Edu Afya NHIF Medical Scheme for Secondary Students; Complete Guide

Parents, are you aware that your public secondary school child has a comprehensive medical cover courtesy of the government? I bet most of you don’t know.

Edu Afya- Health Public Secondary Cover

Your son or daughter has a comprehensive Health Cover for Public Secondary school Form 1- 4- by the Goverment of Kenya and NHIF

They are covered in both Outpatient and In-patient- They can access foreign medical care, from INDIA or any other COUNTRY (Overseas Treatment) and you do not have to pay any cent. (After Preauthourization)

Also read:

NHIF Cover For Secondary School Students, Edu

THE COMPREHENSIVE MEDICAL INSURANCE COVER: Edu Afya

1.Out patient benefits

• Medical- Drugs- Optical- Dental- Radiology
• Ct-scan, MRI Oncology and Dialysis
• Inpatient – admission- surgeries-etc – Your Child can be admitted to Mater, Agha-khan, Nairobi or any other hospital and access specialists in that cover
• Drugs and Substance – Rehabilitation Conselling also in the Cover
• You do not need to do Fundraising or WhatsApp Harambees – recently a student who incurred a bill of 10 million from Alliance was all paid-by the Ministry of education through Edu Afya cover.
• In case of Death- in an event where a student die- the parent are given 500,000 as the last expense-
• If your Child died between 2018 ( When the Cover was started) to 2021 you can still claim the money- only need to take Nemis number Death and Birth certificate and the names are constant,
• Personal Accident- if a child is involved in an accident the student is supposed to be paid Ksh.400,000
• Emergency Evacuation- You can get ambulances, air evacuation for that cover in case of an accident to your child- in that cover
• Road Ambulance Emergency Services- 0738395395

Ensure your child has NEMIS No, and Headmaster has registered your son or daughter and they have the UPI (Unique Person Identifier) number and Student NHIF Number.
-No Nemis No. No NHIF no.

Toll Free No.NHIf 800720601 24hrs
Dan NHIF Eduafya – 0723490623

Next time you have a sickness situation, try this… and please share widely many don’t know.

Eligibility/ Qualifications.

• A student in a public secondary school in Kenya.
• The student should be registered in the NEMIS database.
• The student should also be registered with NHIF.
• Only the Student shall be covered under the scheme and not a dependant.
• Students shall be exited from EDUAFYA upon completion of secondary education.

How to Register for Edu Afya

• It is the responsibility of the principal of the school to register all the students in the NEMIS database, issue a valid UPI number and to submit the data to NHIF for registration of the student with NHIF.
• Once a UPI number is generated in NEMIS, the biodata should be submitted to NHIF via the link in NEMIS for auto-registration of the student with NHIF.
• The school can view the student’s NHIF number through the NEMIS portal.
• Biometric registration of the students is done at the NHIF service points.

UPI NUMBER NOTIFICATION TO STUDENTS.

The principal shall inform the students of their UPI and NHIF numbers through the following ways:

• Class lists
• Class registers
• Student ID
• Report cards

v

vStudents will access benefits in the any of the health care providers contracted by NHIF to offer EDUAFYA.

vTo access services at the health care provider while in school,  the student shall present a letter of introduction written, duly endorsed and signed by the respective school principal or the designate.

vThe letter should contain the following information:

• Name of student
• Name of School
• UPI Number
• NHIF Number

ACCESS TO BENEFITS OF THE SCHEME

Students will access benefits in the any of the health care providers contracted by NHIF to offer EDUAFYA.

To access services at the health care provider while in school,  the student shall present a letter of introduction written, duly endorsed and signed by the respective school principal or the designate.

The letter should contain the following information:

• Name of student
• Name of School
• UPI Number
• NHIF Number

While on school holidays/away from school, a copy of the birth certificate and the UPI number

There is no waiting period for access to service for new students once registered with NHIF.

How to access services at the health care providers(HCP).

• The students can access services in any of the health care providers contracted by NHIF for EDUAFYA.

Requirements at the health care provider:

• Letter from the principal ( during the school term)
• A copy of the birth certificate and the UPI number(during school holidays/away from school).
• The HCP will carry out fingerprint verification(biometrics).

Where can these benefits be accessed?

1. Public healthcare providers

2. Faith-based healthcare providers

3. Private healthcare providers

NB: List of declared health care providers is available in the NHIF Website

BENEFIT PACKAGE.

Benefits Package Details

BENEFITS	CONTENT
Outpatient Cover	Consultation with a General Practitioner & Specialists, Basic laboratory investigations, prescribed medications, x-ray, ultrasound, health education, wellness and counselling, physiotherapy services and the following vaccines: Anti – rabies and Anti –Snake venom.
Inpatient cover	Hospital stay with health care diagnosis, consultation, accommodation/bed charges, nursing care, diagnostic  laboratory tests, radiology examinations, specialist consultations or visits, prescribed medications and dressings.
Surgical Package	Includes all surgical procedures including transplants with an exception of cosmetic surgeries.

