NHIF comprehensive cover

A comprehensive cover is a managed scheme where an institution has negotiated with NHIF to offer an enhanced medical scheme to its employees.

Just like how a company can contract a private insurance such as jubilee to offer a medical scheme to its employees, is the same way an institution can contract NHIF to offer the same but at an extra cost.

It’s key to note that an employer( for example the government in the case of civil servants) chips in an extra amount for its employees, up and above what they are deducted from their payslips as statutory deductions thus qualifying to get a comprehensive cover.

Who qualifies for NHIF comprehensive cover?

  • Civil servants who are employees of the National government
  • The National Police and Kenya Prison Services,
  • Government Parastatals
  • Some county government employees
  • Former MP’s.
  • Companies that have contracted NHIF to offer a comprehensive medical scheme to its employees

Types of NHIF comprehensive cover

  1. Fixed fee for service(FFFS)- This is where a fixed amount is paid to a hospital every time a member is treated.
  2. Fee for service(FFS)-This is where a hospital invoices NHIF the cost of treatment incurred by a member.

Advantages

  • Walk in and walk out without paying a dime
  • One does not need to choose a hospital thus not limited to a specific hospital

Disadvantages

  • The fee for service option has a limit.Therefore, if you exhaust your limit within the financial year you will have to pay out of pocket.
  • You can only cover a maximum of 6 dependents i.e. your spouse and 5 children. If you want to add more beneficiaries to your card, you have to chip in some extra amount.
See also  What is NHIF?

Benefit packages under the NHIF comprehensive

Under the comprehensive cover, members can access various benefit packages namely;

  1. Outpatient package-This covers;
  • General consultation
  • Diagnosis and treatment
  • Prescribed laboratory tests
  •  X-ray and ultra-sound imaging services
  • Prescribed drug administration and dispensing
  • Physiotherapy
  • Occupational therapy
  • Management of chronic ailments such as diabetes, asthma, hypertension
  1. Inpatient package-Under inpatient the following services are offered
  • Triage and pre-admission consultation and reviews
  • Hospital accommodation charges, meals and nursing care
  • Bedside services including physiotherapy, occupational therapy, oxygen supply, and medical consumables.
  • Laboratory investigations
  • Post discharge medication
  1. Maternity cover-Mothers with the NHIF comprehensive cover get the following services;
  • Consultation  with a gynecologist ;
  • Prescribed laboratory tests;
  • Labor, delivery, aftercare for the mother together with the newborn
  • Post discharge medication
  • Midwifery and services pertaining to childbirth by ways of normal delivery,
  • Caesarean section as necessitated
  • Ward care and accommodations
  • General nursing care
  • Lactation consultations
  • Meals and special diets
  • Prescribed drugs and medicines
  1. Radiology-This covers;
  • Medical consultation to determine the appropriate imaging examinations needed.
  • MRI and CT Scans diagnostic imaging services
  • Reviewing and interpretation of radiological images and giving the diagnostic opinion
  1. Oncology-The following services are administered under this cover for purposes of cancer treatment;
  • Chemotherapy
  • Radiotherapy
  • Brachytherapy
  • Routine laboratory investigations
  • Anti-cancer (cytotoxic) drugs –oral and injectable
  • Hormonal therapy
  • Support medication
  • Pet CT Scan
  1. Dialysis-The following services are covered under the dialysis package
  • Specialists reviews
  • Cost of the catheter
  • Catheter insertion and removal
  • Nursing and dialysis services
  • Prescribed lab tests
  • Dispensed medications
  • Pre-dialysis, intra-dialysis sessions and post-dialysis care
  1. Surgical package-This package under the NHIF comprehensive cover entails;
  • Pre-operative admission and care
  • Minor, major and specialized surgical procedures including transplants
  • Intra- Operative and post-operative care and medication
See also  NHIF hospital selection

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