Overview
The following Benefit package was negotiated by the government and NHIF and will be delivered through a capitation model:
In-Patient Cover
All necessary medical treatment and services provided by or on the order of a clinician
to the Member when admitted to an NHIF Accredited Hospital offering services under levels as defined by the Kenya Essential package for Health (KEPH).
The cover includes hospital bed charges, nursing care, diagnostic, laboratory or other medically necessary facilities and services, physician's,
surgeons, anesthetists', or physiotherapist's fees,
operating theatre charges, specialist consultations or visits and all drugs, dressings or medications prescribed by the physician for in-hospital use.
All necessary outpatient medical treatment and services provided by or on the order of a clinical to the member when admitted to an NHIF Accredited Hospital offering services under levels as defined by the Kenya Essential Package for Health (KEPH).The outpatient cover shall include but is not limited to:
i) Consultation
ii) Laboratory investigations
iii) Drug administration and dispensing
iv) Dental health care services
v) Radiological examination
vi) Nursing and midwifery services
vii) Minor surgical services
viii) Physiotherapy services
ix) Optical care
x) Occupational therapy services
xi) Referral for specialized services
xii) Any other benefit as approved by the NHIF Board of management
This cover will include for Delivery and Caesarean section. For reproductive health cover includes family planning services,
excluding fertility treatment. This benefit is not available for dependants other than declared spouse.
NHIF shall not be liable for Ex-gratia payments upon the limits being exhausted.
NHIF shall pay death benefit upon demise of a member whilst in service subject to provision and receipt of full documentations.
NHIF shall upon written notification of death of a member while this cover is in force, pay to the Client or such other person or persons as the Client may in writing direct,
the amount specified in the schedule to cater for the funeral expenses.
