NHIF supa cover

The supa cover is a national medical scheme offered by NHIF to its members and their declared dependents.

Any Kenyan who attains the age of 18 can automatically qualifies for NHIF super cover.

If you are self-employed and would like to get an affordable and quality health insurance then the super cover is ideal for you.

If you are employed and your employer does not have a comprehensive cover with NHIF, you automatically qualify for NHIF supa cover.

How much is NHIF supa cover?

NHIF super cover payments vary depending on whether one is self-employed or employed

For voluntary or self-employed persons, contribution for supa cover is Ksh 500 while for those in employment, the monthly contribution ranges from Ksh 150 to Ksh 1,700 depending on their salary.

A penalty of Ksh 250 per month is charged if payment is made past the due date which is 9th of the following month

How do I apply for NHIF supa cover?

There are 3 different ways you can register for supa cover

  1. Dial *155# ussd code on your phone
  2. Apply online via the self-care portal
  3. Visit an NHIF branch near you or huduma center in any of the 47 counties

To ensure you benefit from this cover ensure you;

  • Have your fingerprints captured
  • Make the monthly payments if self-employed and if employed ensure your employer deducts from your salary at end month.
  • Choose an outpatient hospital that you will use to access treatment services

How does supa cover work?

  1. A member registers with NHIF
  2. He adds his dependants on his card
  3. NHIF captures their biometrics
  4. Member makes monthly payments
  5. The NHIF Card becomes active after 60 days for self-employed persons and 30 days for those in formal employment.
  6. Member chooses an outpatient hospital for him and his beneficiaries
  7. NHIF gives the hospital that the member has selected money upfront to cater for outpatient treatment for that member and his dependant’s .This happens in the beginning of every quarter.i.e January, April, July, and September.
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For inpatient services, the hospital bills NHIF on a fixed rate commonly known as rebate.

NHIF supa cover benefits

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

  1. Outpatient

This package covers consultation with a general practitioner, lab tests, x-rays, ultrasounds and prescribed medicines.

It also covers management of chronic illness such as hypertension, diabetes, HIV/ Aids and asthma in level 6 hospitals.

  1. Inpatient

This covers admission in a hospital, bed charges ,doctor’s fee, nursing care, diagnostic lab tests as well as drugs administration.

Before admission, it is prudent you enquire from the hospital whether it is a comprehensive facility so that you don’t have to pay a penny as in the case of un-comprehensive facility where you will have to co-pay.

  1. Maternity

This is administered via Linda mama.

Services that are offered under this package are antenatal and postnatal care including administration of immunization vaccines, and delivery through normal delivery or caesarean section.

It also takes covers the aftercare for the mother together with the new-born.

  1. Mental and behavioural health services

Due to the rise of vices such as depression and drugs and substance abuse, NHIF has now added this service to the supa cover benefit package.

A member benefits from counselling and psychotherapy services as well as gets the prescribed medication.

  1. Surgery

NHIF covers all types of surgeries ranging from minor and major operations including transplants and specialised surgeries such as heart surgery.

This package covers the cost of the operation, surgeons and anaesthetist fees, nursing care, hospital admission, and drugs dispensation during and after hospital stay.

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NHIF covers up to a limit of Ksh 40,000 for minor surgery while for major surgery it covers up to a limit of Ksh 240,000.

  1. Oncology

NHIF is committed in tackling the cancer menace through its oncology package.

It caters for chemotherapy, radiotherapy, brachytherapy and PET scans.

For basic chemotherapy NHIF pays for 6 sessions each cycle costing up to Ksh 25,000 while for complex chemotherapy it pays up to Ksh 100,000 per session for 6 cycles.

  1. Overseas treatment

It covers for treatment costs pertaining to medical and surgical interventions that cannot be done in Kenya.

One has to get an approval letter from the Ministry of Health at Afya House where a specialist will evaluate each case to ascertain that Kenya does not have the capacity to conduct the required procedure.

  1. Dialysis

It caters for specialists’ reviews, nursing and dialysis services, intra-care and dispensed medications, routine laboratory tests, nutrition, counselling and follow up care.

NHIF pays for a maximum of 2 sessions per week each costing Ksh 9,500.

  1. Radiology services

NHIF also covers diagnostic imaging services such MRI and CT scans .

You have to get approval or what is commonly known as preauthorization from NHIF before they are offered.

  1. Emergency evacuation

NHIF has contracted the Kenya Red Cross to provide road ambulance services for its members.

It caters for on-site evacuation and transfer of a sick member or their declared dependents for treatment to the nearest NHIF declared facility.

If in need of ambulance services and you are an active NHIF member, contact Red Cross by dialling 1199 to get assisted.

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What does NHIF not cover?

Under supa cover, NHIF does not cover glasses nor does it cover dental problems such as tooth filling, root canal and dental braces.

Hospitals that offer NHIF supa cover

The NHIF supa cover is offered in comprehensive facilities previously known as Contract A and contract B hospitals.

Hospitals that fall under contract A facilities are government and county public hospitals while contract B facilities are faith based mission hospitals and low cost private hospitals.

These types of hospitals are not allowed to co-charge. You walk in and out without paying a dime.

To view a comprehensive list of hospitals offering the NHIF super cover, we recommend you visit the NHIF website.

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