The National Hospital Insurance Fund (NHIF) is a Kenya government state corporation with a mandate to provide health insurance to Kenyans. The core business and mandate for NHIF is to provide accessible, affordable, sustainable and quality health insurance for all Kenyan citizens. NHIF registers all eligible members from both the formal and informal sector. For those in the formal sector, it is compulsory to be a member. For those in the informal sector and retirees, membership is open and voluntary.
Benefits of being an NHIF member
NHIF members enjoy the following benefits.
- Upon admission in hospital an NHIF member is accorded services and the hospital makes a claim to the Fund for reimbursement
- An in-patient cover for the contributor, declared spouse and children
- Provides comprehensive medical cover in majority of accredited Government facilities, Mission health providers and some private health providers across the country
- Provides in-patient services in private and high cost hospitals on a co-payment basis
- Comprehensive maternity and CS (Caesarian) package in government hospitals, majority of mission and some private hospitals
- Dialysis at Ksh 2,500 per session at the following medical facilities:
- Kenyatta National Hospital, Nairobi
- Moi Teaching & Referral Hospital, Eldoret
- Provincial General Hospital Kisumu
- Rift Valley Provincial General Hospital, Nakuru
- Coast General Hospital, Mombasa
- Siloam Hospital, Kericho
- Mediheal Hospital & Fertility Centre
- Muranga District Hospital, Muranga
- Thika Level 5 Hospital, Thika
- P.C.E.A Hospital, Kikuyu
- Consolata Hospital, Nyeri
- Tawfiq Hospital, Malindi
- Africare Limited
- Kakamega County General Hospital
- Family planning’ Vasectomy and Tubal Ligation
- NHIF does not exclude any disease
Contributions and deductions
Formal sector employees’ contributions are deducted and remitted to the Fund by their employers. This is done by Cheque or through E-banking. For members under the voluntary category, they pay Ksh 500 per month (Ksh 6,000 per annum). For those in formal employment, contributions are made as per their income.
The following premium rates apply:
Monthly premium amount
Up to Ksh 5,999
Ksh 6,000 – Ksh 7,999
Ksh 8,000 – Ksh 11,999
Ksh 12,000 – Ksh 14,999
Ksh 15,000 – Ksh 19,999
Ksh 20,000 – Ksh 24,999
Ksh 25,000 – Ksh 29,999
Ksh 30,000 – Ksh 34,999
Ksh 35,000 – Ksh 39,999
Ksh 40,000 – Ksh 44,999
Ksh 45,000 – Ksh 49,999
Ksh 50,000 – Ksh 59,999
Ksh 60,000 – Ksh 69,999
Ksh 70,000 – Ksh 79,999
Ksh 80,000 – Ksh 89,999
Ksh 90,000 – Ksh 99,999
Ksh 100,000 and above
Payment of claims
Claims are submitted by hospitals directly to NHIF after the contributors have been discharged from the hospitals. The claims are examined by the Fund to ensure validity before payment. A claim can however be rejected and the hospital informed accordingly to incorporate either the missing documents or to address the abnormalities identified. The Fund strives to pay claims within 14 days upon receipt of the claim from the hospitals. Members who opt to clear the bills with the hospital may launch a general claim directly to NHIF for reimbursement.
NHIF seeks to establish partnership with individuals and organizations to finance health insurance for indigents including orphans and vulnerable children, poor older persons, persons with disabilities and destitute families. The indigents shall be identified by NHIF or the sponsors. Enrolled indigents and their dependants shall have access to the current benefit package of inpatient cover in any of the health providers accredited to NHIF countrywide.
Services covered by NHIF
Here are the services covered by NHIF.
- Inpatient services health cover
- Outpatient services health cover
- Civil Servants schemes health cover
- Linda Mama services health cover
- NHIF Supa/Super cover
Accrediting and contracting hospitals
The Fund strives to accredit as many hospitals as possible so as to ensure all members access NHIF benefits whenever they are across the country. NHIF has an objective accreditation criteria and guidelines that aim to encourage hospitals towards quality improvement. Accredited organizations are those recognized by the Fund and allowed to offer services to NHIF members and claim reimbursements thereof. The contracts spell out the obligations of the health provider and NHIF.
Accreditation of a health provider takes into account the services, personnel, infrastructure and equipments among other issues that the institutions have. The level of rebate therefore corresponds to the grade after scoring the various aspects. The Fund, further contracts the health facilities to ensure they provide services comprehensively. This means that NHIF members walk in and walk out of the facilities fully treated at the cost of NHIF without making additional payments.
To register for NHIF as a member, you must meet the following requirements.
- A resident of Kenya, who has attained the age of 18 years. (No age limit after the age of 18 years)
- Total income from salaried or self-employment is more than Ksh 1,000 per month or Ksh 12,000 per year
- Drawing an income from Kenya
- Working under contract or casual terms of employment
- A voluntary contributor. This includes foreign visitors permitted to work or study in Kenya
- Kenyan residents must have:
- Copy of National I.D (including spouse if applicable)
- Copy of Employer Appointment/Introduction Letter (excludes self-employed/voluntary contributors)
- Coloured passport photo (including spouse & dependants if applicable)
- Original & copies of birth certificate(s) for dependants
- Foreign residents must have:
- Copies of passport, alien certificate or work permit (including spouse if applicable)
- Coloured passport photo (including spouse and dependants if applicable)
- Foreign students must have:
- Copy of passport
- Coloured passport photo
- Submit the required amount under the Voluntary/Self Employed Category
To register for NHIF as an employer or organized group, you must meet the following requirements.
- Certificate of Registration
- KRA PIN Certificate
You can reach NHIF using the contacts below.
NHIF Headquarters, along Ragati Road, off Ngong Road, Upper Hill, Nairobi
P.O. Box 30443 – 00100, Nairobi, Kenya