The National Insurance Health Fund has announced changes in its member’s management aimed at the attainment of Universal Health Coverage and while at it enhancing member retention.
In a notice to its Regional managers, Branch manager and senior officials seen by Urbwise, the fund has listed a number of revisions for waiting period to members effective 1st January 2020.
New voluntary national scheme members,
The board has revised the waiting period from the current 60 days to 90 days and introduced a one year upfront payment, payable while observing the due dates before one is eligible for any benefits.
Penalty for defaulting beneficiaries will be 50% of the monthly contribution for each month paid up late, up to 11 months coupled with the requirement to pay for one year in advance and a thirty-day restriction before one can be eligible or the benefits.
For 12 months and above defaulters, the affected member will start payments afresh and will be eligible for benefits after three months from the date of resumption in addition to a one year twelve month upfront payment payable within the waiting period, while observing the penalty.
Maternity and Specialised Services
For voluntary members, access to maternity benefit to be restricted to six months postcard for members or spouse declared at the point of registration.
For both maternity and specialized services, any dependent declared after initial registration shall be subjected to six months waiting period with exceptions for newborns if declared six months from the date of birth.
Inpatient and outpatient dependents will benefit after 30 days of waiting similar to the case of a change of spouse.
New members will be eligible to the benefits from specialized services after six months waiting period,while defaulters shall pay all penalties, one year upfront payment of contribution and a thirty-day waiting period.
National Card System
With the National Card System, the number will be limited to max one spouse, five children while a managed scheme will have a few extras. Additional dependents will be included subject to payment of additional premium to be communicated.
Government-funded programs that target vulnerable groups including Health Insurance Subsidy Program, Free Maternity Program (Linda Mama), Elderly Persons With Severe Disabilities and Inua jamii Program will be exempted.
The Board has advised members to communicate these changes to the declared health providers in their jurisdictions noting that the same will be observed when processing claims.