Understanding the NHIF cover

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National Hospital Insurance Fund (NHIF) was established in 1966 with a mission  to provide accessible, affordable, sustainable, equitable and quality social health insurance to all Kenyans.

It is compulsory for all salaried employees to register with NHIF and contribute premiums which are automatically deducted from their salaries every month. Contributions are calculated on a graduated scale based on income, with members contributing between KES 150 to KES 1700 per month.

For the self-employed and those in the informal sector, membership is open and voluntary for a fixed premium of Ksh 500 per month. To be a member of NHIF, one must be a Kenyan resident aged 18 or older.

In April, 2018 the government launched another scheme with NHIF that covers all public secondary school students in Kenya.

Benefits available to NHIF members

  • Inpatient cover
  • Outpatient cover
  • Renal dialysis
  • Kidney transplant
  • Maternity
  • Radiology: MRI and CT Scan
  • Cancer treatment
  • Rehabilitation for drug and substance abuse
  • Reproductive health services
  • Surgical procedures
  • Emergency road evacuation services
  • Treatment overseas

Difference between NHIF and private health insurance covers

NHIF Cover Private Health Cover
Age Anyone from the age of 18 years and above can have an individual NHIF cover as long they have an identity card.


NHIF also introduced a cover for high school students.


It has no upper age limit

Between 18 years and 65 years for most insurance companies for individual covers.
Dependants No limit on the number of dependants


Dependants are covered at no additional cost.


Age limit for children is 21and up to 25 for school going


There is no age limit for dependants with disabilities

Additional premiums for each dependant, spouse and children is charged.


For employee cover, the employer determines whether or not to include dependants including a spouse or children and the total number of dependants per member.


Age limit for children is 18, and 25 years for those who are still schooling

Scope of cover One can access outpatient and inpatient services declared spouse and children.


The benefits include;

·         Inpatient cover

·         Maternity

·         Outpatient cover

·         Renal dialysis

·         Kidney transplant

·         Radiology: MRI and CT Scan

·         Cancer treatment: Chemotherapy and radiotherapy

·         Rehabilitation package: drug and substance abuse

·         Specialized lab test package

·         Surgical package

·         Emergency road evacuation services

Members can only access services depending on the premiums paid


The more the services the higher the premiums.

Premiums Salaried individuals contribute from Kshs 150- 1700 based on salary bands. This is deducted from their salaries on a monthly basis.


Self-employed individuals pay Ksh 500 per month regardless of age and number of dependants.

Depends on the type of cover 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.


Payment is usually done once and in full but there are insurance companies that allow installment payments

Hospitals NHIF accredited hospitals which are in three categories as follows;


A (government hospitals) where members can enjoy full and comprehensive cover for medical, surgical and maternity services


B (private mission hospitals) where members may be required to copay where surgery is required.


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 depend 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.

Exclusions Caters for most medical services including rehabilitation for drug and substance abuse, maternity, cancer treatment, dialysis etc Most insurance policies excludes fertility treatment, maternity, rehabilitation for drug and substance abuse, cancer treatment etc depending on the type of cover purchased


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