Self-employed Kenyans will have to pay Sh6,000 before starting to use their National Hospital Insurance Fund (NHIF) cards under new measures that will also make it nearly impossible for newly expectant mothers to use the service.
This is a departure from the old rules that required new members to pay Sh1,500 and wait for two months to start using the card to access medical services.
The waiting period for new members’ cards to mature has been extended to three months, delaying the benefits for voluntary contributors.
The new rules, whose enforcement quietly started on January 1, are likely to slow down the uptake of the NHIF scheme, which is a key plank of Kenya’s plan to achieve universal health coverage under President Uhuru Kenyatta’s Big Four Agenda.
The rules are contained in a memo by NHIF acting head of registration and compliance Robert Otom and copied to acting CEO Nicodemus Odongo.
NHIF has instructed regional and branch managers to immediately effect the changes in what it terms as a move to align the organisation towards “attainment of sustainable universal health care coverage and enhancing member retention.”
“Please communicate the changes to the declared healthcare providers in your jurisdiction and explain to them that the same will be observed when processing claims,” said Mr Otom in the memo dated January 7.
Both Mr Odongo and Health Secretary Sicily Kariuki were by last evening yet to respond to calls and text messages on the new rules that have not been made public and which complicate both the onboarding of new members as well as the use of the cards.
Kenya Union of Clinical Officers (KUCO) secretary-general George Gibore said NHIF did not consult stakeholders before introducing the new rules, which he described as punitive.
“It is a deterrent for people to register because so many people in the informal sector do not receive regular income. This defeats the purpose NHIF exists for,” he said. “The penalties for delayed premiums are also punitive.”
Those intending to use the NHIF card for maternity may have to register before the pregnancy sets in or miss out on the benefits altogether.
“For voluntary members, access to maternity benefit be restricted to six-months post-card maturity to principal members or spouse declared at the point of registration,” states the memo.
The six-month period, added to the three months required before the card becomes active, means a one-month pregnant unregistered user cannot enroll and use the NHIF card for delivery. This deals a blow to government’s campaign to ensure safe delivery.
A husband who declares his wife as a beneficiary after the initial registration will also have to wait for a further six months before the spouse can become eligible for maternity cover services.
Babies added to the cover beyond six months after delivery will also have to wait for another six months to become beneficiaries of their parents’ NHIF card. The same window will apply for any member that is added along the way and seeks specialised services.
“For medical inpatient and medical outpatient, additional dependants shall be eligible for benefit after 30 days waiting period. This will also apply in case of change of spouse,” said NHIF.
Contributors who default on premium payments will have to pay all the defaulted premiums with an additional Sh250 for each defaulted month up to 11 months.
They will then have to make a fresh upfront payment of Sh6,000 and wait for a month before becoming eligible for the services again.
“In case of default for 12 months and above, the affected member will start payment afresh and be eligible for benefits after 90 days from the date of resumption of payment in addition to a one-year upfront payment, payable within the waiting period while observing due dates,” NHIF said in the memo.
NHIF has also cut the number of dependants per card to a maximum of five children and one spouse for the national scheme. Previously, the card could accommodate up to 10 members.
Only the government-funded programmes — health insurance subsidy, free maternity, elderly persons with severe disabilities and Inua Jamii — all which target vulnerable groups have been exempted from the sweeping changes.
The new changes come barely two years after the suspended controversial changes in which NHIF was seeking to cap outpatient visits to four visits per contributing card.
NHIF had over 7.65 million principal contributors paying premiums of Sh32.9 billion in the year ended June 2018. Informal sector contributors have been rising at a faster rate since 2013/2014 to close the gap with formal sector members.
While in 2013/2014 the informal sector contributors were half that of those from formal sector, the gap has been narrowed to less than 10 percent. In 2017/2018, membership from the formal sector rose by 4.3 per cent to four million compared with a 23.3 per cent rise in the informal sector to 3.62 million.
The economy has been churning out more informal sector jobs than formal ones with 2018 having accounted for 83.6 per cent of the 840,600 jobs created in the period under review.