Health insurance is an insurance that covers the whole or a part of the risk of a person incurring medical expenses, spreading the risk over a large number of persons. By estimating the overall risk of health care and health system expenses over the risk pool, an insurer can develop a routine finance structure, such as a monthly premium or payroll tax, to provide the money to pay for the health care benefits specified in the insurance agreement.
The benefit is administered by a central organization such as a government agency, private business, or not-for-profit entity. In this edition our focus is on Government Agency known as National Health Insurance Fund (NHIF).
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 its beneficiaries as per Standard Treatment Guidelines issued by the Ministry of Health and Social Welfare (MOH&SW) alongside the Fund`s regulations. The package includes:-
1. Registration and Consultation
This covers for costs related to Registration and 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.
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 and MRI.
4. Surgical Services
Includes Minor, Major and Specialized surgical services performed from Health centers 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 same.
7. Eye and Optical Services
NHIF covers the costs for optical services to all beneficiaries.( Treatment of Eye diseases and refraction for visual defects.
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 and root canal treatment.
10. Retirees Health Benefits
Comprehensive Medical Services are offered to the Retired principle members and their spouses, for their entire lives.
11. Medical/orthopedic Appliances
The Fund provides supportive orthopedic and medical appliances including White Cane for blind people, Neck and Thoracic Spine Collars, Hearing Aids, Lumbar Cossets and Braces, Walking Crutches and leg orthopedic Supports, (ankle, knee and above knee orthopedic supports).
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