Only one wife and 5 children: NHIF announces new rules, penalties
The National Hospital Insurance Fund (NHIF) will not cater for extra spouses in a polygamous family set-up.
In a raft of changes contained in a memo sent out to all regional and branch managers, NHIF says married individuals will only be allowed to enlist a single spouse and a maximum of five children as beneficiaries.
“For National Scheme members, number of dependents per card to be limited to a maximum of one spouse and five children,” reads part of the memo dated January 7, 2020.
The memo from the acting NHIF CEO further stipulated what has been termed as punitive measures aimed at curbing defaulters, a move that spells nightmares for Kenyans in the informal sector.
Members voluntarily joining the fund will now have to wait for 90 days before they start accessing services or benefits. In addition to that, one has to make a one year upfront payment within the waiting period.
If one makes a late payment, he or she will incur a fine of 50% of the monthly contribution coupled with a requirement to pay for one year in advance. He or she will be restricted against claiming benefits for a period of 30 days.
Defaulting for 12 months and above will force one to start payment afresh and can only be eligible for benefits after 90 days upon resumption of payment. A one year upfront payment will be applied and strict adherence to deadlines.
“In case of default for 12 months and above, the affected member will start payment afresh and be eligible for benefits after 90 days from the date of resumption of payment in addition to a one year upfront payment, payable within the waiting period while observing due dates,” adds the notice.
The memo further states that access to specialized services shall be restricted to a six-month waiting period following card maturity for new members.
Access to maternity benefit will henceforth be restricted to 6-months post card maturity for principal members or spouse declared at the point of registration.
For both maternity and specialised services, any dependent declared after initial registration shall be subjected to a 6-month waiting period. Newborns will however be exempted from this waiting period and will be considered eligible for benefit provided they are declared within six months from the date of birth.
“For medical inpatient and medical outpatient additional dependents shall be eligible for benefit after 30 days waiting period. This waiting period of 30 days will also apply in case of change of spouse,” adds NHIF.
NHIF says the new regulations which took effect on January 1, 2020 are aimed at attaining sustainable Universal Health Coverage.
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