NHIF announces rates it will pay to hospitals in medical scheme

NHIF Chief Executive Officer Simon Kirgotty briefing the media. FILE PHOTO | SALATON NJAU |

What you need to know:

  • Fund will also pay Sh1,200 for those visiting private hospitals rated level II-IV.
  • Trade Unions Congress criticises capitation rates, arguing they were too modest and insignificant compared to the amount deducted from Kenyans.

The National Hospital Insurance Fund (NHIF) principle contributors will only be allowed access to medication of between Sh 1,000 and Sh 1,400 outpatient cover per year under the new regulations.

NHIF Managing Director Simon ole Kirgorty has issued a circular to the Fund’s managers across the country notifying them of the new capitation rates.

The new capitation rates based on actuarial analysis according to Mr Kirgotty will see those attending level II-IV hospitals limited to a capitation rate of Sh 1,000 per year while those attending level V-VI hospitals would benefit up to a limit of Sh 1,200 annually.

The arrangement means that service providers will be paid the declared amount depending on the number of contributors who chose their hospitals whether the contributor seeks care or not.

The benefit to the service providers is dependent on the numbers they are able to enroll and prayers that many people don’t get sick while the contributors will benefit from the universal value of the amount capitated in total.

Workers in private firms contributing a similar amount monthly in private medical schemes enjoy out patient cover of up to Sh100,000 for the recommended household.

The private sector schemes normally subsidized by the employers also allows access to decent optical and dental cover and an extensive inpatient cover of between Sh150,000 and Sh500,000 in some companies.

The actuarial report has also put those attending National Referral hospitals on a limited capitation of Sh1,400 per year.

The NHIF will also pay Sh1,200 for those visiting private hospitals rated level II-IV while those attending hospitals rated level V-VI would be capitated at Sh1,400.

“The NHIF Board of Management has approved roll out of National Outpatient cover. The mode of provider payment shall be on capitation basis,” read a letter by Mr Kirgotty seen by the Sunday Nation.

He further wrote: “Having drawn experience from the civil servants scheme and having carried out extensive review and actuarial analysis, it was established that the average cost of an outpatient visit is about Sh2,300.”

The NHIF contributions have been enhanced to between Sh500 and Sh1,700 sparking protests from workers across the country.

The Mr Kirgotty further said that the board’s actuarial department was still reviewing the rebate rates payable under the inpatient scheme in a view to enhancing them to cover full hospitalisation comprehensively.

“Kindly share this information with health providers as you engage them and communicate to us feedback received,” said the letter.


On Saturday, the Trade Unions Congress of Kenya officials criticised the new capitation rates, arguing they were too modest and insignificant compared to the amount deducted from contributors.

TUC-K National Chairman Tom Odege and Deputy Secretary-General Charles Mukwaya said the rates did not match the amounts collected by NHIF from contributors and will not be allowed.

“If they are collecting Sh20,400 from contributors how then does it turn out that one can only access Sh1,400. This is a rip off,” said Mr Odege.

The TUC-K boss insisted that workers will only support the new rates if NHIF allowed input from the concerned trade unions.

He said that NHIF’s new capitation arrangement is similar to the one that initially failed, forcing the board to review it in 2012.

Knut Secretary-General Wilson Sossion, who is also the Secretary-General of the public servant’s labour centre, on Saturday announced that teachers would join in the strike and called on all the 288,000 teachers across the country to boycott classes tomorrow.

“Teachers are part of TUC-K and we want to make an appeal to each and every teacher to stay away from classes from Monday. What happened on Thursday was a warm up to a national strike that will be bigger than ever seen in this country,” the Knut boss stated.

On Friday evening, however, the Industrial Court stopped the strike called by TUC-K after the acting Labour CS Rachael Omamo, Devolution’s Anne Waiguru and Education’s Prof Jacob Kaimenyi and Teachers Service Commission moved to court to block it.


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