NAIROBI, Kenya, Jan 5 – Civil Servants and the disciplined services will from this month access a comprehensive health cover under a new medical scheme to be implemented by the National Hospital Insurance Fund (NHIF).
Public Service Minister Dalmas Otieno said on Thursday that the medical scheme would cover more than 220,000 civil servants at a cost of Sh4.3 billion in this first year.
It includes unlimited inpatient and outpatient cover in accredited hospitals, with the exception of the higher job groups N to T who would have a specified ceiling. Staff will also get life insurance and a mandatory annual check up.
“The question of whether we are taking our officers to public health facilities where there is no medicine, no medical equipment and no doctors is being addressed concurrently and by the end of this year a number of outstanding issues of our health facilities are going to be addressed,” stated the minister.
He said the government had settled on NHIF to provide the cover after negotiations with private medical insurers collapsed.
“Largely due to the size and geographical spread of the clientele they could not meet all the conditions that the government had put in place to ensure quality service to its employees and their families,” he said.
The funds will be obtained from the monthly medical allowances payable to employees while the government will cover the difference to ensure that the quality of cover was comparable to medical covers applicable to other public servants.
The Chairman of the NHIF Board Richard Muga said 600 government, mission and private health facilities had been approved to offer the medical services.
Civil servants will be required to present their NHIF and employment cards to receive treatment.
“In the roll out of the scheme, the basic financial arrangement will be what we call capitation for outpatient and this will help us to safeguard against fraud and we will disburse the money according to the number of civil servants and disciplined forces who have registered in a particular facility,” Muga said.
Capitation is described as a system of payment for medical service providers where a fixed amount of money per patient per unit of time is paid in advance to the facility for the delivery of health care services.
The cover caters for the principal member, spouse and three dependant children under 18 years of age and up to a maximum of 25 years of age if still a full time student.
NHIF will also make provision for employees who wish to cover additional members to pay extra premiums directly.
Employees will be expected to choose their preferred hospitals from the list of approved health facilities.
Chronic diseases like HIV/AIDS and cancer are also covered as well as dental and optical care.
Union of Kenya Civil Servants Secretary General Tom Odege termed the scheme as “better” than the medical allowance the civil servants have been receiving.
“The major challenge we are foreseeing with the scheme is entirely lying on the side of the NHIF because people have been previously questioning their capacity to administer such a huge fund. Another challenge is with the two ministries of health because if majority of members will opt to go to private and mission hospitals, we are going to kill public hospitals,” he said.
Previously, civil servants received as low as Sh375 per month as medical allowance while the highest was Sh2,940.