Health insurance is a type of insurance that covers for medical expenses incurred as a result of sickness or injury. In addition to medical expenses health insurance may also cover for disability, dismemberment, accidental death or losses from accidents.
The range of benefits that a medical insurance covers however depends on the contract between an individual and the insurance provider.
In Kenya, the two main providers of health insurance are private insurance companies and the government run National Health Insurance Fund (NHIF).
The NHIF began as a department in the Ministry of Health in 1966 after being established under Cap 255 of the Laws of Kenya.
At the time, NHIF only accepted members who were in formal employment. In 1972 however, the law was amended to allow membership of those in informal employment.
We are now going to take an in-depth look at how NHIF works, their covers, services and ultimately their contacts. This is going to be a long article, so if you need to jump straight to a particular section please use the table of contents below.
All NHIF members and their dependants are enrolled into the national scheme expanded benefits package called SUPA cover.
This is a comprehensive medical insurance cover that bears no upper age limits, covers chronic illnesses, requires no deposit on admission and does not exempt those with pre-existing illness from membership. The only exclusion is for cosmetic procedures.
It’s also a family based cover that includes the principal member along with his or her dependants into the cover. Eligible dependants include a declared spouse and children below the age of 18 years.
Benefits under this package include:
NOTE: NHIF does not cover for dental and optical services under the SUPA cover though they’re available to members in the EduAfya and Civil Servants schemes.
NHIF boasts of a network of over 5000 health facilities across the country. These include all government (public) hospitals and a majority of private and mission (faith-based) hospitals.
The comprehensive cover offered under SUPA cover is however not available in all the accredited facilities. This is instead determined by the category under which a given hospital is contracted by NHIF to offer in-patient services.
The two contract categories available are comprehensive and non-comprehensive. These two broad categories are further broken down into Categories A, B and C.
In the non-comprehensive category, NHIF covers the cost of some services and the member is expected to cover the rest out of pocket (i.e. copayment).
It should be noted that these categories only apply to the in-patient cover which members can access at any accredited hospital.
For out-patient services members are expected to choose a preferred out-patient facility where NHIF will cover them comprehensively at no added costs.
In addition to the national scheme, NHIF has designed additional products that target specific groups. These include:
Linda Mama Services is an expanded programme for free maternity services that aims to provide universal access to maternal and child health services.
The service is also meant to act as a launch pad for the transitioning into Universal Health Coverage (UHC).
Benefits provided under this programme are available for a period of one year and include:
All expectant women who are Kenyan citizens are eligible to join the programme. The Linda Mama membership however lasts for a duration of only one year and expires after the postnatal period.
It’s therefore important for the mothers to be enrolled into the national scheme if they wish to benefit from other NHIF services in addition to adding their children as dependants.
Pregnant women can register for Linda Mama services through the following ways:
After registration, the woman needs to visit the nearest facility for confirmation of pregnancy and activation of the cover.
A list of hospitals that have been accredited to offer Linda Mama services can be viewed on the NHIF website.
EduAfya is a comprehensive medical insurance cover from a partnership between the ministry of Education and NHIF that targets students in public secondary schools.
To be eligible for this cover, a student must be enrolled in a public secondary school and be registered by NHIF through the National Education Information System (NEMIS).
The cover however only applies to the students and doesn’t cover their parents or any dependents they might have.
Benefits available to students under the EduAfya services include:
This is a comprehensive managed scheme for civil servants and the disciplined services which comprise the Kenya Police, Administration Police, Prisons Service and National Youth Service.
This scheme covers the principal member and their eligible dependants who may include a spouse and five children of up to 21 years of age.
The children may however be covered up to the age of 25 years provided they’re full time students. There is no age limit for dependants with a disability.
Members of this scheme falling in job groups A-K can access in-patient treatment in various government, mission and select private hospitals with no limits.
Those in job groups of L-T can in addition to this access some high-cost private hospitals along with their dependants but within specified limits.
