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.

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