June 14, 2024

News requirements NHIF card holders must fulfill before seeking treatment

3 min read
News requirements NHIF card holders must fulfill before seeking treatment

Kenyans will have to strict requirements before seeking treatment abroad in the NHIF (National Health Insurance Fund) reforms

Kenyans will have to strict requirements before seeking treatment abroad in the NHIF (National Health Insurance Fund) reforms.

Under President William Ruto’s proposed reforms, Kenyans who seek to undergo medical treatment outside of Kenya must first fulfill five strict requirements before their care would be paid by the National Health Insurance Fund (NHIF).

Beneficiaries must have paid all contributions and arrears according to the proposed NHIF Regulations 2023, which are intended to ensure a more simplified and efficient process for health coverage. 

The national insurer must also receive a letter of recommendation from the patient’s physician.

The nature of the disease, the length of time the doctor treated the patient, the treatment or procedure for which the patient is being referred, among others, are some of the information referring doctors are obligated to submit.

The doctor must also indicate whether the treatment is available in Kenya and why it is sought abroad. 

“If yes, state why the treatment, procedure or investigation outside the country is necessary and essential to the prognosis of patient’s condition.” read the form in part.

Patients will also be required to obtain a letter of no objection from the Director General for Health.

“The Board shall consider the request for authorization of treatment outside Kenya to verify that the health service requested for authorization is unavailable in Kenya.

“Where the Board is satisfied that the health care service is not available for the beneficiary, the Board shall authorize the treatment of the beneficiary outside Kenya,” reads the regulations in part.

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Most Kenyans usually go to other countries for specialized treatment for cancer and heart-related diseases.

Significantly, in the proposals, Kenyans with chronic diseases will get unlimited coverage even if they deplete their limit. However, they will have to complete all their areas and contributions.

Contributions

It is proposed for employed and self-employed Kenyans to pay 2.75 percent of their salaries or income monthly.

Some unemployed Kenyans will pay Ksh1,000 monthly in the government’s latest proposals. 

“The amount payable by the National Government on behalf of indigent and vulnerable persons shall be Ksh13,300,” NHIF proposed.

Ruto has championed reforms underlining its benefits to many Kenyans struggling to make ends meet while criticizing the current payment model, which he argued was unfair and unbalanced.

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