Members of this scheme are expected to choose their preferred out-patient facility similar to those in the national scheme. Hospitals for in-patient services are determined on referral from their selected out-patient facility.
A list of hospitals that civil servants can access outpatient services and their respective job groups is available on the NHIF website.
Benefits available in this package include:
The Kenya Defence Forces (KDF) personnel are not covered under the civil servnats scheme. They and their dependants instead access healthcare services from military hospitals which are not open to the public.
KDF staff however contribute to the Kenya Defence Forces Medical Insurance Scheme (DFMIS) which provides a medical insurance cover for them and their dependants upon their retirement.
NHIF membership is open to all Kenyan citizens above the age of 18 with a monthly income of Ksh1,000 and above. Foreign residents and students with valid documentation are also eligible for membership.
Membership to the NHIF can either be compulsory or on a voluntary basis.
Compulsory membership is required for all individuals in formal employment within Kenya including civil servants and those working in the private sector.
Voluntary membership on the other hand is open to those working in the informal sector, the self-employed and retirees.
NHIF registration can be done either physically or online via the NHIF website, My NHIF App or USSD.
Applications are available for Kenyan residents, foreign residents and foreign students. In all cases certain requirements are needed in order to complete the registration. They are as follows:
NHIF Requirements for Kenyan Residents
NHIF Requirements for Foreign Residents
NHIF Requirements for Foreign Students
Before making your registration online via the website, app or USSD make sure you have the following information with you:
After completing your registration successfully, your card should be available for collection after 14 days at any NHIF branch office or Huduma centre near you.
In some cases however it may take longer this. There are some reported cases over on social media of some members going months without the card after registration.
To avoid the likelihood of this happening, make a point to visit a NHIF branch office near you to sort out any possible issues causing the delay.
Even though applicants are issued with a memebr number immediately after registration they are not be able to access NHIF services until a certain window period is over.
For voluntary members the waiting period for the card to mature is 60 days (2 months) while for the employed the waiting period is 30 days (1 month.)
On January of 2020 NHIF announced new rules that revised the waiting periods to 90 days along with a one year upfront payment of KSh6000 for voluntary members. These rules were however halted later on by the president.
After the waiting period is over, members and their registered ependants can begin to access NHIF services at their preferred health facilities.
NHIF members may need to manage their accounts to do any of the following:
Let’s take a look on how to accomplish these functions.
Members can select or change their preferred outpatient facility by dialling *155# using their registered NHIF phone number.
Alternatively, they can also do this online through NHIF self-care portal or by using the My NHIF app.
Only one outpatient facility can be selected for each beneficiary. Principal members are however allowed to select different hospitals for their dependants (spouses and children).
This is useful in cases where dependants may be living, working or studying in different areas from their principal members.
Members enrolled to the national scheme (Supa Cover) are only allowed to change their preferred facility once every quarter (3 months) while those in the civil servants scheme twice a year (after 6 months).
NHIF may however require members to update their facilities outside these periods. Case in point, all members were required to select their preferred outpatient facilities afresh at the start of 2020.
Members may need to amend their NHIF details in the following situations:
To amend any of the above details members are expected to visit any NHIF office or Huduma centre with required documents and fill the amendment form.
The required documents for each case are as follows:
The above is needed even if the spouse was already a registered member. Couples not in a formal marriage (“come we stay”) can use a sworn affidavit as proof of marriage.
Employed members that ar eenrolled in NHIF’s national scheme are deducted a monthly premium from their salaries.
The monthly premium ranges from a low of Ksh.150 to a maximum of Ksh.1700 depending on one’s salary scale.
