Health In­sur­ance

Doctor's Plaza Health Magazine - - Contents -

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).

BEN­E­FITS 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 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.

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 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.

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 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).

EFOR PUB NC LI A C R I U N S S T N I I H U T T L I A O E N H S EFOR PR NC IV A A R T U E S C N O I M H P T A L A N I E E H S ANCE UR FO S R N I H E T T I L R A E E H S AITH STAFF RF TE OF N R I E R L I O G F O E U C S N D A E R N U S O N M I I H N A LT T I A O E H N S PR IVATE GR R O U O P F S E O C F N E A N R T U R S E N P I R H E LT N A HE UR S

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