Benefit Package

The National Health Insurance Fund (NHIF) has an attractive benefits package that is offered to its beneficiaries through accredited health facilities countrywide. This package has a total of eleven (11) benefits that are offered to beneficiaries as per Standard Treatment Guidelines issued by the Ministry of Health alongside the Fund`s regulations. The package includes:-

1. Consultation – This covers for costs related to Consultations.

2. Medicines and medical supplies – The Fund covers for the costs relating to medicines prescribed in Generic names and medical consumables as per the National Essential Medicines List (NEMLIT) and additional medicine list recommended (to NHIF) by experts and stakeholders.

3. Investigations – The Fund covers for the costs of Investigations and Diagnostic tests as per the Investigation List in the benefits package. There are 321 Investigations including Ultrasound, Echocardiography, CT-Scan, MRI and Ultrasound.

4. Surgical Services – Includes Minor, Major and Specialized surgical services performed from Health centres to Referral level hospitals.

5. Inpatient Care Services including ICU and HDU – The Fund covers for the daily admission costs depending on the level of the facility and the agreed daily rates as per the Fee Schedule, Investigations, Medicines and Medical Consumables dispensed while the member is admitted.

6. Physiotherapy and rehabilitation services – This is provided to inpatients and outpatients where the facility has specialists for the related services.

7. Eye and Optical Services – NHIF covers the costs for optical services to all beneficiaries. ( Treatment of Eye diseases and refraction for visual defects.

8. Spectacles – The Fund also pays for visual corrective spectacles to the principle member (one pair for a period of 3 years).

9. Dental and Oral health Services – This is provided to inpatients and outpatients where the facility has specialists for the same. This includes dental conservation surgeries (Carries and dental filling), gum diseases, dental extractions, root canal treatment, Orthodontics and denture

10. Retirees Health Benefits – Comprehensive Medical Services are offered to the Retired principle members and their spouses, for their entire lives.

11. Medical/Orthopaedic Appliances – The Fund provides supportive orthopaedic and medical appliances including White Cane for blind people, Neck and Thoracic Spine Collars, Hearing Aids, Lumbar Cossets and Braces, Walking Crutches and leg orthopaedic Supports, (ankle, knee and above knee orthopaedic supports).

The benefit package contains a wide range of Outpatient and Inpatient Services. These services include 354 Investigations, 51 Ordinary Procedures,52 Specialized Procedures, 94 Minor Surgeries, 210 Major Surgeries, 148 Super Specialized Surgeries,16 Medical and Orthopaedic appliances, 522 types of Medicines, 40 Cancer Medicines, 17 Immunosuppressant and Immunostimulants and 40 Medical Supplies.
Special approval services (read more on its page)

These are services that are offered through a special permit, these include:

  • Cancer chemotherapy for cancer patients
  • Immunosuppressant medicines for patients, who have organ transplants,
  • Haemodialysis and erythropoietin for patients with renal failure,
  • Reading glasses and special radiological imaging such as CT scan and MRI
  • Medical and Orthopaedic appliances
  • Complex Implants
  • Advanced Cardiac Services
  • Some selected Medicines
  • PolypropyleneMesh
  • EMG needle
  • Dentures
  • Orthodontic Services
  • Radiotherapy services