The current NHIF contribution rates are as follows:
|Gross income (Kshs)||Monthly Premium Amount (Kshs)|
|0 – 5,999||150|
|6,000 – 7,999||300|
|8,000 – 11,999||400|
|12,000 – 14,999||500|
|15,000 – 19,999||600|
|20,000 – 24,999||750|
|25,000 – 29,999||850|
|30,000 – 34,999||900|
|35,000 – 39,000||950|
|40,000 – 44,999||1,000|
|45,000 – 49,000||1,100|
|50,000 – 59,999||1,200|
|60,000 – 69,999||1,300|
|70,000 – 79,999||1,400|
|80,000 – 89,999||1,500|
|90,000 – 99,999||1,600|
|100,000 and Above||1,700|
Contributions for salaried members are deducted and remitted by employers on behalf of their employees through cheques or e-banking. The deadline for remitting these contributions is the 9th of every month
Employers that fail to pay their employees’ contributions before the deadline are hit with a penalty that requires them to pay double the contribution amount.
Voluntary members on the other hand pay a monthly fixed rate of Ksh500 or a yearly lump sum contribution of Ksh6000.
These monthly contributions are supposed to be paid in before the 9th of every month. Failure to pay on time attracts a penalty of KSh250 for each month.
Contributions for voluntary members can be paid through:
Let’s take a look at how members can pay their contributions and penalties using M-PESA.
Members can check their contribution status and any outstanding penalties by using My NHIF app, dialling *155# on their registered line or through SMS.
For the SMS method, members can do this by sending a message to 21101 with the word ID followed by a space and then their National ID or Passport number e.g.
The cost of this SMS is Ksh10.
Members can also confirm their account status by visiting the nearest NHIF branch office.
A members can reactivate their dormant NHIF account by paying the contributions for all the defaulted months plus the accrued total penalties.
So for instance if a member defaults for 6 months and wishes to reactivate their account they’ll have to pay:
This brings the total amount to Ksh4500
NHIF however does sometimes offer amnesties which waive these amount for accounts dormant for over one year.
The latest amnesty in July 2020 for example allowed members that had defaulted for more than 12 months to reactivate their accounts by paying only Ksh1500. A waiting period of 60 days was however imposed before their cards could be active again.
You can always contact NHIF to find out if an amnesty is available for your dormant account.
Member can get a replacement for their NHIF card in case it gets lost or defaced.
To do this, a member needs to first make a payment of Ksh100 at National Bank, Equity Bank, Co-operative Bank or KCB Bank. The teller should be informed that the payment is being made for NHIF card replacement.
After making the payment the member is expected to present the banking slip at any NHIF office or Huduma Centre to have a new card printed for them.
In certain cases a member may be required to fill certain forms in order access or authorize particular services. Some of these forms include:
The above forms will usually be provided by the health facilities or at the NHIF offices. Copies can however also be downloaded from the NHIF website here.
Members can reach NHIF for support either physically or through any of their online platforms.
For detailed inquiries and serious issues it’s always advisable to pay them a visit at their head office or one of their satellite branches across the country.
The NHIF head office is located in Upper Hill, Nairobi along Ragati Road off Ngong road. The postal address, phone and email contacts for the head office are as follows:
P.O BOX: 30443 – 00100, Nairobi, Kenya
Phone: 020 272 3246
Toll Free Line: 0800 720 601 (no charges)
Safaricom: 0726 268 933
Fax: 020 271 4806
The office is open Monday to Friday from 8AM to 5PM and remains closed on Saturday and Sunday.
In the table below is a list of the NHIF branch network including their location, phone number and email addresses where available.
The offices are open Monday to Friday from 8AM to 5PM and remain closed on the weekend.
