Health Insurance & Why you need NHIF

The first wealth is health”

Ralph Waldo Emerson

I don’t know about you, but I find health insurance in Kenya an interestingly hard nut to crack! Of course, there is no dispute on the importance of all of us taking out insurance to cover us for those visits to the doctor, because we agree those visits are not cheap and they tend to add up very quickly! However, the pricing and what the policy covers are sometimes Greek to the policyholders. It is very disheartening to go to a hospital, only to discover that the insurance company will not cover the costs when all along you thought you were fully covered.

Let’s get some medical insurance jargon out of the way

Sub-limits; are limits within the provided amounts for use in the insurance cover. For instance, a family of 4 could have an outpatient cover of KES. 100,000. However, under the outpatient cover, the insurance could limit each family member to spend say KES 25,000 only. Therefore, where one family member exhausts their cover, they cannot utilize any other member’s available cover, due to the limit placed.

A preexisting condition is a condition that a person has had, before taking their health coverage. Usually such a condition the cover may be limited by the insurer, or longer cooling period provided e.g. a maternity cover may only become active 10 months after a member joins the health insurance scheme or it may not be covered at all.

Exclusions, these are generally those conditions that the medical insurance will not cover

A congenital disorder is a condition that a child is born with. It may be noticeable at birth, or it may be discovered later when the child is grown. Some insurance companies exclude this from the covers they provide.

Co-pay, I see this mostly on consultation fees, where the insurance company will require the patient to pay a portion of the fee while they foot the balance. I’m not certain what the aim is for this but perhaps it works as a deterrent for “unnecessary” hospital visits.

Why Health Insurance?

Health insurance is an important component in wealth creation because it comes in handy to cater for medical bills whenever they arise. Its importance cannot  be overemphasized as I know some of us have been part of a fundraiser to help a relative or friend to cater for medical bills. Medical emergencies have the potential to wipe out the fortunes of a family, and it is because of this risk that we need to take out a health cover. It is not a preserve of rich people; it is for all of us.

Generally, the younger you are the cheaper the premiums tend to be compared to older policyholders. I am yet to find health insurance tailor-made specifically to one’s lifestyle for instance if you are sporty or in contrast, if you lead a sedentary life, should there be a distinction in the premium you pay. It may be a worthwhile metric to track, but I digress….Of course, the more members you are in a family the higher the premiums are expected to be.

Insurance companies have a cap on the age at which you can join a health insurance scheme. That age limit ranges from 60 years to 75 years. This is probably because it may be difficult to assess the kind of liability they are taking on, or the liability generally too high and not acceptable.

enjoying life

Guys, Health insurance does not need to be an expensive affair for your pocket if you live in Kenya. There is a solution provided in Kenya by the government that helps ensure that as many of us have medical insurance. This is through the National Hospital Insurance Fund (NHIF), which is a compulsory contribution for those in formal employment while it remains open and voluntary to those in the informal sector. I am quite excited by the revamped NHIF cover i.e. NHIF Supa+ Cover.

I think it is one of the best products from the government which bridges the gap in accessing healthcare both for people in the formal and informal sectors. I can tell you it reduces the frustrations of mainstream health insurance such as what we talked about earlier on Sub-limits, Exclusions on pre-existing conditions among other limitations. Sometimes it can be heart-rending when you discover how limited your cover is, when you need it the most.

For what it offers to cover, the best feature of the NHIF Supa+ cover is its pricing. It is quite affordable. If you are in the informal sector, you are only required to pay KES 500 per month, translating to KES 6,000 annually. For employees in formal employment, there is a graduated scale of payment depending on your level of income per month. This in my opinion is a MUST have cover as the first line of defense, in health care for every Kenyan.  Some of the benefits covered as enumerated on the NHIF website include.

  • Outpatient cover,
  • Maternity cover,
  • Specialized Diagnostic Tests such as MRI and CT scans,
  • Kidney renal dialysis,
  • Surgical packages,
  • Rehabilitation for drug and substance abuse,
  • Oncology and cancer treatment,
  • Emergency rescue ambulance, and
  • Specialized lab-tests.

Of course, in all these, terms and conditions apply, but NHIF deserves due recognition because it has come some way, from footing specific amounts for inpatient bed charges only, to handling the whole cocktail in healthcare service. Making the monthly payments has been made accessible and can be done through their Portal and Mobile money wallet options

I am convinced we need to prioritize this insurance because it empowers us and everyone around us to live in a healthier ecosystem. As a people, where matters health insurance is concerned, we tend to default to hope as our main strategy. We hope that we and our loved ones will not fall sick. While it is important to pray and hope, anybody who has ever been sick or had a sick loved one will tell you it is usually an expensive affair.

Recently my dad had to have an MRI scan done, as an outpatient. I was pleasantly surprised that the scan, which ordinarily costs about KES 16K was subsidized by NHIF and we paid about KES 5K. I know what you are thinking….if NHIF is all that …why didn’t they foot the whole bill. I thought the same but much later after the dust had settled. At the hospital, I was only too glad and thankful for the co-shared bill.

Chosen correctly, Health Insurance is a tool that allows you to protect your health and affords you some peace of mind. Granted there are some risks that you just have to live with for the most part……. like the very high likelihood that you will forget that all-important answer during the exam and then you remember it as you walk out of the exam room!!! I wish there was insurance for that.

In conclusion, I am not saying that NHIF is the be-all and end-all, as far as health insurance is concerned but it is a very good starting point, to cover your bases. It should be an integral part of your health plan.  

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