NHIF which is established under Cap 255 of the laws of Kenya has become the leading comprehensive medical cover provider offering a wide range of services both for inpatient and outpatient services. These services are offered to the principal member and their dependants as registered. To join NHIF, one needs to be over 18years old and have a valid nation ID card.
After registering, you will choose the hospitals that you will prefer to get the services from. Upon visiting the hospital, you will be required to produce your ID card and the NHIF card to access services.
Benefits Under Super Cover Scheme
The supa cover package offers enhanced services to the members and thse include the following;
- Outpatient. This are all services that are enjoyed by other members.
- Inpatient. Any hospital stay period
- Maternity. Both normal and CS
- Surgical. Any treatment that requires surgery
- Renal Dialysis. Incase of kidney diseases that require dialysis
- Kidney Transplant
- Radiology (MRI and CT scan)
- Oncology (Chemotherapy, Radiotherapy)
- Drug & Substance Abuse Rehabilitation
- Emergency Evacuation
Please note that dental and optical services are not covered under the Supa Cover.
Services Included In The Inpatient package
When one is hospitalized, NHIF will cater for the bill and the in-patient package covers among others;
- Consultations. Doctors and specialist doctors’ consultation fees.
- Accommodation. This is the hospital bed fee charged by the hospital.
- Nursing care. Cost of nursing provided by the hospital
- Laboratory tests carried out during the course of hospitalisation
- Radiology examinations carried out while admitted
- Physician’s fees. Cost of the physician attending to the patient
- Operating theater charges where surgery is required
- Prescribed medications while one is admitted at the hospital
- Dressings and Maternity charges where one has wounds that require dressing.
Services Included In The Outpatient package
NHIF offers both inpatient and outpatient services. The outpatient services have been enhanced and many people are benefitting as they will rarely be hospitalised but will use outpatient services on a regualr basis. The services included in the outpatient package are;
- Consultation with General Practitioners
- Laboratory investigations
- Daycare procedures
- Drugs & dispensation
- Health education
- Drug and substance abuse
- Rehabilitation and physiotherapy services
NHIF Services That Require Preauthorization
Preauthorization is a type of legal restriction placed on certain health services, medications and tests by NHIF. This obliges the Healthcare Provider to check and take permission from the NHIF first, before providing certain services to determine if the patient’s plan covers the cost of the said service or not. This includes the following;
- Oncology Benefit Package (Chemotherapy, Radiotherapy, Brachytherapy)
- Dental Benefit package
- Optical Benefit Package
- Radiology Benefit Package (MRI, CT Scan)
- Surgical Package
- Overseas treatment
How To Get NHIF Preauthorization
To get preauthorization;
- Facility sends a pre-authorization request online via hospital portal. The hospital is supposed to send all pre-requisite documents to support the requisition
- Request is received by NHIF online
- The request is reviewed and actioned
- Member is notified via text or hospital notifies members on the outcome of the preauthorization
*Emergencies are acted upon as per the constitution and the contract between NHIF and the Healthcare facility. Turnaround for response is up to a minimum 24 working hours or a maximum of 48 hours once all relevant information has been received.
For you to get the services mentioned above, you need to be covered and paying. You can check your NHIF status by following this guide. Payments can be made through M-pesa as outline in this article.
