Covid: You’re on your own if you pay Sh500 to NHIF

The National Hospital Insurance Fund (NHIF) is not paying Covid-19 hospital bills for Kenyans contributing Sh500 and below per month in premiums, the Sunday Nation has established.

NHIF Chairman Lewis Nguyai indicated that it only covers members under the enhanced scheme, including civil servants and county employees.

It also caters for the Covid-19 hospital bills of those who remit Sh1, 700 per month through their employers.

Supa Cover, which is apparently Kenya’s largest, reliable, accessible and affordable medical insurance cover, costs Sh500 per month for the principal members and beneficiaries.

The decision by the Fund has left many Kenyans who depend on it to pay for treatment stranded, unable to take care of the bills. It also bring into question why the Fund exists if it cannot cover bed charges for the poor.

With Kenya predicting another wave in the next two months, thousands of people across the country are likely to be infected and may need to be hospitalised, many of them will therefore find themselves in a bind.

Huge treatment costs

According to the Fund, with Covid-19 being a pandemic with huge treatment costs, it is not possible for it to continue paying the treatment costs.

Covid-19 treatment costs vary hugely depending on the severity of the disease and the hospital.

According to a model by the Kenya Medical Research Institute (Kemri), Covid-19 case management costs per patient in hospitals range from about Sh21,000 per day for asymptomatic patients and those with mild symptoms, Sh24,705 for patients with severe disease and Sh51,684 for critical patients in intensive care units.

Going by Kemri’s estimates, a patient with severe symptoms put in isolation for a week would be required to pay over Sh350,000 in hospital bills, or Sh750,000 if in critical care.

Mr Maurice Omondi, a farmer from Muhoroni, yesterday told the Sunday Nation that he was admitted at Jaramogi Oginga Odinga Teaching and Referral Hospital for five days only for the Fund to decline to pay the bill when he was being discharged.

“I struggle to pay Sh500 every month hoping that when I am unwell the card will help me. If it cannot even pay for bed and drugs, then why am I remitting that money every month?” he asked.

Mr Omondi represents a huge number of people who are in the informal sector and on the Supa Cover.

NHIF is the biggest health insurer in the country, with a coverage of 15.8 per cent, which is equivalent to over 80 per cent of the total population with any form of health insurance in Kenya.

NHIF membership had grown from 4.4 million in 2013 to 8.4 million households in 2019, according to the latest Economic Survey, which is 70 per cent of the 12.1 million households.

Not feasible

Justifying why they are not paying for those under the Supa Cover, Mr Nguyai said that statistically, it is not feasible given that they are only paying Sh500 yet claims are accruing to Sh8million, an amount that is too high for the Fund to pay.

“Divide Sh8 million and see how many families paying Sh500 will have deprived the Fund. Statistically, this is not attainable at present. We are working on modalities to see how we can cover them, though it is a risk that we also don’t understand,” said Mr Nguyai.

Ms Monica Salome had to do a mini harambee for her niece in Kakamega after NHIF declined to clear the bill.

“I don’t think they are taking care of other bills, leave alone the Covid-19 ones. A colleague of mine who did not even have Covid-19 had to clear his bills after they declined to pay for his treatment,” she said

Early this month, when Mr Nguyai was taking over from his predecessor, he said there were discussions that could see Kenyans receive partial relief of Covid-19 treatment costs.

The discussions by the board were aimed at ensuring that Kenyans are cushioned while ensuring that the Fund remains sustainable.

“There are many ailments that we cover, hopefully, we want to include Covid-19 as well,” he said at the time.

Last year, the Fund indicated through a circular that it will only pay rebates on treatment bills incurred by Covid-19 patients at the Kenyatta National Hospital, Kenyatta University Teaching and Referral Hospital, Mbagathi Hospital and other Health ministry-designated hospitals in the counties. It stated that it would not cover treatment in private hospitals.

“We shall support all Covid-19 positive members and their declared beneficiaries who get admitted to the Ministry of Health designated facilities. NHIF shall not be liable for bills incurred in non-MoH designated health facilities,” Peter Kamunyo, the Fund’s chief executive officer said in the circular.

In a Bill yet to be discussed in Parliament, it is proposed that NHIF only pays hospital bills after patients have exhausted the limits of their private insurance covers.

Last resort

The government-backed NHIF (Amendment) Bill 2021 introduced in Parliament last week wants NHIF to only step in as a last resort for those contributors who also have private covers.

The proposal is a shift from the current practice where NHIF makes the first payment, usually a small portion of the total bill, leaving the rest to private insurers.

“Where a beneficiary has a private health insurance cover, the private health insurance shall be liable for payment up to the limits the beneficiary is covered” reads the Bill. “The Fund (NHIF) shall cover the outstanding bill where the private insurance cover’s limits have been exhausted, subject to the Fund’s applicable limits,” it adds.