NHIF Guide – All You Need to Know About NHIF

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.

NHIF National Scheme (SUPA Cover)

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:

1. Outpatient cover including:
   • Consultation
   • Laboratory Tests
   • Daycare Procedures
   • Drugs and Dispensation
   • Health Education
   • Wellness and Counselling
   • Physiotherapy Services
   • Immunization and Vaccines as per the KEPI Schedule
2. Inpatient cover
3. Maternity Package which includes:
   • Antenatal
   • Prenatal care and
   • Deliveries (Normal and Caesarean section)
   • Reproductive Health Services and Family Planning
4. Surgical Package which includes all surgical procedures such as:
   • Minor surgery
   • Major surgery
   • Specialist including Transplants
5. Renal Dialysis Package
6. Kidney Transplant
7. Oncology Package including:
   • Cancer Treatment
   • Chemotherapy
   • Radiotherapy
8. Radiology Package which includes:
   • X-rays
   • CT scan
   • MRI
9. Overseas treatment for specialized surgeries not available locally
10. Rehabilitation for drugs and substance abuse
11. Emergency road evacuation services

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.

Accredited Health Facilities for SUPA Cover

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 comprehensive category, NHIF covers all the costs for the in-patient treatments. Hospitals under this category include all government hospitals and some select mission and private hospitals.

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.

A list of hospitals that accept the NHIF in-patient cover and their respective categories can be found in the NHIF website as well as those offering out-patient services.

Other Medical Insurance Schemes

In addition to the national scheme, NHIF has designed additional products that target specific groups. These include:

1. Linda Mama Services

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:

1. Antenatal Package including:
   • A total of 8 clinic visits – 4 antenatal (prenatal) and 4 postnatal
   • Antenatal profile (i.e. lab tests and screening)
   • Preventive services for Malaria, Deforming, Iron and Folate Supplementation (IFAS)
   • Prevention of Mother to Child transmission (PMTCT)
2. Delivery (Normal or Caesarean section)
3. Postnatal Care (Up to 6 weeks)
4. Conditions and complications during pregnancy
5. Care for Infant

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:

• Through USSD by dialling *263# on their mobile phones
• At any NHIF office branch countrywide
• At any Huduma Centre with provision for NHIF services
• Through contracted health care providers e.g. Beyond Zero

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.

2. EduAfya Services

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:

1. Outpatient services
2. Inpatient cover
3. Dental cover including:
   • Extraction
   • Root canal
   • Dental X-ray Services
4. Optical cover including:
   • Consultation
   • Eye testing
   • Prescription for ophthalmic treatment and prescription of eye glasses
5. Emergency Road Rescue (i.e. Ambulance services)
6. Emergency Air Rescue
7. Overseas Treatment
8. Group personal accident cover and last expense

3. Civil Servants Scheme

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:

1. Out-patient cover including:
   • Consultation
   • Laboratory investigations
   • Drug administration and dispensing
   • Radiological examinations
   • Nursing and midwifery services
   • Minor surgical services
   • Physiotherapy services
   • Optical care
   • Occupational therapy services
   • Referral for specialized services
2. In-patient cover
3. Maternity cover (valid only for the declared spouse)
   • Normal and Caesarean delivery
   • Family Planning (excluding fertility treatments)
4. Dental cover
5. Optical cover
6. Group Life and Last Expense cover

Are KDF covered under this scheme?

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

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

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

1. Copy of National I.D (including spouse’s if applicable)
2. Copy of Employer Appointment/Introduction Letter (excludes voluntary contributors)
3. Coloured passport photo (including spouse & dependants if applicable)
4. Original and copies of birth certificate for dependants

NHIF Requirements for Foreign Residents

1. Copies of passport, alien certificate or work permit (including spouse’s & dependants’ if applicable)
2. Coloured passport photo (including spouse’s and dependants’ if applicable)

NHIF Requirements for Foreign Students

1. Copy of passport
2. Coloured passport photo
3. Submit the required amount under the Voluntary/Self Employed Category

How to Register for NHIF at NHIF Offices or Huduma Centre

1. Visit your nearest Huduma Centre or NHIF Branch office with the above requirements.
2. Request for the registration forms and fill them accordingly. You can also download the registration form from the NHIF website and print.
3. Attach the required documents and passport photo(s) and submit your form.
4. Voluntary members will be required to pay a registration fee of Ksh 1500 which covers for the first three months contributions.

How to Register for NHIF Online

Before making your registration online via the website, app or USSD make sure you have the following information with you:

• National ID Number
• Date of Birth
• Mobile Phone Number (preferably Safaricom)
• Employer’s NHIF Code if you’re Employed
• Your County
• Nearest NHIF Office

Register via the Website

1. Visit the NHIF Self-registration portal.
2. Enter your ID number and year of birth.
3. Fill the online form details and submit your details.

Register via My NHIF App

1. Download and install the My NHIF app from the Android Playstore or iOS App Store.
2. Tap the Registration button.
3. Enter your ID number and year of birth.
4. Follow the prompts to complete your registration.