|Ruaraka||ICPAK Building near KCA university||020- 2465578||[email protected]|
|Industrial Area||Liberty Plaza Opposite Imara Junction off Rd||0775587958 020-2538871||[email protected]|
|Mama Lucy Kibaki Hospital||Mama Lucy Kibaki Hospital Spine Rd off Kangundo Rd||020-2659608|
|Buruburu||Mesora Centre||020-2465577 020-7786690||[email protected]|
|Kangemi||Palace Building Cooperative Bank||[email protected]|
|Westlands||Rainbow Tower||0772-614799 0773-313083||[email protected]|
|Eastleigh||Sunrise Shopping Mall||020-8055788||[email protected]|
|Ruiru||Central Plaza 2nd floor Ruiru-Githunguri Rd||020-2385345||[email protected]|
|Thika||Nellion Centre Kenyatta road||067-2222271 067-2231446 020-2039910||[email protected]|
|Limuru||Njegi Plaza 3rd Floor Market Street||066 3545484||[email protected]|
|Kiambu||Mapa House Lower Ground Biashara Street||066 2022137 066 2022057||[email protected]|
|Muranga||Arahuka Building 2nd floor Kenyatta Highway||0771386103||[email protected]|
|Mwea||Digital Complex (Makutano/Mwea Rd)||020 2465272|
|Kerugoya||Ushirika Bank Building 1st Floor Kerugoya/Kutus Rd||0771067992||[email protected]|
|Othaya||Nyeri Coop Union House Ground Floor Othaya -Mukurwe-ini Rd||020-2665055||[email protected]|
|Nyeri||Lwale place 1st floor Kimanthi Way Field Marshall Mutungi Rd||061-2032899 061-2030957 0774757483||[email protected]|
|Mombasa||Jubilee Building||041-224360 041-2227463 0771109099||[email protected]|
|Ukunda||Ali Mbarak Building Ground floor Beach road||040-3202904 041-201105||[email protected]|
|Kilifi||Equity Building 1st floor, Kwa Charo Wamae Road||041-2011024 041-2588864||[email protected]|
|Mariakani||NHIF Office Next to Total Service Station||020-2476668||[email protected]|
|Malindi||Barani Plaza 1st floor, South Wing Jomo Kenyatta Road||041-2008951||[email protected]|
|Mtwapa||Shella Properties Ltd||020-2588865||[email protected]|
|Hola||Rayaan Complex||020-8032490||[email protected]|
|Lamu||Zawadi House Sea front Road||041-2011052||[email protected]|
|Voi||Mughonyi Plaza 1st Floor||043-2030052 043-2030547 020-2437484||[email protected]|
|Taveta||Taveta Sub County Hospital||0721820409|
|Machakos||KCB 3rd Floor Syokimau Rd||044-2021043 044-2021686 057-2508256||[email protected]|
|Mwingi||Osavinya Bd, 1st floor||0774713810|
|Matuu||Bidii Textile Building Gatangi Road||0773985933|
|Kangundo||Homeland Plaza Tara-Kangundo Rd||0771237651|
|Mwala/Masii||Peter Mulei Building Masii -Tawa Rd||0771648758|
|Makueni||Double K Plaza Punda Road||0774261541 020-2360350 0776090260||[email protected]|
|Makindu||Siesta Guest House, 1st floor||0774261550|
|Kibwezi||Mohammed Omar Building Kibwezi Road||0775869174|
|Ol’Kalou||Business Park Building 1st Floor||020-2611187 0771290087||[email protected]|
|Kitui||Zein Building, 1st Floor Kilugya Street||044-4422920||[email protected]|
|Embu||Eastern Emporium 1st floor Kenyatta highway||068-2230062 068-2230546 0776241475||[email protected]|
|Chuka||Mombasa Hse Near Equity Bank||061-230350 0771263765||[email protected]|
|Maua||Maua Methodist Hospital||020-8001920|
|Meru||NHIF Building Tom Mboya Street||064-3130137 064-3130629 064-2311052/ 0776003600||[email protected]|
|Isiolo||Ibada Plaza, 2nd Floor||061-2303451||[email protected]|
|Moyale||Sharif Guest Hse Opp. Moyale Police station||061-2308632||[email protected]|
|Marsabit||Dadacha House||057-2513758||[email protected]|
