NHIF Rates: somebody explain to me like am 5 how these figures arrived at

NHIF collects ksh 20400 per year from civil cervants na hao wengine using it but it will only allow one to use upto ksh 1400 per year. where the F do they take the other ksh 19000?

Story ndio hii. warning too long

The National Hospital Insurance Fund (NHIF) principle contributors will only be allowed access to medication of between Sh 1,000 and Sh 1,400 outpatient cover per year under the new regulations.

NHIF Managing Director Simon ole Kirgorty has issued a circular to the Fund’s managers across the country notifying them of the new capitation rates.

The new capitation rates based on actuarial analysis according to Mr Kirgotty will see those attending level II-IV hospitals limited to a capitation rate of Sh 1,000 per year while those attending level V-VI hospitals would benefit up to a limit of Sh 1,200 annually.

The arrangement means that service providers will be paid the declared amount depending on the number of contributors who chose their hospitals whether the contributor seeks care or not.

The benefit to the service providers is dependent on the numbers they are able to enroll and prayers that many people don’t get sick while the contributors will benefit from the universal value of the amount capitated in total.

Workers in private firms contributing a similar amount monthly in private medical schemes enjoy out patient cover of up to Sh100,000 for the recommended household.

The private sector schemes normally subsidized by the employers also allows access to decent optical and dental cover and an extensive inpatient cover of between Sh150,000 and Sh500,000 in some companies.

The actuarial report has also put those attending National Referral hospitals on a limited capitation of Sh1,400 per year.

The NHIF will also pay Sh1,200 for those visiting private hospitals rated level II-IV while those attending hospitals rated level V-VI would be capitated at Sh1,400.

“The NHIF Board of Management has approved roll out of National Outpatient cover. The mode of provider payment shall be on capitation basis,” read a letter by Mr Kirgotty seen by the Sunday Nation.

He further wrote: “Having drawn experience from the civil servants scheme and having carried out extensive review and actuarial analysis, it was established that the average cost of an outpatient visit is about Sh2,300.”

The NHIF contributions have been enhanced to between Sh500 and Sh1,700 sparking protests from workers across the country.

The Mr Kirgotty further said that the board’s actuarial department was still reviewing the rebate rates payable under the inpatient scheme in a view to enhancing them to cover full hospitalisation comprehensively.

“Kindly share this information with health providers as you engage them and communicate to us feedback received,” said the letter.


On Saturday, the Trade Unions Congress of Kenya officials criticised the new capitation rates, arguing they were too modest and insignificant compared to the amount deducted from contributors.

TUC-K National Chairman Tom Odege and Deputy Secretary-General Charles Mukwaya said the rates did not match the amounts collected by NHIF from contributors and will not be allowed.

“If they are collecting Sh20,400 from contributors how then does it turn out that one can only access Sh1,400. This is a rip off,” said Mr Odege.

The TUC-K boss insisted that workers will only support the new rates if NHIF allowed input from the concerned trade unions.

He said that NHIF’s new capitation arrangement is similar to the one that initially failed, forcing the board to review it in 2012.

Knut Secretary-General Wilson Sossion, who is also the Secretary-General of the public servant’s labour centre, on Saturday announced that teachers would join in the strike and called on all the 288,000 teachers across the country to boycott classes tomorrow.

“Teachers are part of TUC-K and we want to make an appeal to each and every teacher to stay away from classes from Monday. What happened on Thursday was a warm up to a national strike that will be bigger than ever seen in this country,” the Knut boss stated.

On Friday evening, however, the Industrial Court stopped the strike called by TUC-K after the acting Labour CS Rachael Omamo, Devolution’s Anne Waiguru and Education’s Prof Jacob Kaimenyi and Teachers Service Commission moved to court to block it.

man eat man society

Whaaaaaaat! That’s stark thieving!

I wish county governments could see how NHIF is ripping them off and reject NHIF patients. A hospital gets 1400/- per year for a patient and is supposed to sort that patient’s medical problems and that of his dependants for a whole year ?? It’s a giant con scheme

The older NHIF was paying between 1000 and 2000 per day for a maximum of 60 days, right?

