
hospitalization from the incurred bill.
While for the contracted hospitals
under category A, the entire bill is
made by the Fund.
The
Fund reimburses member for
costs incurred to the extent of the
daily rebate if for one reason or
another he /she is unable to use the
card in hospital.
All claims should be received within
90 days after hospitalization.
ACCREDITED HOSPITAL
415 health care providers have been
enlisted across the country to provide
services to NHIF beneficiaries under
various contracts.
Accreditation by NHIF is based on
certain set standards and criteria for
purpose of NHIF benefits.
Quality Assurance and Standards
Department consistently monitors the
quality of services.
MILESTONES
Increased rebates up to a maximum of
2,200 depending on hospital
accreditation.
Extensive branch network – 27
branches, satellite and window
offices.
Decentralized services.
Computerized operations and
services.
Computerized operations and
services.
Quality Assurance and Standards
department in place.
FUTURE OF NHIF
Use of magnetic stripecard in
hospitals to access benefits
Introduction of diversified
product lines.
Introduction of diversified
product lines.
Further expansion of our branch
network.
End.
Thank You.