|Siaya||Siala Plaza 1st floor Court Road||057-5321300 0771109101||[email protected]|
|Kisumu||Re-insurance Plaza Ground Floor OgingaOdinga street||057-2020638 057-2020028 057-2500640 0776008713/4||[email protected]|
|Homabay||Coldsprings Building 1st Floor||0775369644||[email protected]|
|Oyugis||Olando Plaza Ground Floor||020-2018067 0705813796||[email protected]|
|Mbita||Mbita District Hospital Administration Block||0723732629||[email protected]|
|Migori||Amicus Plaza 2nd floor||059-20174/20927 0771109096 0774891301 0776033281/2||[email protected]|
|Kisii||Ouru Complex 1st floor Kisii-Kisumu Road||058-2030426 0774865423||[email protected]|
|Nyamira||Sakami Hse 1st Floor (main street)||020-8064128 0775369601||[email protected]|
|Kakamega||Mega Mall, 2nd floor||056-2030399 056-2030408||[email protected]|
|Mumias||Bemak House, 2nd floor Ooff Nabongo Road||056 641484 056641005||[email protected]|
|Vihiga||Cherry House, Ground floor||020-2063909||[email protected]|
|Bungoma||Daimah Plaza Bungoma-Kanduyi Rd||0771109095||[email protected]|
|Webuye||Bettylyne Bd, Ground floor Webuye-Bungoma Road||020-2139955||[email protected]|
|Busia||Ingonyera House 2nd floor Kisumu – Busia Road||0772161957 0772989896||[email protected]|
|Bomet||Aggie Plaza||020-2531445||[email protected]|
|Eldama Ravine||KCB Bd 2nd Flooor Mercy Hosp. Road||051-752122|
|Eldoret||KVDA Plaza, Ground floor||053-2030749 053-2061400 0774530762||[email protected]|
|Gilgil||Barclays Bank Building||0722454284 0733345309|
|Iten||Baraka Plaza||0773 781 133||[email protected]|
|Kabarnet||Mart Properties Ltd||053-8000312/21844||[email protected]|
|Kajiado||Hibo House 1st floor Namanga Rd||0710 376931||[email protected]|
|Kapenguria||Kazeto Building||0770867421 0721354219||[email protected]|
|Kapsabet||Kapsabet Post Office Building Alfred Bungei Road||0776401995 0776401952||[email protected]|
|Kericho||Sinedet Building 1st floor Kisumu-Busia Rd||052-2020518 052-2020618 051-8007097||[email protected]|
|Kilgoris||Kilgoris Business Centre||0770 585 078||[email protected]|
|Kitale||Trans Nzoia Teachers plaza Mazingira Rd||054-31841/879 077449260||[email protected]|
|Kitengela||EPZ Plaza||0774544818 0773669216 073668916||[email protected]|
|Lodwar||Africana Bldng||054-2221011 0770914918||[email protected]|
|Loitoktok||Emparakuoni Plaza Ground Floor||0770145754||[email protected]|
|Maralal||Oryx Service Station Ground Floor||[email protected]|
|Molo||Cooperative Bank Building 1st floor||0770380263|
|MTRH||Moi Referral Hospital||020-2148635 020-2688748 053-203347|
|Naivasha||Prema Plaza||050-2020818 050-2021489||[email protected]|
|Nakuru||AFC Building 1st Floor Kijabe Road||051-2211118 051-2213278 077939907||[email protected]|
|Nandi Hills||Nandi Hills Plaza||0776401995||[email protected]|
|Nanyuki||Cider Mall||020-2198401 062-31400/01 0774608427||[email protected]|
|Narok||Maa Towers 1st floor Nairobi – Bomet Road||0773881838 0775513014||[email protected]|
|Nyahururu||Kimwa Centre, 1st floor Nyeri – Nyahururu Highway||020-2620705 051-8007099||[email protected]|
|Olenguruone||AIC Church Building Ground floor||0713117214|
|Ongata Rongai||Masai Mall||0776827879 0776833969||[email protected]|
|Sotik||Bureti Tea Growers Sacco Building||0770348695/700||[email protected]|
|Wamba||Wamba Mission Hospital|
Members can alternatively reach NHIF customer care through their official social media profiles as follows: