Taking a Closer Look at How NHIF Works in Kenya

Written by Ruth Njiri

The National Hospital Insurance Fund or NHIF is a State Parastatal that was established in 1966 as a department under the Ministry of Health. The original act of parliament that set up this Fund has over the years been reviewed to accommodate the changing healthcare needs of the Kenyan population.

The transformation of NHIF from a department of the Ministry of Health to a state of the corporation was aimed at improving its effectiveness and efficiency.

The Fund’s core mandate is to provide a medical insurance cover to all its members and their declared dependants (spouse and children). The NHIF membership is open to all Kenyans who have attained the age of 18 years and have a monthly income of more than KES 1000.

The NHIF membership is open to all Kenyans who have attained the age of 18 years and have a monthly income of more than KES 1000.

How Do You Register For NHIF?

NHIF 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 as an individual, one needs to fill in the members’ form. To register as a company or an organized group, fill in the employer’s Form.

Benefits of NHIF Membership

Some of the benefits of being an NHIF Member include:

  • Treatment and comprehensive medical cover upon admission to an accredited hospital or health institution
  • An in-patient cover for the contributor and their declared spouse and children
  • Comprehensive maternity and CS (Caesarian) package
  • Dialysis at Ksh 2,500 per session

How Do You Make Contributions to the Fund

For people who are formal sector employees, contributions are deducted and remitted to the Fund by their employers at particular  premium rates as per their pay grade.

For people who contribute under the voluntary category, they pay KES.500 per month (or KES.6000 per annum).

How Are Claims Settled?

Claims are submitted by hospitals directly to NHIF after the contributors have been discharged from the hospitals. The claims are then 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.

 Learn more:

  1. Importance of Having NHIF in Kenya
  2. NHIF website list of accredited hospitals

About the author

Ruth Njiri