How medical scheme will work

President William Ruto on Thursday October 19 signed into law the Social Health Insurance Bill, thereby establishing a Social Health Insurance Fund, a Primary Health Care Fund, and a Chronic Illness and Emergency Fund.

Every Kenyan household, a non-Kenyan resident that has lived in the country for over 12 months, national and county governments and employers shall be required to contribute towards the Social Health Insurance Fund.

However, the other two shall receive their funds from appropriations from the National Assembly, grants and donations and other sources.

Contributions will be collected in various ways based on the contributor's circumstances. This means that Kenyan households with income from salaried employment will see monthly deductions from their wages or salary by their employer at a rate specified in the Act.

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Households without salaried employment will make annual contributions based on their income, determined through means testing.

Households in need of financial assistance will, however, receive support from the government, funded through appropriations by Parliament and county assemblies.

The government will also cover the contributions of persons under lawful custody. Permanent non-Kenyan residents will contribute to the fund at a rate set by the Act.

All Kenyans shall be required to make their payments at the time of registration. This means that parents of children born as from yesterday, shall, upon registration at birth, be required to make payments.

Non-Kenyan residents shall, however, be allowed to make annual contributions.

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Members of the fund shall only access health care services when they actively contribute to the fund. The government will also ensure that premium financing products are available for non-salaried individuals to aid in paying for social health insurance.

Should one fail to make contributions on time, they will incur a penalty of two per cent of the unpaid amount and the total annual contributions.

Those with outstanding contributions and penalties shall also be required to clear their dues before they can resume contributions.

The Primary Health Care Fund, which shall be used to pay for primary healthcare services from healthcare institutions, shall receive their contributions from “monies appropriated by the National Assembly, any grants, gifts, donations or bequests, monies allocated for that purposes from fees or levies administered and monies accruing to or received by the Fund from any other source”.

This fund shall only spend money within budgetary limits prepared by the Social Health Authority at the beginning of every financial year.

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The Emergency, Chronic, and Critical Illness Fund shall cover costs associated with managing chronic illnesses once the social health insurance cover is depleted, as well as to provide financial support for emergency medical treatment.

The fund shall receive its contributions from appropriations by the National Assembly, gifts, grants, donations, endowments, and other lawful sources. The fund shall be regulated by guidelines set by the Cabinet Secretary, in consultation with the Board.

The law will also see the establishment of a Claims Management Office, that will validate and appraise medical claims to protect the funds from fraud, which plagued the National Health Insurance Fund (NHIF).

The signing of the Bills comes ahead of the UHC plan launch in Kericho County during the Mashujaa Day celebrations today.

Speaking when the President signed the bills at State House, Tharaka-Nithi Governor Muthomi Njuki, who is chair of the Council of Governors Health committee, said the council is satisfied with the state of the Digital and Primary Health Care Bills.

He explained that while the Digital Bill would ensure that doctors access patient medical records anywhere in the country, the Social Health Insurance Bill would call for more contributions to avoid raising out of pocket health bills.

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“The other two Bills, in the state that they are in now, may not be implementable,” he said.

President William Ruto said the new Social Health Insurance Act will “address financial barriers to healthcare and the existing challenges faced by NHIF by establishing the Social Health Authority.”

“The Primary Healthcare Fund will finance services from health facilities at levels 1 to 3, while the Social Health Insurance Fund will cover services at levels 4 to 6 facilities. The Emergency, Chronic and Critical Illness Fund will fund emergency and chronic illness costs, once social health insurance is depleted,” said the President.

The finances raised shall be used to ensure that health services are available, accessible, acceptable, affordable and of good quality and standard, facilitate primary health care and preventive services at the community level and fund ambulance services for the transfer of patients from one health facility to another.

Additional reporting by Pauline Ongaji.