Eligibility

All Kenyans above 18 years are eligible to register for NHIF membership. One can apply for a single membership or family membership which allows them to include their declared spouse and children below 18. NHIF also doesn’t check for pre-existing conditions.

Registration

Self-employed members can register online. Alternatively, they can visit any of our nearest offices or Huduma Centres countrywide with the following documents:

1. A copy of ID
2. A colored passport sized photo
3. A copy of spouse’s ID if applying for a family cover
4. Sworn affidavit or marriage certificate if adding a spouse
5. Copy of birth certificates (or birth notification for children below 6 months) if one is adding children
6. Colored passport sized photo of spouse and children
7. Kshs 1,500 as payment for first registration which will cover one for three months. Afterwards, one is required to pay KES 500 monthly to avoid penalties.
   
   

Employed persons can also register online and sending their to their employers for monthly remittance or go physically to any of our offices or Huduma Centres countrywide with an introduction letter from the employer or with the registration form stamped by the employer.

Access of Services

It takes 60 days for self-employed persons to access services and 30days for those in formal employment.

NHIF Card

Processing and issuing of membership cards is done within a period of 14 working days if all documents are provided. If you have not received your NHIF card after the 14 days elapse visit any of our offices or Huduma Centres countrywide and get your card printed. Make sure your payments are up to date.

You can replace your card at any of our NHIF Branches or Huduma Centers countrywide. Replacement fees is KES 100/- paid to KCB, Equity, Cooperative or National Bank. Kindly note that we do not collect cash from any of our branches.

Scope

NHIF covers the nuclear family which includes the principal member and legally declared spouse and children. You cannot include other relatives apart from your legally declared spouse and children.

You can only add one spouse to your card. Additional spouses will require individual covers.

You can add orphans and/or adopted children to your card. You have to obtain proof of legal Guardianship/adoption letter from the children’s department at the county offices.

Adding Children

You will be required to physically visit our offices or any Huduma Centre countrywide to add a child to your card. You will need to present the following documents:

1. Copy of Birth Certificates (or birth notification for children below 6 months).
2. Proof of legal Guardianship/adoption letter from the children’s department at the county offices.
3. Copy of your ID.

Adding a spouse

You will be required to physically visit our offices or any Huduma Centre countrywide to add a spouse to your card. You will need to present the following documents:

1. Copy of your marriage certificate or an affidavit from an advocate/magistrate or commissioner of oaths.
2. Copy of your ID.

Removing a spouse

You will be required to physically visit our offices or any Huduma Centre countrywide to remove a spouse from your card. You will need to present the following documents:

1. In the event of death, you will need a copy of death certificate. In the event of a divorce, you will need a divorce certificate
2. Copy of your ID

Changing a spouse

You will be required to physically visit our offices or any Huduma Centre countrywide to change the spouse in your card. You will need to present the following documents:

1. Copy of your divorce certificate.  A copy of the marriage certificate of the new spouse to be added to your card or an affidavit from an advocate/magistrate or commissioner of oaths.
2. Copy of your ID

Access of Services

One will need their National ID and your NHIF card to access services in hospitals. For a spouse, they will need the Principal Member’s ID card and their NHIF Card and for children, a birth certificate and the Principal Member’s ID card will be required.

Benefits Under Supa Cover
Through the National Health Scheme (Supa Cover) NHIF members can access various benefit packages namely:

1. Outpatient
2. Inpatient
3. Maternity
4. Surgical
5. Renal Dialysis
6. Kidney Transplant
7. Radiology (MRI and CT scan)
8. Oncology (Chemotherapy, Radiotherapy)
9. Drug & Substance Abuse Rehabilitation
10. Emergency Evacuation

*Dental and optical services are not covered under the Supa Cover

The Inpatient Benefits Package

The scope of cover for inpatient benefit package includes:

1. Consultations
2. Accommodation
3. Nursing care
4. Laboratory tests
5. Radiology examinations
6. Physician’s fees
7. Operating theater charges
8. Prescribed medications
9. Dressings and Maternity

The Outpatient Benefits Package

The scope of cover for outpatient benefit package includes:

1. Consultation with General Practitioners
2. Laboratory investigations
3. Daycare procedures
4. Drugs & dispensation
5. Health education
6. Drug and substance abuse
7. Rehabilitation and physiotherapy services

The NHIF Preauthorization Process

Preauthorization is a type of legal restriction placed on certain health services, medications and tests by NHIF. This obliges the Healthcare Provider to check and take permission from the NHIF first, before providing certain services to determine if the patient’s plan covers the cost of the said service or not.

NHIF Benefit Packages That Require Preauthorization

1. Oncology Benefit Package (Chemotherapy, Radiotherapy, Brachytherapy)
2. Dental Benefit package
3. Optical Benefit Package
4. Radiology Benefit Package (MRI, CT Scan)
5. Surgical Package
6. Overseas treatment

How The NHIF Preauthorization Process Works

1. Facility sends a pre-authorization request online via hospital portal. The hospital is supposed to send all pre-requisite documents to support the requisition
2. Request is received by NHIF online
3. The request is reviewed and actioned
4. Member is notified via text or hospital notifies members on the outcome of the preauthorization

*Emergencies are acted upon as per the constitution and the contract between NHIF and the Healthcare facility.

