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How to Apply for NHIF Cover

The national hospital insurance fund (NHIF) in Kenya is a body created for the provision of health insurance to Kenyans. NHIF contains directives useful for citizens to have access to affordable and quality healthcare services. Due to the high percentage of Kenyans who cannot afford quality health care services the NHIF created NHIF cover limits to make sure that each and every citizen was covered.

Some of the NHIF cover limits

NHIF in collaboration with the Kenya essential package for health (KEPH) has made sure that there are packages available for everyone.

Some of the NHIF covers available include :

1. outpatient cover

2. inpatient cover

3. group life cover

4. maternity cover and reproductive health.

5. last expense cover

6. Ex-Gratia payments.

Outpatient cover

This service was launched in July 2015under as a national scheme, this NHIF cover is available to declare NHIF members in accredited hospitals in Kenya. the essentials of outpatient coverage are

  1. Laboratory services
  2. consultation
  3. radiology
  4. drug administration
  5. optical services
  6. nursing services
  7. dental services
  8. occupational therapy services
  9. physiotherapy services
  10. minor surgery services
  11. referrals

Inpatient cover

This cover includes all the services and medical treatment that are provided on the order of a clinician to an NHIF member. the cover can also apply if a member is admitted to a hospital that is accredited by the NHIF, the inpatient cover the following :

  1. Nursing care services
  2. Hospital bed charges
  3. Laboratory
  4. Diagnostic
  5. Specialist’s consultation services
  6. Dressing services
  7. All drugs and medications

Maternity and reproductive health cover.

This cover is widely known as the Linda mama cover

It ensures quality  and affordable access to health services for women and infants the main aim of the Linda mamma scheme is to ‘’achieve  universal cases to maternal and child health services and contribute towards the country’s progress towards UHC(Universal health care )

Maternity cover is only available to accredited hospitals

It also offers

-all post-natal services: this includes family planning services

-all antenatal services: antenatal profile for; tests are done and preventive services.

Comprehensive NHIF cover

The comprehensive cover caters to outpatient and inpatient medical treatments either within the country or outside the country, for the principal members and eligible dependents. for the principal members are offered group life and last expense cover.

Procedure and requirements for applying for an NHIF cover

Registration of National Hospital Insurance Funds can be done either online by visiting NHIF, offline by dialing *155#, or by visiting the Huduma center. To be eligible, one must have attained 18 years of age and earns more than KES1000  a month and KES12000 a year. He/she should be a Kenyan citizen. However, foreign students can also apply for the same provided they meet all the requirements.

NHIF rates in 2019 were introduced with the contributions as follows;

  • KES 150 on a monthly income of up to 5,999.
  • KES1700 on a monthly income of up to 100,000.
  • KES 500 for self-employed persons.

NHIF registration has the following requirements

  • Copy of employment letter for employed people
  • Copy of national ID
  •  Copy of your spouse’s national ID  if applicable
  • Original copies of birth certificates for dependents.

Requirements For International Students

a passport photocopy.

passport-size, colored photo.

   Requirements For Foreign Citizens

copies of the passport, work permit, and alien certificate.

passport-size colored photo (Spouse and dependents included if applicable).

necessary requirements for Dependents

The only insurance that enables you to add dependents to their coverage is NHIF. You can edit the form to add or delete your spouse in the event of a death or divorce.

Download and complete each form on the NHIF website before submitting it to the nearby NHIF office or Huduma center. These conditions must be met if you need to update dependents:

A copy of both your ID and that of your spouse.

a duplicate of your marriage certificate or a magistrate’s court sworn affidavit

a copy of the kids’ birth certificates.

notification of birth for infants younger than six months.

passport-sized colored pictures for each dependent.

Adding Dependents: Steps

Fill out form number 26 (APPLICATION FOR AMENDMENT/UPDATES), which you can get at Huduma Center or NHIF offices. You may also download the form from this page.

Include copies of the paperwork requested on the form above.

Give the Huduma center officer the documents.

How to use a mobile phone to check your NHIF status

Knowing your contribution status requires checking your status. It is significant to note that payments made after the ninth of every month are considered to be late and are subject to a fee. People who are self-employed will incur a penalty equivalent to 50% of their monthly contribution, while those who are employed will incur a penalty equal to their monthly salary. They will therefore be charged twice.

Importance of NHIF covers

a)An NHIF member is provided with health services upon admission and the hospital makes claims to the fund for reimbursement.

b)NHIF provides cover in over 400 government hospitals that are accredited, some mission health providers and also private providers offer NHIF SERVICES too

c)comprehensive maternity and cesarean packages are offered in government hospitals, mission schools, and hospitals.

d)Family planning services are also offered.

e)NHIF does not exclude any disease

f)dialysis offered in Kenyatta hospital and Moi-teaching and referral hospitals are offered at a rebate.

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