For inpatient cover only; it had no outpatient cover.

The 1,400/= being referred to in the article refers to outpatient cover only. It’s an almost negligible benefit for patients with long term illnesses such as diabetes (single mixtard vial costs Ksh.300-400 on average, injections cost Ksh.10), hypertension, psychiatry,epilepsy, etc.

If anyone wants to know the mess that’s NHIF, scratch the surface a little and find out how they’ve mismanaged the existing civil servants’ outpatient cover. For it to be implemented, all civil servants surrendered their medical allowances which ranged from around 1500/= p.m depending on job groups. Now the same are being asked to contribute even more towards a service that rarely benefits them, characterized by poor and inconsistent funding and consequent drug stock-outs. This is the reason many private and mission hospitals and clinics are no longer willing to treat civil servants and have terminated their contracts.

Of course, devolution has contributed in no small measure to the mess by introducing an extra layer of bureaucracy, with most counties not forwarding the money to the concerned hospitals.

Incidentally, I’m one of those who holds the view that NHIF is, as constituted, an unnecessary waste of taxpayers money. I believe we can disband this wasteful body (spending half of our contributions on ‘administrative costs’) and replace their charges with some sort of a ‘health tax’ administered by KRA which already has the administrative structures.

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So, this implies if I am contributing 1,000 every month to NHIF, i will have paid 12,000 at the end of the year. Then, the regulation require me to access outpatient care worth 1,400 for the entire year?..pig shiet!
from their proposed benefits, they have indicated they will pay for
[li]Prescribed laboratory tests/investigations[/li][li]Drugs/medicines[/li][li]Prescribed X-rays and ultra sound diagnosis[/li][li]Treatment of Sexually Transmitted Infections[/li][li]Treatment, dressing or diagnostic testing[/li][li]Family planning[/li][li]Ante-natal and post-natal care[/li][li]Clinical counseling services[/li][li]Health and wellness education[/li][li]General consultation with general practitioners[/li][/ul]
Are all the above included in the 1,400 per year? the figure is not even enough for consultation fee in most of the private hospitals listed.
Somebody is cheating Kenyans bigtime here

Wakanyama kuja hapa .

We need a sober discussion on this issue. Civil servants have woken up and they don’t want to be misused anymore.

I second. This thing as currently structured is nothing but pure bull. And that is before you factor in the universal cover they now wanna roll out and which is the subject of that newspaper article.

Incidentally, who recalls Ngilu’s failed attempt to introduce the then called National Social Health Insurance Fund in Kíbakí’s first term?

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The government was supposed to chip in 60% and support the fund to ensure that all Kenyans received free medical cover, but the government of the day thought otherwise. It was shot down in parliament with a very mp turn out to fight for the people. There is no way Kenyans will feel the impact of this rebates until the government plays a big role in it.The idea is good but the only way it will work out is if the public is allowed to participate and books audited by reputable firms.

I think the parliament should ammend the law to make NHIF optional if one has another cover. I dont understand why i need to pay 1700, my hubby pays 1700+ has a company cover, and i pay 1000 for my linda jamii which serves me and my family perfectly well.

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kindly elaborate on the benefits of this health scheme

I second you. Making NHIF contributions compulsory then wasting the money is a way of fleecing industrious Kenyans. If the proposed contributions are implemented, that will be a huge deduction from many people’s meagre wages and I’m sure we won’t see any corresponding improvements in cheaper and better health care. I wonder what demons have infiltrated NHIF.


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The very demons that infiltrated NSSF, I’m afraid.

The civil servants’ outpatient cover was supposed to pilot prior to rolling out the same to the general populace. However, the scheme has so far been spectacular in its failure and inefficiency characterized mostly by delayed and insufficient rebates, so much so that most (if not all) private and mission-run health facilities have discontinued the same leaving gov’t run facilities majorly running the scheme.

From last month, linda jamii is no longer accepting individuals. It’ll only cover groups and SMEs. Existing individual clients will continue till end of their cover.