Why Kenya’s National Hospital Insurance Fund is Becoming So Expensive

Health care is set to get more and more expensive in Kenya, with the latest guidelines on the National Hospital Insurance Fund (NHIF) which would result in citizens bearing more of the cost.

This is a setback in the universal health coverage goal that seeks to provide affordable health care for all. 

In a Special Full Board Meeting held on December 17,  2019, the NHIF board resolved that as from January 2020,  the waiting period for new members shall be increased to 90 days from 60 days and they should have paid KSh 6,000 upfront for the 12 months before enjoying the benefits.

The board has also put in punitive measures for those who default to pay their monthly contributions with a 50% penalty for each defaulted month “and a restriction of 30 days before being eligible for benefits”.

“In 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 otherwise ( the 50% penalty) will also apply,” read the statement.

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Maternity and specialized services

Further, Voluntary Members’ access to maternity benefit will be restricted to six months of postcard maturity for principal members or spouse declared at the point of registration.

“For both Maternity and Specialized Services, any dependent declared after initial registration shall be subjected to a 6-month waiting period after such declaration with exception of newborns who shall be considered eligible for the benefit provided they are declared within 6 months from the date of birth,” adds the statement.

Dependants

The board reduced the number of dependant children to five from the current 10, while eligible spouses will remain at one. Additional dependents will only be included subject to payment of additional premiums to be communicated after actuarial valuation.

The Board exempted the Health Insurance subsidy, Linda Mama, Elderly persons with severe disability and Inua Jamii program from the reviewed.

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Under the Bill of Rights in Kenya’s Constitution, citizens are entitled to the fundamental right to the highest attainable standards of health and the UHC agenda seeks to deliver on this right. It is also in line with Sustainable Development Goal (SDG) 3.8 “achieve universal health coverage, the Astana Declaration on Primary Health Care (PHC) 2018 that aims at ensuring people-centered care that offers universal access, social equity and financial protection with a PHC-led approach among other global commitments on health.