NHIF announces new rules, penalties

√ Only one wife and 5 children; The National Hospital Insurance Fund (NHIF) will not cater for extra spouses in a polygamous family set-up.

√ 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.

√ 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.