 

BENEFITS	CONTENT
Renal Dialysis	It caters for dialysis for the needed care plan including Specialists’ reviews, nursing services, intra-care, dispensed medications, routine laboratory tests, nutrition, counselling and follow up.
Rehabilitation Package: Drug and Substance Abuse	Includes rehabilitation treatment for  a student addicted to harmful or hazardous psychoactive substances.
Oncology Package	Includes treatment for cancer patients using radiotherapy and chemotherapy

 

BENEFITS	PACKAGE CONTENT
Radiology Package	Includes ALL diagnostic imaging services e.g. CT-Scan, MRI, PET scan
Medical devices	Includes orthopedic appliances such as crutches, wheelchairs, prosthetics and other devices like hearing aids.
Optical Package	Includes cost of consultation with ophthalmologist/optometrist, eye testing and prescription for ophthalmic treatment. Frames and glasses shall be accessed in NHIF-contracted government facilities or any other contracted facility approved by NHIF subject to pre-authorisation.

 

BENEFITS	PACKAGE CONTENT
Dental Package	Includes dental consultation, orthodontics, root canal, dentures, Cost of filling, X-rays and Extractions including surgical extractions together with anaesthetics fees, hospital and operating theatre cost. Dental treatment and care will be accessed at NHIF contracted Government facilities or any other contracted facility approved by NHIF subject to pre-authorisation.
Local emergency road ambulance service	Emergency evacuation, transportation & transfer of a sick student for treatment at the nearest NHIF contracted hospital. Service provider: Eplus (Kenya Red Cross) TOLL FREE LINE 1199 0700395395|0738395395

 

BENEFITS	PACKAGE CONTENT
Emergency air rescue service	Transportation and transfer of an injured member to an NHIF contracted facility where adequate care available within the territorial limits of Kenya. Service provider: AMREF Flying Doctors Rescue: +254 (0) 206 992000 | +254 (0) 730 811000 | +254 (0) 709 962000
Foreign Treatment	Cover for treatment costs arising from a condition that warrants treatment that is not available in Kenya. Cover includes; Cost of travel and accommodation for the student and one person accompanying the patient, Cost of travel and accommodation for medical personnel accompanying a patient on recommendation by the referring doctor for a period not exceeding two days.

 

Overseas Treatment

uTreatment costs for beneficiaries for a condition that warrants treatment not available in Kenya will be covered subject to pre-authorization by NHIF.

The process is as follows:-

1. Referral letter from the treating doctor.

2. Approval from the Director General, Ministry of Health.

3. A letter from the school principal.

4. A potential donor must be a registered NHIF member

Benefits

• Travel & accommodation for the patient & one accompanying person.
• Travel & accommodation for the organ donor.
• Treatment costs.

Overseas treatment also caters for emergency services for a student who is out of the country on school related activities. The period of cover does not exceed 6 weeks.

This is covered in form of travel insurance.

Requirements

• Letter from Ministry of Education/clearance letter
• Passport
• Travel dates/air tickets

Features of travel insurance.

• Cover for Maximum of 6 weeks
• Processed in 72hrs

Cover Package:

• Medical Expenses
• Medical Evacuation Expenses
• Repatriation of Mortal Remains/Burial Expenses
• Coffin Expense Accompanying Family Member
• Personal Accident
• Emergency Assistance

Specialized Treatment

Requirements

• Specialized services will be on referral basis.
• The health care provider is required to seek preauthorization from NHIF.
• Specialized services are available in NHIF contracted Facilities

Services covered

• The services include the following:
• Renal Dialysis & Renal Transplant.
• Optical & Dental.
• Radiological tests e.g., MRI & CT Scan.
• Oncology (cancer treatment).
• Orthopaedic and other medical appliances e.g. wheelchairs, crutches, pressure stockings e.t.c.
• Drug and Substance Abuse Rehabilitation

LAST EXPENSE (FUNERAL COVER).

Upon death of a Registered student, NHIF shall pay to the next of kin the amount specified in the limits upon receipt of the following documentation;

• Duly filled claim form;
• Copy of burial permit; and
• Copy of birth certificate.

GROUPLIFE COVER

In addition to the Last Expense, NHIF shall upon death of a student, pay to the next of kin the amount specified in the limits upon receipt of the following documentation;

• Duly filled claim form;
• Original burial permit;
• Original death certificate; and
• Original birth certificate.

Last expense and group life claim process.

• The last expense and group life claim form is uploaded in NEMIS.
• Upon demise of a student, the last expense and group life claim form shall be completed by the Principal of the school of the deceased student.
• The Next of Kin then fills the claim form in the presence of the Principal of the school of the deceased student
• The claim form is then presented to the next of kins bank for countersigning and stamping by the Bank’s authorized representative to confirm the bank account details.

Benefit Package.

• Outpatient &Inpatient Cover
• Dental & Optical
• Overseas treatment
• Radiology Services

• Drug & Substance Abuse Rehabilitation
• Chronic Illness
• Renal Dialysis
• Evacuation Services
• Last expense
• Group life
• Group personal accident

Exclusions of the EduAfya

• Treatments arising from non-accredited health facilities and/or un-authorized referrals
• Cosmetic surgery or beauty treatment & cosmetic procedures including complications arising from them
• Massage (except where certified as a necessary part of treatment following an accident or illness).
• Treatment by chiropractors, acupuncturists and herbalists
• Self-prescribed procedures
• Medical costs related to/or incurred in research environment & clinical trials
• Treatments not covered under the contract-stay overseas more than six weeks.
• Laser eye surgery for correction of refractive errors

EduAfya Contacts.

Customer Contact Centre

For all enquiries we now have a 24 hr Customer care Centre

Toll Free Line :0800720601

Email: enhancedschemesdivision@nhif.or.ke

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Website:  www@nhif.or.ke

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