Turnaround Time For Preauthorization at NHIF

Turnaround for response is up to a minimum 24 working hours or a maximum of 48 hours once all relevant information has been received.

Outpatient Facility

An outpatient facility is an NHIF accredited hospital where one regularly visits to receive the services outlined in the Outpatient Package. It is simply an NHIF accredited facility where one goes for services like general consultations, laboratory tests or even drugs. Every member in the National Scheme (Supa Cover) is required to select an outpatient hospital.

Inpatient Facility

An inpatient facility is an NHIF accredited hospital where one can receive the services outlined in the Inpatient Package. It is simply an NHIF accredited facility where one can get admitted. One does not choose an inpatient facility. Any registered member whose premiums are up to date can get inpatient services from any NHIF accredited inpatient facility in the country.

Choosing or Changing an Outpatient Facility

One can only choose one outpatient facility for the principal member and also one for the spouse & dependants depending on their locality. One can choose an outpatient facility that is nearest to them.

Hospital/facility changes are done quarterly for the National Scheme (Supa Cover) members and twice in a year for civil servants. Some members in managed schemes (ffs) do not need to select facilities as they can access any NHIF accredited hospital.

One can access a list of all contracted facilities by clicking here or from any of our branches or Huduma Centres countrywide.

A facility/hospital choice/change is no longer being done at NHIF offices. A member is now required to choose or change their outpatient facility by dialling *155#, using the ‘My NHIF’ App which can be downloaded from Google Play or App Store or the Selfcare Platform.

Ways to Pay

For convenience, NHIF has adopted several payment modes to make it easy for members to remit their contributions. One can pay through:

1. Mpesa (Paybill 200222 A/C No: (Your ID No)
2. Various banks like Equity bank, National Bank(NBK), Kenya Commercial bank(KCB) and Cooperative Bank (Note: NHIF Printed Banking slips are available.
3. Safaricom Bonga points are redeemable to pay for your NHIF. One dials *126#, goes to Lipa na Bonga, then indicates Paybill 200222, account number is one’s National ID number.

Contributions & Penalties

Every registered self-employed member is required to make a monthly contribution of KES 500 to their accounts. Existing members are required to pay on or before the 9th of the following month to avoid penalties.

If payments are made after the 9^th of the following month, then a penalty of 50% (KES 250) of the voluntary monthly contribution will be surcharged. A member will be required to pay the outstanding arrears and a penalty of kshs.250 for each month late contributions were remitted.

Ways to Pay Monthly Contributions Through MPESA

The following steps are used to make monthly contributions through MPESA.

1. Go to the Mpesa menu, click on Lipa na Mpesa then Pay Bill.
2. Enter 200222 as the NHIF Business Number.
3. Enter your National ID as the Account Number.
4. Enter KES 500 for every month you wish to pay for or KES 6,000 if you wish to pay for the whole year. The system can only accept a maximum of KES 6,000 at a go if you wish to make bulk payments.
5. Enter your PIN Number.
6. You will receive a message from MPESA confirming that you have successfully paid the penalty. The M-PESA message you receive is proof of payment.

* Note that you are supposed to use your ID Number and not your Member Number You have to pay premiums up to the current month for your card to be active. Safaricom’s Terms and Conditions Apply

Paying Penalties Through MPESA

The following steps are used to pay for penalties through MPESA.

1. Go to the Mpesa menu, click on Lipa na Mpesa then Pay Bill.
2. Enter 200222 as the NHIF Business Number.
3. Enter your National ID and the letter ‘y’ at the end of the ID as the Account Number.
4. Enter KES 250 for every month defaulted e.g. if you have defaulted for 4 months enter KES 1,000 as the amount.
5. Enter your PIN Number.
6. You will receive a message from MPESA confirming that you have successfully paid the penalty. The M-PESA message you receive is proof of payment.

* Note that you are supposed to use your ID Number and not your Member Number. Safaricom’s Terms and Conditions Apply

Erroneous Payments

If one makes an error during the process of payment e.g. one inputs their NHIF Member Number instead of their ID Number, they can visit our Accounts Department at any of our offices with a copy of their ID or NHIF Card with the M-PESA message from Safaricom capturing the transaction they made and they will be assisted.

Defaulted Payments

If a member defaults for more than 12 Months, they will be treated like a new entrant/member in the scheme. They can reactivate your NHIF card by paying KES 1,500 which will be their three months’ contributions. One will then have to wait for 2 months (60 days) from the date of payment to start using their card. One is advised to subsequently make monthly payments to avoid penalties.

Statements

One can get your account statement by:

1. Dialing *155# on your phone and following the prompts.
2. By downloading “My NHIF” Mobile App on either Play Store or Apple Store and then following the prompts accordingly.
3. Visiting the nearest NHIF office or Huduma Center.
4. Sending a text message with the format [ID {space} Your ID Number] e.g. (ID 12345678) to 1550.
5. Sending an email to customercare@nhif.or.ke