NHIF cover limits

NHIF cover limits

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.

Outpatient package

Level of HospitalReimbursment Rate
IIKsh 1,000
IIIKsh1,000
IVKsh 1,400
VKSh 1,400
VIN/A

Inpatient Package

Level of HospitalComprehensive facility Reimbursment RateNon-Comprehensive facility Reimbursment Rate
IIIKsh 2,000Ksh 1,600
IVKsh 3,000Ksh 1,800
VKsh 3,500Ksh 2,000
VIKsh 4,000Ksh 4,000
See also  NHIF hospital selection

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