The National Hospital Insurance Fund (NHIF) announced major changes to its coverage terms for self-employed contributors. The National Health Insurance says the changes are necessitated by the need to position NHIF towards the achievement of universal health coverage as well as enhance members’ retention. But, the punitive measures introduced could work against the goal to retain members.
NHIF has termed this change as a “Member Management Review”. The intention, we think, is basically to manage its cash flows because they affect members’ contributions into the fund. Are these new regulations justified? What does this mean for Kenyans? What are we looking at? Let’s quickly break down these regulations for you.
The first thing NHIF has done is to increase the waiting period for new members from 2 months to 3 months (90 days). Within this period of time, a member is expected to pay upfront for the one year cover, that is, pay Kshs 6,000 in premiums. This translates to about Kshs 2,000 per month instead of the Kshs 500 monthly for 12 months that members have been paying. There is also a 6-month waiting period for dependents disclosed following the initial registration, a 30 day waiting period for additional dependents and a 6-month waiting period for specialised services.
The second change in coverage is a 50% penalty for every month that one will have defaulted or not paid the premium. For example, if you default for one month, you will need to pay an additional Kshs 250 bringing your total to Kshs 750. This is for a maximum of 11 months for each month in default. If one defaults for over 12 months, then you’re considered a new member and must start afresh. This means you must go through the three month waiting period.
Maternity access will have a 6-month waiting period and new births must now be declared within 6 months. If a member defaults, maternity access is now restricted to six months after the card matures.
The NHIF has also limited the dependents to a single spouse and five children. This will make it more expensive polygamous families across the country, to access medical treatment.
However, there are specific programs run by the NHIF that are exempt from these changes, these are; Inua Jamii program, elderly persons with a disability, Linda Mama, and the Health Insurance Subsidy.
Are these changes likely to have more people retained within the scheme? The answer is probably not because low and middle-income Kenyans are not used to paying for medical insurance. Most people only take action when they fall ill. And, almost 50% of the population lives under a dollar a day so to ask people to pay the annual premium of Kshs 6,000 in three months is a tall order. With these changes, the government is unlikely to meet its stated goal of universal health care for all Kenyans.
It is yet to be seen whether these changes will remain given that the National Assembly’s Health Committee has already written to the NHIF Board demanding that the rules be suspended until the Board meets parliamentarians.