NHIF Frequently Asked Questions And Their Answers

Do you have any burning questions on NHIF? Well. Look no further. Here are all your answers to any NHIF questions that you may be having.

What Role Does NHIF Play in the Attainment of Universal Health Coverage?

The National Hospital Insurance Fund (NHIF) is a critical vehicle that the government is using under the Ministry of Health to scale up Universal Health Coverage.

For close to six decades, NHIF has been working to ensure Universal Health Coverage for all by providing affordable, accessible, sustainable, and quality health insurance through strategic resource pooling and healthcare purchasing in collaboration with stakeholders.

Thus, NHIF works to secure financial risk protection against the cost of health care services for all Kenyan residents while ensuring Kenyans are not exposed to financial hardships due to catastrophic medical expenditures. Let us realize UHC by leaving no one behind.

LIST OF HOSPITALS ACCREDITED BY NHIF.

You can get the list of accredited hospitals per county by visiting the NHIF website (http://www.nhif.or.ke/healthinsurance/outpatientServices) or the nearest Branch office or Huduma centre.

If you do not see a facility in the list, it means it is not NHIF accredited.

Get all the NHIF related portal here.

What does the Cancer Package entail?

The Package has radiotherapy and chemotherapy sessions of treatment. The package is offered at contracted healthcare facilities with prior authorisation. It is capped at six sessions of basic chemo and four for complex chemo.

Can I check my NHIF account status via phone?

Yes. Compose a new SMS, Type the letters “ID”, a space, then your ID number e.g., ID 12345678 Send to 1550. You can also check ‘MY NHIF’ app or dial *155# for more.
Note: Subscriber charges apply.

MOBILE NUMBER; Do I need to update it with NHIF?

Yes, you do. You can visit the nearest NHIF service point or Huduma Centre or call the toll-free number 0800 720601. You can also send an email to customercare@nhif.or.ke.

This will enable you get real time information when your NHIF card is used.

What of drugs and substance abuse rehabilitation?

Yes, this is covered under Supa Cover. The Drug and Substance Abuse Rehabilitation Services package includes treatment for persons addicted to alcohol and illicit drugs. The package is offered comprehensively in all Level V and VI GoK facilities and on a co-payment basis in Private Rehabilitation centres.

OTP What Is It?

OTP stands for One Time Password/pin sent to your registered phone number that you use to log into the NHIF selfcare system to manage your account.

Is Renal dialysis and kidney transplantation part of the package?

Yes. The Renal Dialysis and Kidney transplantation package includes care for prescribed renal conditions through dialysis as an intervention and other related treatment.

Applicable for inpatient and outpatient care and is offered comprehensively in over 100 contracted Dialysis Centres across the country. It requires pre-authorisation from NHIF.

What is the NHIF Supa Cover?

NHIF SUPA Cover is Kenya’s largest, affordable, accessible, sustainable, and quality medical insurance cover that enables you and your family to enjoy an unparalleled benefit package.

The Fund covers members in the formal and informal sectors, and those under the Health Insurance Subsidy Programme(HISP) for Elderly & Persons Living with Severe Disabilities, Orphans & Vulnerable children, among other sponsored programmes; all these to ensure no one is left behind.

What if I need treatment outside Kenya?

Foreign Treatment package comes into play when medical and surgical intervention that is not available in the country becomes necessary. It requires approval by Director General of Health and NHIF.

How to Join NHIF Supa Cover.

It is very easy to join NHIF. To register your family, please visit the NHIF website (www.nhif.or.ke) and attach a copy of your ID, colour Passport size photograph and fill out the online form.

To add your dependants, visit any huduma center or branch countrywide, fill an application form and attach your spouse’s photo and copy of ID, copy of birth certificate for children over 6 months (birth notification for under 6 months) and their colored passport size.

I lost my NHIF card, how do I go about it?

You can easily get a replacement by paying KES 100.00 at either the National Bank, Equity Bank, Co-op Bank or KCB. Ensure you inform the bank teller you are paying for a card replacement. Once you have paid, present the banking slip to any NHIF office or Huduma Centre to have your replacement printed.

