The National Hospital Insurance Fund (NHIF) has implemented a comprehensive medical cover to cater to students in public secondary schools.
Through the cover dubbed ‘Edu- Afya’, the government paid a premium of Sh1,350 per student targeting three million students who were in public secondary schools to fulfill the Big Four Agenda – provision of affordable health care.
Edu- Afya package was launched to enable students to access quality health services and thereby easing the burden from their parents and guardians. Thus, The Ministry of Education signed a contract with NHIF to provide medical Insurance for all public secondary schools for the duration of the study.
The medical cover caters to any student who is in a public secondary school, registered by NHIF through the NEMIS database.
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Scope of Benefits
The scheme covers essential outpatient and inpatient medical treatment on a comprehensive basis within the country and overseas for the student members. In addition, the cover provides for road and air evacuation, dental, optical, specialized services, group personal accident, group life, and last expense cover as defined in the contract.
The outpatient benefits package includes preventive, promotive, curative, and rehabilitative health services accessed from a capitated or referred-to health facility. This package is implemented at 2 levels of care namely the General outpatient services & Specialized outpatient Services.
The General Out-patient Services are provided in the capitated outpatient facility.
The Specialized Out-patient service is on a referral basis, accessed and provided by or on the order of a physician who is licensed as a specialist or consultant, and to whom a member has been referred to by a general practitioner/Primary Care clinician where a member is capitated.
Also applicable for members with special needs arising from congenital, mental, and/or physical deficiencies.
The inpatient Cover provides for comprehensive hospitalization (inpatient) to a member in an NHIF accredited hospital. This cover includes management of medical and surgical conditions where inpatient therapeutic services are required.
It includes hospital accommodation charges, hospitalization diagnostic services, daily consultation fees, nursing charges, drugs/medicines, dressings, diagnostics: imaging, laboratory or other medically necessary services, Rehabilitation services, In-patient physiotherapy.
The cover also caters for emergency Road rescue Ambulance services for the transportation and transfer of a sick member for treatment from a place of incident or facilities where adequate care is not available to the next available NHIF accredited Hospital or medical facility within the territorial limits of Kenya.
The scope of cover also caters to dental Optical, Surgical, drug and substance abuse, health, and wellness education and among others.
The student cover was launched to ease parental healthcare responsibilities towards their children as well as meeting Kenya’s vision towards universal healthcare coverage.
