As a worker, you have
12 payments a year deducted from your salary as your contribution to the
National Hospital Insurance Fund, and this goes on for many years.
You
never get to see your statement because there is no way to readily
check your status – until you’re in hospital and want to make a claim.
NHIF
reimburses the hospital up to Sh1900 per night, which will cover your
payments at a rural hospital and represents a fractional reduction of
your bill at a Nairobi hospital.
The
hospital will run a check on your card but if there’s one payment
missing from your statement, such as in January 2008, your entire
membership is invalidated and you have to pay a penalty of up to five
times the missing payment.
It
doesn’t matter whether you or your company was responsible for making
the payment which is missing from your statement - you simply can’t
benefit from the NHIF.
At
this stage, you can make the missing payment of Sh160 or Sh320 to the
hospital, which is empowered to receive the payment and a penalty of
five times this amount on behalf of NHIF, but the hospital cannot change
your NHIF status. You have to go to an NHIF office and adjust it.
Besides
hospitals, the same pattern is seen in other NHIF payment channels. You
can conveniently pay your contributions by M-Pesa, call the NHIF call
centre or visit their desk at a Huduma Centre, but you will find that
while staff at the Huduma Centre or NHIF call centre are able to confirm
your membership status, they are not empowered to do things like change
your status or membership. For that you still have to visit a NHIF
office or headquarters.
It
could be something as simple as inputting your NHIF number instead of
your national ID number when making an M-Pesa payment, but this can only
be fixed at the NHIF office
This
month, Kenyans get to start paying new rates to the NHIF. The Cabinet
Secretary for Health gazetted the new NHIF rates that will now be
effective April 1, 2015. In the new plan, workers’ monthly contributions
to the NHIF are set to rise from the current Sh320 to Sh1,700 per
person for the highest contributors, who earn salaries of above
Sh100,000.
Despite
some contributions going up almost five times, there will be no
increase in the daily bed compensation that NHIF pays to hospitals.
Also,
while the new contributions are said to come with more benefits like
meeting costs of some laboratory tests, drugs, X-rays and ultrasound,
doctor consultation, and even family planning, it seems NHIF is yet to
formally communicate these outpatient benefits to service providers like
hospitals, where patients still have to pay cash or though their
medical insurers.
NHIF
is a vital institution, but one which does not inspire much public
confidence. This is because, like its sister NSSF, it is often mentioned
in the news for procurement scandals, a revolving door of directors and
executives, and court wrangles that always burden the taxpayer further.
It also did not help when a former health minister said Kenyans should not hesitate to pay for NHIF as the amount was still less than what he paid for lunch.
But
using the NHIF is challenging, and this is sad because they are really
the medical insurance options for groups like Kenyan retirees. Once you
are 55 or 60 years or older, you have almost no local medical insurance
options in Kenya besides NHIF.
The
NHIF should empower both its staff and its members to create a better
experience. They can send expiry notices by SMS. Members should also be
able to view, query and reconcile missing payments without having to
visit NHIF offices. Hopefully, these new contributions will lead to a
better experience in future.
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