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National Hospital Insurance Fund (NHIF)

last updated Sep 27, 2011

Overview

Implementing organization: 
National Hospital Insurance Fund
Legal Status: 
State/government
Year Launched: 
1966
Stage: 
Existing/expansion stage

Funding

Primary Source of Funding: 
Government

Scale

Number of Clients Served: 
2.7 million people covered
Number of Facilities Operated/Networked: 
600 contracted facilities (150 public, 450 private)
Summary: 

The National Hospital Insurance Fund (NHIF) is the primary provider of health insurance in Kenya with a mandate to enable all Kenyans to access quality and affordable health services.

Click here to read a full case study from the Joint Learning Network (JLN) for Universal Health Coverage.

Key program components: 

The National Hospital Insurance Fund (NHIF) requires compulsory membership for all salaried employees with premium contributions automatically deducted through payroll. Contributions are calculated on a graduated scale based on income, with a majority contributing between KES 30 to KES 320 per month. For the self-employed and others in the informal sector, membership is contributory and is available for a fixed premium of 160 KES per month.

To be a member of the National Hospital Insurance Fund (NHIF), one must simply be a Kenyan resident age 18 or older. NHIF covers certain dependents of the primary policy holder automatically, including spouses, children under the age of 18, students (even if over the age of 18), and disabled dependents. Other adult family members require separate premium contributions to be covered. NHIF is responsible for enrolling and registering all eligible members from the formal and informal sectors.

The benefits package includes coverage of inpatient expenses with the share of expenses covered determined largely by the type of hospital. The NHIF’s hospital network is broken into three tiers of hospitals. At “Contract A” hospitals, which include primarily government hospitals, NHIF beneficiaries receive comprehensive cover with no overall limit on the amount of benefits received.

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