Register via USSD

1. Dial *155# on your phone with your Airtel or Safaricom line.
2. Select the menu language to use between English and Kiswahili.
3. Enter your ID number followed by your year of birth.
4. Follow the prompts to complete your registration.

NHIF Card Processing and Collection

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.

NHIF Account Activation

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 Account Management

NHIF members may need to manage their accounts to do any of the following:

• To select or change preferred outpatient facility
• To make amendments to their details or those of their dependants
• To make their contributions
• To check their contribution status
• To reactivate a dormant account
• To replace their NHIF card

Let’s take a look on how to accomplish these functions.

1. Hospital Selection

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.

2. NHIF Details Amendment

Members may need to amend their NHIF details in the following situations:

1. In case of wrongly captured information of the principal member or their dependants.
2. To add a new dependant (e.g. a spouse for the newly married or a new child).
3. To change a dependant (e.g. due to death of a spouse or after divorce).
4. When switching between the employed or voluntary membership (e.g. due to retirement, lay off or transition to self-employment).

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:

Amendment of Wrongly Captured Information

1. Copies of National ID, Passport or Alien Certificate
2. Copies birth certificate or birth notification (for children below 6 months)

Adding a Spouse Dependant

1. Copy of National ID
2. Copy of marriage certificate or sworn affidavit from the Magistrate
3. Coloured passport size photo

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.

Adding a Child Dependant

1. Copies birth certificate or birth notification / immunization card (for children below 6 months)
2. Coloured passport size photo
3. Documents supporting adoption or fostering of a child

Change of Spouse in the Event of Divorce

1. Copies of National ID for both parties
2. Divorce certificate or a sworn affidavit

Change of Spouse in the Event of Death

1. Copy of National ID
2. Death certificate of deceased spouse or burial permit

3. NHIF Contributions and Deductions

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:

• M-PESA
• Banks – National Bank of Kenya (NBK), Kenya Commercial Bank (KCB), Equity Bank or Co-operative Bank (inquire for NHIF banking slips)
• At Huduma Centres

Let’s take a look at how members can pay their contributions and penalties using M-PESA.

How to Pay NHIF Contributions with M-PESA

1. Go to the M-PESA menu and select Lipa na M-PESA followed by Pay Bill
2. Enter 200222 as the business number for NHIF
3. Enter your National ID number as the Account Number
4. For the amount enter KSh 500 if paying for a monthly contribution or Ksh 6000 if paying for the whole year
5. Enter your PIN number
6. You will then receive a confirmation SMS verifying your contribution

How to Pay NHIF Penalties with M-PESA

1. Go to the M-PESA menu and select Lipa na M-PESA followed by Pay Bill
2. Enter 200222 as the business number for NHIF
3. Enter your National ID number as the Account Number followed by letter y at the end e.g. 12345678y
4. For the amount enter KSh 250 for every month that you’ve defaulted e.g. 750 if you’ve defaulted for 3 months
5. Enter your PIN number
6. You will then receive a confirmation SMS verifying payment of the penalty

4. Checking NHIF Account Status

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.

ID 12345678

The cost of this SMS is Ksh10.

Members can also confirm their account status by visiting the nearest NHIF branch office.

5. Reactivating a Dormant NHIF Account

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:

• 500×6=Ksh3000 in contributions
• 250×6=Ksh1500 in penalties

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.

6. NHIF Card Replacement

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.

6. NHIF Forms

In certain cases a member may be required to fill certain forms in order access or authorize particular services. Some of these forms include:

1. Amendment Form – required when changing your details as explained earlier.
2. Outpatient Claim Form – this is filled at your preferred outpatient facility and confirms that a member received a particular service which the hospital will be compensated for by NHIF.
3. Choice of Outpatient Medical Facility Form – this is filled when a member is selecting their preferred outpatient facility i.e. physically as this can also be done online or via USSD.
4. Referral Form for Overseas Treatment – this is filled when a member is seeking referral for overseas treatment (there are two forms of this type, one for those in the national scheme and another for those in the managed scheme i.e. civil servant scheme)
5. Treatment Outside Kenya Form – this is filled when making an application to claim benefits for treatment done overseas.
6. Pre-authorization Form – this form is filled when a member needs to access services that require authorization from NHIF before a hospital can provide them. They include surgical services (major and minor), CT/PET Scan, MRI and Ultrasound imaging.

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.

NHIF Contacts

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.

NHIF Head Office Location and Contacts

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:

Postal Address:
P.O BOX: 30443 – 00100, Nairobi, Kenya

Telephone Numbers:
Phone: 020 272 3246
Toll Free Line: 0800 720 601 (no charges)
Safaricom: 0726 268 933
Fax: 020 271 4806

Email Addresses:
Inquiries: [email protected]
Complaints: [email protected]
Liaise: [email protected]
Fraud: [email protected] or 020 271 4803

The office is open Monday to Friday from 8AM to 5PM and remains closed on Saturday and Sunday.

NHIF Branches’ Location and Contacts

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.

NHIF Social Media Handles

Members can alternatively reach NHIF customer care through their official social media profiles as follows:

Facebook Page: https://www.facebook.com/nhifkenya
Twitter: http://twitter.com/nhifkenya
Instagram: https://www.instagram.com/nhifkenya/