New NHIF changes 2020: all you need to know

In a memo posted on January 7 2020, NHIF announced a bevy of changes which are primarily aimed at discouraging defaulters, according to the insurer.

Here is rundown of the myriad NHIF changes as highlighted in the memo.

Summary of NHIF Changes 2020

  1. New members have to wait for a period of three months up from 60 days. During this waiting time, you’re expected to pay Ksh6,000.00 (to cover 12 months) in the course of the waiting period. This is the first time that NHIF has set up such an upfront premium payment requirement.
  2. Members who have defaulted/paying late are to top up a 50% penalty. Again, you can only delay (and pay penalty payments) for up to 11 months because after the lapse of the 12 consecutive defaulted month, you have to apply afresh in which case the first point applies.
  3. Still on defaulting members, you will have to wait for 30 days to qualify for any benefits even after updating the payments and strictly adhering to the premium payment deadlines(Under the existing NHIF policy, you would access benefits immediately after updating your premiums).
  4. The circular further states that newly added dependents shall only be eligible for NHIF benefits (inpatient and outpatient) after the expiry of the 30-day waiting period. The same applies for those changing the dependent spouse.
  5. Perhaps more drastic is the limitation of the number of children dependents-these have now been capped at 5 meaning that Kenyans with large families have to look for alternative medical insurance covers for some of their kids.
  6. At the same time, you will now only be allowed to include one spouse as a dependent under the national insurance scheme.

Other NHIF Changes are as follows:

  • On maternity access (apart from Linda Mama) and other specialised services: you can only benefit after six months from the date your card matures, assuming no defaulted payments (if any, points 1 & 2 applies)- and this is for the principal/spouse declared during the initial registration.
  • You have to declare a newborn within six months after birth to have their medical bills covered.

However, the following programs/parties are unaffected by the above NHIF changes:

  • Linda Mama (maternity care)
  • Elderly persons (with severe disabilities).
  • Inua Jamii programme

NHIF says the raft of changes will help achieve and sustain the Universal Health Coverage (UHC) program and promote member retention.



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