NHIF new rates have become necessary as the old NHIF structure only provided in-patient medical cover. The NHIF new rates are intended to give NHIF members both in-patient and out-patient cover. These new NHIF rates would have come into effect in July 2010 but were delayed by a court case. Out-patient cover services included in these NHIF new rates include:

• Family planning
• Drugs and medicines
• General consultation with general medical practitioners
• Prescribed Laboratory tests and Lab investigations
• Treatment of Sexually Transmitted Diseases.
• Prescribed ultra sound diagnosis and X-ray
• Treatment, dressing and diagnostic testing
• Clinical counseling services
• Post-natal and ante-natal health care
• Health and wellness education

Out-patient Cover.

The outpatient benefit package includes both curative & preventive services which comprise, but not limited to:

i. Consultationii.

Laboratory investigations

iii. Drugs administration & dispensing

iv. Dental health care services

v. Radiological examinations

vi.Nursing and midwifery services

vii.Maternal Child Health/Family Planning

viii.Minor surgical procedures

ix.Optical care

x.Rehabilitation services

xi.Annual medical check-up

xii.Referral for Specialized Services

xiii.Ambulance services

xiv.Day care services such as Manual Vacuum Aspiration (MVA),

surgeryand other medical services deemed fit by the clinician e.g. caseswhereby a clinician may use the local anesthesia to numb a particularpart of the body which may include minor surgery like incision,drainage and suturing of wounds.

Dental Care

The Dental Cover includes

dental consultation,

orthodontics,

root canal,

dentures,

Cost of filling,

X-rays and Extractions including surgical extractions together with anaesthetics fees, hospital and operating theatre cost.

TheDental Cover can be accessed as per the provided limits in Table B on a Fee for Service basis.

Table B- Dental and Optical Limits(Per year, per family)

Provided the total cost in any one period of insurance does not exceed the limits specified in Table B.

 Optical Care

A member shall benefit in the proportion of expenses on a Fee for Service basis as shown on table B for the cost of the eye glasses and eye testing.

 Tests for Organ Donor(s)

NHIF shall meet the pre-test costs for the kidney donor identification uptoa maximum of two (2).

The potential donors shall be a paid up registeredmember/be enrolled as a member of NHIF.

Annual medical Check

The principal member and spouse are eligible for annual general medicalcheckup at the selected healthcare facility. Medical checkup will entail examination of the following:

i.Body mass index

ii.Full Haemogram

iii.Cholesterol

iv.Blood sugar

v. Gamma GT

vi.Urinalysis

vii.PSA(Prostate Specific Antigen for Men above 40)

viii.Pap smear for all women

ix.Mammogram

NB:Health Care Facilities that are unable to offer the above scope ofservices are advised to refer the member to other facilities (members shall not be required to pay for these services on referral)

Vaccinations

KEPI vaccines,

Rota virus vaccine,

Anti – rabies,

Anti –Snake venom and

yellow fever vaccine are catered for in the scheme. The vaccinations willbe availed at the selected health care facilities.

Steps to Access Out- Patient

Members are expected to seek Out-Patient treatment in their selected medical facility. Members in job groups A-K will have unlimited outpatient services in their selected facilities. Members in job groups L-T will access outpatient services in their selected facilities subject to their annual limits as indicated in Table C.The following documents are required at the point of service:i. A copy of NHIF card ORii. A copy of the National Identification card of the principal member or Staff Identification Card