NHIF vs Private Insurance Medical Cards (private health hospital covers) in Kenya

This article explains and exposes the differences and discripancies of using NHIF vs other medical insurance (private health hospital covers) in kenya. The information in here is important since you need to know why you should choose one insurance over the other. Particulary, this hits hard those in the formal sector who are covered by their employees.

The uptake of health insurance cover among Kenyans is rising owing to increased availability and affordability of health insurance covers. National Hospital Insurance Fund (NHIF) is the primary provider of health insurance in Kenya with a mandate to enable all Kenyans to access quality and affordable health service. It has schemes such as Civil Servants & Disciplined Services Medical Cover, Health Insurance Subsidy Programme for the poor, and elderly and people with severe disabilities.

Private health insurance covers are offered by private insurance companies such as Britam, UAP, AAR insurance, Eagle Africa, heritage, first assurance, jubilee insurance, AON and many other insurance companies. Many employers are also buying medical covers for their employees and dependants.The information below will help understand some differences between NHIF and private health insurance policies.

NHIF vs Insurance Medical Cards

  NHIF PRIVATE HEALTH INSURANCE POLICY
Age Anyone from the age of 18 years and above can take an NHIF cover as long they have an identity card. Between 18 years and 65 years for most insurance companies.
Dependants
  • No limit in the number of dependants at no additional cost.
  • Age limit of children is 21, school going up to 25
  • There is no age limit for dependants with disabilities.
  • Additional premiums for each dependant, spouse and children.
  • Employers may limit the number of dependants to one spouse plus 3 to 4 children.
  • Age limit for children is 18, and 25years for those who are still schooling
Scope of cover
  • With NHIF one can access Outpatient services, inpatient services and maternity for declared spouse
  • ·Others such as dental services, optical services, group life cover and last expense cover are for civil servants and disciplined services members

 

  • Members can only access services as per the premiums they choose to pay. The more the services the higher the premiums. Premiums can be paid for the following cover.
  1. Outpatient
  2. Inpatient
  3. Maternity
  4. Optical and dental

 

Premiums Salaried individuals contribute from Kshs 150- 1700 based on salary bands and Self-employment 500 per month regardless of age and number of dependants. Can be paid in a monthly basis

 

 

 

Depends on the covers purchased and number of dependants. The rate of the premiums increase with age. People taking their cover for the first time at older age pay more in premiums than their younger counterparts for the same type of cover. Usually a one off payment for a year.
Hospitals NHIF accredited hospitals which are in three categories as follows

 

  • Category A (government hospitals) where members can enjoy full and comprehensive cover for medical, surgical and maternity services
  • Category B (private mission hospitals) where members may be required to copay for where surgery is required.
  • Category C (private hospitals) NHIF pays a specified daily limit and the member is required to up the rest

 

Depend on the insurance company, mostly prefer private hospitals and mission hospitals.

 

Daily limits on bed charges depended on the premiums paid by the member. If a member spends more than the specified limit then they are required to pay the extra amount. Payments are usually net of NHIF.

Limits For outpatients the limit in terms of visits/ amount is yet to be outlined. For inpatient services it usually unlimited. However, for members able dental and optical services the limit depends on the job group of the principle member There is usually a maximum amount per cover that a member should not exceed within a certain period.
Exclusions NHIF does not cover vaccines other than those in the KEPI schedule, ant-rabies, anti-snake venom vaccines and yellow fever.

 

It also doesn’t cover cosmetic surgery and fertility treatments

Vaccines not in the KEPI schedule may not be covered depending on the insurance company and cover purchased.

 

Most do not cover Family planning, Fertility treatments ,newborns admitted to NBU and any other services outside the purchased covers.

Gynecological conditions, Chronic illness and some dental procedures may be covered with some conditions for different insurance companies.

**It is always advisable to confirm with your insurance what they and what they because these varies across companies.


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Date published: 22/09/2017
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