What’s the number that I can use to check my status?

Kindly SMS your ID NUMBER to 21101. Compose a text message with the letters ID followed by a space and your ID number e.g ID 32676499 and send to 21101. You will get your reply immediately.

How long does it take to transfer outpatient services from one hospital to another?

Please note that changing of facility happens twice a year i.e June and December

REIMBURSEMENTS: I have never been sick. Can I get my money back?

NHIF is a social insurance fund, which means monies are pooled from different contributors to save you on a rainy day.

This way you not only benefit from the protection of not using your money for your medical needs, but you also get to help another in need.

For these reasons, and like all other insurances, we do not refund money you have contributed over the years and did not use. It is the same as if you had a car which you pay for vehicle insurance every year.

Would you get a refund because you did not get an accident that year?

What about X-Rays, CT-Scans etc?

Radiological services including diagnostic imaging for X-Rays, Ultrasound, MRI and CT-Scans are offered at contracted facilities with prior authorisation.

Note: that X-rays and ultra-sounds are offered under the outpatient package and that MRI and CT scans are limited to patients with stroke, cancer or those that have suffered injury through accidents.

MRI and CT scans are limited to 2 per year per card.

How do I Choose/Change My Outpatient Facility?

Facility choice/change is no longer being done at NHIF offices, to select or change the Preferred out-patient hospital, kindly do so via USSD code *155#, or Mobile App “My NHIF” on Play Store and Apple Store or Website (http://www.nhif.or.ke/healthinsurance/nhifselfcare/)

WHAT YOU NEED TO KNOW ABOUT THE SUPA COVER PACKAGE What does the Outpatient package cover?

The Cover includes consultation, laboratory investigations, day-care procedures, drugs & dispensation, health education, wellness and counselling, physiotherapy services, immunisation / vaccines as per KEPI schedule.

A member chooses an outpatient facility with an option of changing within six months.

FACILITY OF CHOICE: How Long Should I Wait to Use My Hospital of Choice?

If you change your facility between now and December 2021 the choice of Facility will come into effect on 1 January 2022.

Choice or selection of facility is a continuous process that is carried out throughout the year but implementation of the new choice of facility is done biannually (July & January).

You can only choose one hospital per beneficiary in your card.

And the Inpatient care product?

Covers hospital stay with health care diagnosis, procedure, and treatment. The package is offered on a comprehensive care basis at contracted facilities.

Does it cover Road Ambulance costs?

Yes, it covers emergency evacuations and transportation to the nearest contracted healthcare facility.

Do I also need to choose my inpatient facility?

No, you do not. Inpatient services can be accessed in any of the NHIF accredited facilities countrywide.

What if you require Surgery?

NHIF Supa cover includes a Surgical Package which covers all surgical procedures, including transplants except for cosmetic surgeries.

We cover for minor surgeries up to KES 40,000 major surgery (KES 130,000) and up to KES 500,000 for specialized surgery. This requires pre-authorization.

And of course, there is a maternity package.

Yes, this caters for normal or Cesarean section delivery costs for expectant mothers.

How can I get more information on NHIF Services?

For more information;

• dial USSD code *155#,
• visit: www.nhif.or.ke I Call Toll Free: 0800 720601,
• Download the NHIF mobile app “My NHIF” on Apple Store and Google Play Store.

1. Q. I have been trying to select my facility/hospital of choice, but I have not been successful. Please help?

   A. Kindly select your choice of hospital/facility using your feature phone (mulika mwizi) by dialing *155#, the Mobile App “My NHIF” that is available on Play Store/Apple Store and/ or the self-care portal on our website http://www.nhif.or.ke/healthinsurance/nhifselfcare/

2. Q. What is a facility name? What is facility choice?

   A. Facility name is the hospital you want to choose for out-patient service, while facility choice is the preferred hospital you want to select/change.

