Anxiety over fears the civil servants will lose enhanced medical cover in new Ruto’s SHIF (Social Health Insurance Fund) plan.
Public employees who have been receiving enhanced medical coverage from the National Health Insurance Fund (NHIF) are in a state of anxiety as the State launches a new program.
At least 73 public institutions, among them civil servants, that have been enjoying comprehensive medical cover offered by NHIF have now been left hanging in the balance following the enactment of the new social health scheme.
Millions of retired public servants and officers who have been dependent on the program are also impacted because nearly all commercial medical insurance plans do not provide coverage for them because of age restrictions.
Additionally, concerns have emerged regarding the possibility that certain influential government figures are setting the stage for private insurance companies to supplant the all-inclusive coverage previously provided by NHIF.
The Social Health Insurance Fund (SHIF) Act 2023, which was recently gazetted by Health Cabinet Secretary Susan Nakhumicha, has eliminated the expanded coverage option that has long been available to public officers, civil servants, and workers of other government agencies.
The removal of SHIF’s comprehensive coverage has incited outrage among retired public officials, academic institutions, physicians, and civil servants who have been beneficiaries of the package.
This comes also after NHIF Chief Executive Elijah Wachira revealed that government will scrap EduAfya, a scheme that has benefited millions of secondary school students.
Other sectors that have been enjoying NHIF comprehensive cover include all civil servants, county government and assembly employees, public universities, National Police Service, Kenya Prisons Service, NYS and several parastatals.
Notable universities and parastatals whose employees have been enjoying the enhanced scheme include Moi, Alupe, Bomet, Kenyatta, Nairobi, National Defence, JKUAT, Egerton, Kisii, Dedan Kimathi and Maseno and Kenyatta National Hospital, Wildlife Research Institute, Nyayo Tea Zones Development Corporation, Kenya Power Pensions Fund, Water Resources Authority, Lapset Corridor Development Authority, Kenya Veterinary Board, Coast Water Works Development Agency and National Social Security Fund (NSSF), among others.
According to NHIF, Comprehensive hospitals offer all-inclusive services of all the packages to enhanced scheme members without pay (walk in and walk out).
The comprehensive package comprised hospital stay with health care diagnosis; procedure and treatment including consultations and specialist doctor’s fees; bed charges; nursing care; diagnostic laboratory and radiology investigations; and prescribed medications and dressings.
For employees of an institution to enjoy the NHIF comprehensive cover, the employer was only required to pay an enhanced premium different from the ordinary rates.
Once SHIF comes into operation, all government employees enjoying such special services will lose out as they have not been included in the new scheme.
The Kenya Medical Practitioners, Pharmacists and Dentists Union (KMPDU) has now raised the alarm, claiming that some unnamed individuals in the government could be out to terminate the enhanced insurance schemes being offered by NHIF in order to pave the way for some private insurance firms.
“From the look of everything, it is a well-choreographed scheme to create room for private insurance companies to take over the provision of comprehensive health insurances services to civil servants and other employees working for government agencies,” KMPDU Secretary General David Bhimji Atellah said.
According to Dr Atellah, the scheme seems to have been hatched almost three years ago when the Insurance Regulatory Authority stopped NHIF from offering commercial insurance services.
Following the directive in 2020, the police, civil servants and some parastatals were forced to seek alternative medical insurance cover as NHIF was to consign itself to the core mandate of only collecting contributions from members in both the formal and informal sectors of the economy and social insurance schemes.
The move saw NHIF lose billions of shillings in premiums from the organisations to which it has been offering commercial insurance schemes.
Dr Atellah says SHIF has been designed in such a way that would force civil servants, county governments and assemblies, police, prisons, NYS, parastatal and other State agencies interested in offering a comprehensive cover to their employees to resort to private insurance firms.
“Those who drafted the Bill and subsequent regulations must have had this in mind…to create opportunity for private insurance companies to make a killing from government and State institutions desirous to offer comprehensive packages to their employees,”Dr Atella said.