NHIF hands members KShs 500,000 surgery cover in deal with Private hospitals


By STELLAR MURUMBA, [email protected]

The National Hospital Insurance Fund (NHIF) has started covering surgical procedures up to Sh500,000 after signing contracts with more than 2,000 hospitals. Chief executive Geoffrey Mwangi said on Thursday fund members can now undergo surgery at no pay at high-end health facilities such as Nairobi Hospital, Aga Khan Hospital and MP Shah.

“The surgical package is now on. We have signed contracts with over 2,000 facilities that are accredited with us,” he said.

The NHIF did not initially cover surgeries and the move is expected to ease the cost burden on Kenyans undergoing specialised treatment at the local facilities. NHIF members seeking minor procedures will enjoy a cover of between Sh30,000 and Sh40,000 for their medical bills. Major surgeries will be covered up to Sh130,000, while those undergoing specialised surgeries for diseases such as cancer would be covered up to Sh500,000. MP Shah chief executive Anup Das said patients at their facilities have been enjoying the benefits since Monday.

“We started offering the surgical benefits this week. Those whose bills surpassed the NHIF cut-off would mix and match with covers from their other insurance companies,” he said on Thursday.

Those without private insurance will be expected to top up cash, he added. The insurer had initially announced the benefits in August and pledged to issue further details on the cover.

“They are our own internal guidelines. For instance, we have a team in Naivasha training on filing for claims and also how to identify patients’ conditions and what package they qualify for, whether minor, major or specialised,” said Mr Mwangi.

The surgical package is a boon to more than two million NHIF members whose monthly contributions were increased more than three-fold. Monthly contributions were increased from Sh320 to between Sh500 and Sh1,700 in April based on a worker’s pay, with the promise of enhanced outpatient benefits at public and private hospitals. For corporates, the enhanced NHIF cover will ease the burden of rising insurance costs that has seen insurers raise premiums in line with increasing medical expenses.



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