NHIF Forms

Overview

Amendment Form Out Patient Claim Form Treatment Outside Kenya Form Choice Of Outpatient Medical Facility Form Referral Form For Overseas Treatment (National Scheme) Referral Form For Overseas Treatment (Managed Scheme)

1. In case of change of spouse one will be required to produce one or more of the following depending on each case-
-Copy of ID for both parties
-Divorce certificate
-Death certificate for deceased spouse
-Coloured passport size photo(s)
2. For change of ID details, one will be required to produce a copy of the National ID.
3. For updating of dependant’s records (child), one will be required to produce birth notification / certificate/immunization (Child Health Card) and/also the necessary documents supporting adoption or fostering of a child and coloured passport size photo(s)
4. For updating of dependant’s records (spouse), one will be required to produce copy of ID, a sworn affidavit from the Magistrate or marriage certificate and coloured passport size photo(s)
Admission Notification Form Hospital Claim Form Long Stay Notification Form Application Form For Accreditation As A Health Care Provider Assessment Checklist For Declaration Of Health Facilities

In order for a Hospital Claim to be processed, the following are required:-
1. Fill NHIF 8 (Claim form) correctly.
2. Original NHIF card and a clear photocopy.
3. Certificates of contribution paid (CCP), if applicable and MUST cover the period of hospitalisation.
4. Carbon copy of FINAL INVOICE indicating DOA and DOD and should bear the hospital seal and indicate the amount of rebate given to the contributor.
Note: For G.O.K hospitals without seal, the receipt and invoice should bear hospital rubber stamp.
5. Contributor to produce of Identity document and that of spouse in case the spouse was the patient and attach their photocopies to the claim. The identity document number quoted should be the one attached e.g. National ID, Passport or Aliens certificate.
6. In case 90 days have elapsed from the date the patient was discharged, a letter must be written by authorised hospital official explaining the reasons behind the delay in submitting the claims.
7. The claim covers contributors, their spouses and children as below:-
Below 18 years of age.
Between 18-21 years and are fully dependant on the contributor.
Over 18years and attending full time course, evidence of attendance of school should should be attached.
Over 18 years but mentally or physically sick and fully dependant on the contributor, a doctors letter to explain the nature of sickness or disability should be attached.
Note: A copy of birth certificate or birth notification should be attached for the above to prove age and relationship to the contributor. Letter of authority for use of card for dependants over 18 years must be given by the Branch Manager.
8. Alterations on hospital documents should be counter-signed and rubber-stamped by the hospital. 9. All cards for self-employed persons must be accompanied by contribution receipts and must cover the month of hospitalisation. In case of late contribution, a receipt for penalty should also be attached.
10. The hospital must send to NHIF office, Nhif 36 within 24 hours of admission and NHIF 37 on 6 th day of admission for those still in admission (through email, fax or hand delivery)

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