NHIF in hot water over delays in service to police, prison officers

Parliament has questioned the capacity of the national medical insurer to provide cover to 131,816 police and prison officers after it emerged that it is taking more than two days to have them attended to in hospitals, or have their claims paid when they die.

This comes as Interior Principal Secretary Karanja Kibicho, in whose docket the police and prisons fall, accused the National Hospital Insurance Fund (NHIF) management of violating the contract on group life and comprehensive medical covers for police and prison officers.

Read: Covid-19 patients stranded after NHIF refuses to pay

The contract signed between the Interior ministry and National Treasury with NHIF allows the claims to be paid in under 48 hours of the death of an officer, but Dr Kibicho said it takes longer.

The capacity of NHIF to insure the officers is further compounded by the fact that it has also been allowed to provide the same cover to the more than 127,000 civil servants in the country.

The latest revelations on the capacity of the NHIF come barely a year after it was allowed to provide a group life cover worth Sh2.3 billion and a comprehensive medical cover that cost taxpayers Sh4.6 billion for the police and prison officers.

Civil servants

The cost of insuring the civil servants by NHIF is Sh6.8 billion for group life cover and Sh5.9 billion for comprehensive medical cover.

During the session of the Administration and National Security Committee of the National Assembly yesterday, Limuru MP Peter Mwathi, who chairs the committee, put the NHIF chief executive Peter Kamunya on the spot over apparent lack of interest and seriousness in affording the officers the required services.

MPs Makali Mulu (Kitui Central), Peter Masara (Suna West) and Rosa Buyu (Kisumu County Woman MP), committee members, claimed that compensation claims for officers who die in the line of duty are taking forever to be paid.

Read: NHIF on the spot over loss of Sh200 million

“The officers are taking longer to be attended to in hospitals,” Mr Mwathi said.

“It is interesting that NHIF does not have a contact person over the weekend to attend to inquiries for those insured and who need services,” the Limuru MP added.

Dr Kibicho told the committee that the issues the police and prison officers are complaining about are the ones that led to a change of insurance service provider from Pioneer Insurance Company to NHIF in January this year.

“We had a number of issues with the then service provider, like delays in paying the claims,” Dr Kibicho told the MPs in what may force the committee to recommend that the National Treasury get another insurance provider for the police and prison officers.

“The contract we have with the NHIF is that claims must be processed and paid within 48 hours. But this has not happened, exposing the officers to serious challenges. We must be guided by the contract and see where it has been violated,” the PS noted.

Dr Kibicho also pushed the committee to recommend an amendment to the law to exempt police and prison officers from “certain conditions” under the Work Injury Benefits Act (Wiba) just like Kenya Defence Forces officers.

The Public Accounts Committee (PAC) of the National Assembly is grappling with issues where the families of dead police and prison officers are taking years to have the claims paid by NHIF.

However, NHIF’s Dr Kamunya blamed the delays in paying claims to the delay in providing documentation of the next of kin of the dead officers.

“We want the claims to be settled in under 24 hours and even in six hours,” said Dr Kamunya.

However, the three MPs would have none of the NHIF boss’ explanations.

“The officers are suffering and getting services from NHIF that are below expectation. NHIF is taking the families of the fallen officers in circles with serious biases against the police officers,” said Dr Mulu.

“The police are suffering whenever they visit hospitals to get treatment. A majority of them have told us that they wished they did not have the cover. We need to get to the root cause of this issue,” the Kitui Central MP added.

Sick police officers

According to Mr Masara, NHIF is not prepared to handle the task of insuring police officers.

“It takes at least two days for the NHIF to clear sick police officers for treatment. You have a lot of responsibilities but you look so unstable,” said Mr Masara.

“When NHIF was given this contract, it was meant to make it stable in terms of the increased remittances but the police officers are complaining of raw services from the hospital fund,” Mr Masara said.

NHIF took over the mandate to cover the police and prison officers early this year after the contract with Pioneer Insurance Company, a private entity, came to an end on December 31, 2020, after six years.

Pioneer was first contracted in July 2014, but service provision issues led to the change.

Initially, NHIF was not allowed to engage in commercial insurance business because it was not registered as a commercial insurance provider as provided for in the Insurance Act.

However, through a gazette notice of June 16, 2020, National Treasury Cabinet Secretary Ukur Yattani exempted NHIF from the provisions of the Insurance Act.

The Act provides that no entity should engage in the provision of commercial insurance in the country if it is not registered in the country and regulated by the Insurance Regulatory Authority (IRA).

Currently, NHIF is not a registered commercial insurance company and is therefore not regulated by the IRA.

 [email protected]