Bomet Governor Hillary Barchok

Bomet Governor Hillary Barchok (second left) checks an online list of beneficiaries of the Universal Health Coverage in the county on August 4, 2021. 

| Vitalis Kimutai | Nation Media Group

Civil servants, NMS staff get improved NHIF medical cover

Civil servants are set to enjoy an enhanced medical cover scheme that will see them get additional benefits and ease reimbursement for their out-of-pocket medication expenses. Nairobi Metropolitan Services (NMS) workers will also now enjoy comprehensive medical insurance cover under the National Hospital Insurance Fund (NHIF), after the Ministry of Public Service and Gender approved their inclusion in the civil servants scheme.

NHIF CEO, Dr Peter Kamunyo, told Nation that the renewed medical cover has add-on benefits, which will make it easier for civil servants to access better medical services.

“We have used our learning from the different utilisation modules to tweak certain elements to make the cover efficient and responsive to the needs of public servants. For instance, reimbursements used to be a fixed fee, but we now have it under fees for service. This should make it easier to use,” said Dr Kamunyo in an interview.

In a letter to Principal Secretaries, Council of Governors and the Director General of NMS seen by Nation, Public Service PS Mary Kimonye says the renewed Comprehensive Medical Scheme for Civil Servants (CMICS) will run for the next one year from July 1, 2021, and will include all civil servants in ministries and state departments, NMS staff, and officers seconded to Counties.

“All scheme members will access both outpatient, inpatient, dental, and optical services in NHIF-declared and recognised healthcare facilities across the country,” Ms Kimonye said in the letter, adding that high-end care facilities will only be accessed on a referral basis.

Civil servants

The shared family limits scheme will see Civil servants access inpatient services of between Sh700,000 for Job Group A-G (CSG 17-13), and Sh2.5 million for Job Group Q-T (CSG 6-4). The Outpatient cover will be between Sh70,000 and Sh350,000, while the dental services and optical services has been capped at Sh50,000 and Sh40,000 respectively, across all job groups. Maternity, which will be charged within the inpatient’s limits will range from Sh100,000 for Job Group Job Group A-G (CSG 17-13) and Sh200,000 for Job Group Q-T (CSG 6-4).

“Specialised services and inpatient discharges will be subject to authorisation by NHIF, to ensure appropriateness and safety of specific treatment, sustainability of the scheme and realisation of value for money,” Ms Kimonye said.

She added that all civil servants promoted within the contract period (July 1-June 30, 2022) will continue to enjoy similar shared family limits until the expiry of the contract.

Civil servants who retire within the new contract period will together with their families continue to enjoy the benefits of the scheme until June next year. For those who will pass on while in service, their families will continue to enjoy the benefits of the scheme but upon paying Sh500 monthly premiums to NHIF, Ms Kimonye said.

The inclusion of NMS staff in the Civil servants’ medical scheme is a win, and a loss at the same time given that they will now require referrals to visit high-end private healthcare facilities, which is a downgrade from their previous cover with AAR insurance that afforded them this service as a first choice.

On the upside, their inclusion in this cover now assures them of inclusion in the NHIF Group Personal Accident (GPA), Work Injury Benefit (WIBA) and Last Expense Cover. It will also allow them access to the Group Life Assurance that includes a comprehensive cover, with Covid-19 insurance, to cushion those on the frontline fight against the Covid-19 pandemic.

In March, NHIF was allowed to offer group insurance schemes following the amendment of the law governing the scheme signed into law by President Uhuru Kenyatta.

Last month, NMS Director-General Mohamed Badi requested Treasury CS Ukur Yattani to fast-track the transfer of the Group Personal Accident (GPA), Work Injury Benefit (WIBA) and Last Expense Cover to National Hospital Insurance Fund (NHIF) and expand the Group Life Assurance to include a comprehensive cover with a Covid-19 insurance rider.

Covid-19 pandemic

“Following the 4th presidential address on Covid-19 pandemic issued on 16th April 2020 by the president directing that a welfare package be developed to cushion civil servants on the frontline fight against Covid-19 through insurance, the Ministry of Public Service and Gender directed the National Treasury to fast-track the process of transfer of the Group Personal Accident , Work Benefit Injury Benefits and Last Expense Cover to the National Health Insurance Fund (NHIF) and expand the Group Life Assurance to include a comprehensive Covid-19 insurance rider," the letter states.

Lt-Gen Badi noted that the contract for the provision of comprehensive group life, last expense, enhanced work injury benefit and group personal accident for civil servants and employees of the National Youth Service, erroneously omitted to include NMS staff, who are part of the civil servants under transferred functions.

Last month, NMS employees, through the Kenya County Government Workers Union, threatened industrial action after accusing the acting Nairobi Governor Ann Kananu's administration of planning to enrol them into the NHIF without consultation.

They demanded that the Nairobi County government address their concerns saying the NHIF proposal of a Sh734 million cover would reduce the benefits that the staff have been enjoying and would be costlier than the AAR cover they had. However, the AAR cover does not include GPA, WIBA and Last Expense cover.

The union had also alleged that NHIF will only cover 4,897 workers out of the 12,000 covered in the lapsed Sh850 million AAR scheme.