3. Q. A valid mobile phone number doesn’t seem to exist on my NHIF account. What should I do?

   A. To update contact details, a member can visit the nearest NHIF service point or call the toll free number 0800720601 or send an email to customercare@nhif.or.ke

4. Q. What is OTP?

   A. OTP is an abbreviation for a One Time Password, this is the password/pin send to your registered phone number, you’re required to use the password to log in NHIF system to update the out-patient facility

5. Q. I have tried using the NHIF application, but I have not received the OTP as indicated what can I do?

   A. Chances are that your mobile number is not updated in the NHIF database. Kindly contact NHIF through the toll-free number 0800720601 or customercare@nhif.or.ke. You can also get assistance in the nearest NHIF service point.

6. Q. How do I change my out-patient facility?

   A. Facility/hospital choice/change is no longer being done at NHIF offices, to select or change the Preferred out-patient hospital, kindly dial the USSD code *155#, or Mobile App “My NHIF” on Play Store and Apple Store or Website (http://www.nhif.or.ke/healthinsurance/nhifselfcare/). Bima Yetu, Afya Yetu!

7. Q. I have not received OTP to my mobile telephone number, what can I do?

   A. There may be a delay in processing the request, if this takes longer than usual, kindly restart the application (dial the USSD code *155#, or Mobile App “My NHIF” on Play Store and Apple Store or Website (http://www.nhif.or.ke/healthinsurance/nhifselfcare/) or call the toll free number 0800720601 or through email customercare@nhif.or.ke

8. Q. Can I choose more than one facility?

   A. NHIF encourages one to choose one facility per Member for one to keep adequate health records per card and for easier accessibility. However, depending on the locality of your spouse & dependents, you can choose a hospital/facility that is nearest to them.

9. Q. Why are some facilities not appearing on the list of selection?

   A. NHIF undertakes a rigorous procedure of contracting hospitals/facilities, but not all facilities are not in a position to offer out-patient benefits package as per our terms and conditions. Therefore, If the facility that you intend to select /choose does not appear on the NHIF list provided, then the facility does not offer the Out-patient benefit package.

10. Q. Can I add dependents online instead of visiting your offices?

    A. Dependents cannot be added online. To add a child, kindly visit the nearest NHIF office with your child’s birth certificate copy and original (for certification) and for children under six (6) months, a birth notification is acceptable.

11. How do I remove a spouse? you will be required to have a divorce certificate.

12. Q. Can I choose my Inpatient hospital also?

    A. For In-patient services, you are not restricted to a particular hospital. You can access in-patient services in any of the NHIF accredited hospital/facility countrywide.

13. Q. Can I change a hospital/facility any time I feel dissatisfied with the chosen one?

    A. Hospital/facility changes are done quarterly for Supa Cover (national scheme) members and twice in a year for civil servants.

14. Q. How can I get a list of all the contracted hospitals/ facilities in my County?

    A. You can get the list of contracted hospital/facilities in your County by visiting the NHIF website (http://www.nhif.or.ke/healthinsurance/outpatientServices) or the nearest Branch office.

15. Q. How come I was denied out-patient services in my chosen hospital/facility?

    A. If denied services in the chosen facility, kindly report to the nearest NHIF office or call the toll free number 0800720601 or send an email through email customercare@nhif.or.ke. Or complaints@nhif.or.ke.

16. Q. I forgot my OTP what do I do?

    A. The One Time Pin (OTP) is valid for 24 hours only. In case you forget, you can restart the process again to generate the request, and the pin will be sent to your phone.

17. Q. Why is it that when selecting my preferred hospital/facility, the system indicates an invalid choice?

    A. When choosing your facility, ensure you know the County and the correct name of the hospital of choice to complete the process.

18. Q. Can I update an out-patient facility for my parent, sibling relative, or friend?

    A. The selection procedure is configured to done by the Member whose mobile phone number is captured in the NHIF system. You can only update the out-patient facility using his/her Mobile telephone number.

19. How long after registration can you access the NHIF services?

    For the informal sector, you have to wait for 60 days while for the formal sector you only wait for 30 days.