NHIF wants 1-year premiums for chronic patients

Chronically-ill National Hospital Insurance Fund (NHIF) covered patients are now required to pay upfront annual premium contributions before receiving treatment in a directive that could see thousands across the country turned away at hospitals.

Patients visiting health centres for costly procedures such as diagnostic tests, dialysis, chemotherapy and radiotherapy sessions as well as those undergoing minor and major surgeries have in recent months been forced to pay upfront premium contributions as a pre-condition for the national insurer to foot their bills.

A number of patients have shared with the Business Daily records of their advance premium payments without which they had been denied treatment.

“Surgical packages, dialysis, chemotherapy sessions, kidney and heart transplants are restricted and it is something that NHIF is doing to cushion itself. There are people who register for just a few months and when they get the medical help they need, they stop contributing. NHIF is requesting that people pay in advance just to cushion itself,” a customer care agent told the Business Daily.

NHIF is a State-supported health insurer into which all formally employed workers are supposed to contribute as a way of subsidising insurance coverage for the poor.

NHIF chief executive officer Nicodemus Odongo denied making upfront payments a pre-condition for members seeking treatment. He said members are only ‘advised’ to pay in advance.

“The requirement to access NHIF service is that a member must be paid up and is not in arrears. This has been the case all along, thus not a new policy. Informal sector members who pay Sh500 per month are usually encouraged to pay for three, six months or even full year to avoid defaulting, which then would block them from accessing benefits at the hour of need. There is no policy to pay in advance,” said Mr Odongo in an interview.

Among the victims of the upfront payments directive that the Business Daily encountered is Keziah Njeri, a peasant farmer whose son went through Tympanoplasty, a surgical procedure performed for the reconstruction of the ear.

She got turned away when she attempted to use her up-to-date NHIF card to foot the hospital bill at Kenyatta National Hospital. Njeri together with other guardians in the ENT ward at KNH were forced to pay Sh6,000, in NHIF premiums for up to May 2020 before the State insurer could cover their bills.

One cancer patient who was first admitted to Mama Lucy Hospital last month was told to pay monthly contributions up to December 2019 before she could be transferred to Kenyatta National Hospital to begin radiotherapy, which again she could not access before she paid upfront premiums for the year 2020.

A low-income country like Kenya continues to bear the biggest burden of non-communicable diseases due to lack of awareness, misdiagnosis, late presentation to hospitals and the high cost of treatment.

The cost of treating cancer and other chronic illnesses remains way above the reach of most households in Kenya.