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NHIF SHOCKER:Only five children and a spouse to be covered by the medical fund in new review

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BY JOAN WANJIKU,NAIROBI,9TH JAN 2020-If you have more than five children as well as more than one spouse you will have to find other ways of having your loved one covered by a medical scheme.You may as well  be forced to seek service from a private medical insurance.This is after the  National Hospital Insurance Fund (NHIF) Board announced a review of its terms, which will among others measures will see the reduction of the number of dependent children to five from the current 10.

The review which came into effect on January 1 however retained the number of eligible spouses at one.

The resolution was arrived at a special full board meeting held on December 17. 2019 last, which approved that additional dependents can be included subject to payment of additional premiums to be communicated after an actuarial valuation.

The review is contained in a circular in which the public health insurer has instructed its Managers and Senior Registration and Compliance Officers that if a member defaults on payment for 12 consecutive months, the membership would be revoked and they would have to start payments afresh.

“In case of default for 12 months and above, the affected member will start payment afresh and be eligible for benefits after 90 days from the date of resumption of payment in addition to a one year upfront payment, payable within the waiting period while observing due dates,” said the NHIF statement.

According to the Information appearing on the NHIF website , Voluntary Category Members pay Sh500 per month (Sh6,000 per annum). For those in formal employment, contributions are made as per their income.

The NHIF Board states that the waiting period for new voluntary National Scheme Members would be increased from current 60 days to 90 days and a one year upfront payment introduced payable within the waiting period.

Medical inpatient and outpatient additional dependents shall be eligible for benefit after a 30-day waiting period, which will also apply in case the of a change of spouse.

The Circular further states that access to specialized services shall be restricted to six month waiting period following card maturity for new members.

Also in the new review ,the penalty for defaulters shall be payment of all penalties and one-year upfront payment of contributions coupled with a 30-day waiting period thereafter. 

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