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National Hospital Insurance Fund (NHIF)

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. In 2010, the NHIF partnered with Safaricom limited to launch a mobile money platform in its efforts to expand health insurance to informal workers through allowing monthly premium payments through the M-pesa payment platform used with mobile phones.

Program goals

National Insurance Fund is the primary health insurance provider in Kenya and is mandatory for all salaried employees, with contributions based on a graduated scale on income and automatically deducted through payroll. It is using mobile money to expand access to workers in the informal sector through creating a more convenient way to pay monthly premiums.

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.

NHIF has partnered with Safaricom Limited, a leading telecommunications company in Kenya, to provide a flexible and convenient platform for remittance of monthly insurance premium contributions from informal sector populations. The use of the highly successful and innovative M-Pesa money transfer platform has enable NHIF to extend health services to informal sector workers who are not captured in formal payroll systems and whose incomes are often less regular or predictable. To use the M-Pesa payment platform, members must already be registered users of M-Pesa and possess a National ID, a requirement for making M-Pesa payments. The option to make monthly insurance contributions using M-Pesa has helped to minimize travel to NHIF offices and time spent in long lines away from productive livelihood activities. Additionally, by allowing workers to make incremental contributions to their monthly premium, the M-Pesa platform has helped to reduce the frequency of NHIF’s penalty charge, -5 times the monthly contribution amount for those who default in remitting contributions, which has been a major deterrent to re-enrollment for defaulted members as well as attraction of new members.