The National Health Insurance Fund (NHIF) has made a raft of changes in the scheme that will punish defaulters. The changes, which took effect on January 1, will affect the voluntary members who pay Sh500 monthly.
MATURITY
For instance, the members will have to wait for six months after registration to access maternity services at any hospital.
In a memo dated January 7, the fund restricts access to maternity benefits to post card maturity for principal members or spouses declared at the point of registration.
The changes exempt programmes that target vulnerable people, including the free maternity, elderly persons with disabilities and health insurance subsidy programmes.
The fund’s management indicated that the reviews will boost attainment of sustainable universal health coverage, and enhance member retention.
The affected members will have to wait for 90 days, up from the current 60, to enjoy the benefits.
The scheme has also introduced a 12-month upfront payment for those joining.
DEPENDANTS
Also, with effect from January 1, a member can include only one spouse and five children as dependants.
“Additional dependants can be included subject to payment of additional premiums to be communicated after actuarial valuation,” the memo adds.
If a member defaults for a year or more, they will start paying afresh and be eligible to benefit after 90 days from the date of resumption of payment, with a year’s upfront payment.
Any dependant declared after initial registration will not benefit from the maternity and specialised package; they will be subjected to six months period after such declaration. The rule does not apply to newborns.
WAITING PERIOD
“Eligibility to access specialised services shall be restricted to a six-month waiting period following card maturity for new members, while for defaulters, there shall be payment of all penalties a year upfront payment of contribution, coupled with a 30-day waiting period” — a rule that could see some members abandon the insurance scheme.
Last year, the fund increased its principal contributors by 13 per cent to 7.7 million, with most new members coming from the informal sector.