In the quest for achieving universal health coverage, NHIF has now standardized reimbursment rates and cost of procedures across all health care providers. The new cover limits are categorized according to whether a hospital has signed a comprehensive contract or non-comprehensive contract with NHIF.
A comprehensive facility is not allowed by law to co-charge a registered NHIF member while a non-comprehensive facility is allowed to co-charge. This means that if a member under the NHIF supa cover scheme opts to visit a non-comprehensive facility, he or she will have to top up and pay the hospital bill as NHIF will only pay a portion of it.
Visit the NHIF website to view a list of the comprehensive facilites.
National Scheme cover limits and reimbursment rates
Also known as NHIF supa cover, hospitals are reimbursed via the capitation model for outpatient services while for inpatient they are reimbursed via the rebate model also known as bed charges.
Below are the reimbursment rate and cover limits for this scheme.
|Level of Hospital||Reimbursment Rate|
|Level of Hospital||Comprehensive facility Reimbursment Rate||Non-Comprehensive facility Reimbursment Rate|
|III||Ksh 2,000||Ksh 1,600|
|IV||Ksh 3,000||Ksh 1,800|
|V||Ksh 3,500||Ksh 2,000|
|VI||Ksh 4,000||Ksh 4,000|