Things your NHIF should cover and how much (explainer)

A concerned Kenyan took to Twitter to lament how NHIF only paid 1% of the total bill of his Hospital bill yet he has never missed any contribution.

A section of Kenyans joined the conversation sharing their grievances and instances in which they received little to no assistance for their medical bills.

Most Kenyans rely on NHIF to pay for their medical bills but many have been frustrated when it comes to paying their hospital bills using their NHIF cards. 

NHIF is supposed to pay for the following things;

1. Inpatient and outpatient cover.
2. Cancer cover.
3. Optical services.
4. dental care services.
5. Surgeries.
6. Maternity services.

Inpatient

They cater for regular and special consultation, blood transfusion, bed, accident fractures, medications, surgeries, lab services, nursing services, and other treatments.

Under the inpatient plan, they should pay Sh1200 a day for a bed in public hospitals while in private hospitals they are supposed to pay Sh4000 a day for a bed.

Outpatient

Consultation fees, physiotherapy services, drug dispensation, laboratory examinations, wellness and counseling, health education, and immunization.

CT scans and MRI scans are also catered for under the inpatient and outpatient services but you have to get pre-authorization from NHIF.

1. CT SCANS- Sh 8000
2. MRI SCANS - Sh15000
3. Ultrasound - Sh3000

Cancer

1. Radiotherapy - 20 radiotherapy sessions max at sh3,600 each or sh18,000 per week in govt owned hospitals.
2. Diagnostics - sh69,500 in private hospitals.
3. Oncology clinics - sh25,000 - sh150,000 per cycle which is 24 sessions max per year.

For diseases like kidney failure, diabetes and hypertension this is what is to be catered for by NHIF.

1. Radiology - sh18,000
2. Monthly check up - sh5000
3. Kidney transplants - sh500,000
4. Dialysis - sh9500 for each session which is 2 times a week

Surgeries

Depending on the hospital and the type of surgery you are having you are entitled to sh500,000 per person.

1. Minor- Sh10,000 to Sh30,000.
2. Intermediate-  Sh40,000 to Sh80,000.
3. Major- Up to Sh130,000.
4. Specialized- Up to Sh500,000.

Dental care covers

Dental consultation, root canal, dental x-rays, dentures, orthodontics, cost of filling and extractions.

They shouldn't exceed a cost of 50,000 per year per family.

Optical services

sh40,000 per year per family from accredited hospitals.

Maternity services

Covered both in private and public hospitals.

1. Normal Delivery- Sh10,000.
2. C-Section- Sh30,000.
3. Ultrasound- Sh3,000.