•New voluntary members-who are mostly self-employed-will have to pay the subscription for a year in advance at registration
•The circular dated January 7, say that the new regulations are set to take effect on January 1, meaning thy are applicable this end month.
Image: FILE
News subscribers to the National Hospital Insurance Fund will have to pay an upfront one year subscription at registration according to new rules announced by the health insurer on Thursday.
NHIF's acting head of registration and compliance R.O Otom in a circular to regional and branch managers imposed new regulations with punitive measures to deter defaulting in monthly contributions.
The full year's subscription will be required to be settled within the 90 days waiting period.
If a member defaults in payment or pays late, the new rules require that he or she will have to pay half of the monthly subscription for each month defaulted or paid late.
They require that if the default is for 11 months, besides the 50 per cent of the monthly subscription for all the months defaulted, they will also have to pay another one-year subscription in advance. They will not be allowed to access the services for 30 days after paying up.
Further, if the default is for 12 months or more, the new rules require the subscriber to register afresh with the requirement of one year upfront payment and 90 days waiting period kicking in.
The new rules require that instead of 60 days waiting period for the card to mature, new subscribers will have to wait for 90 days to use their cards.
The circular dated January 7, says the new regulations took effect on January 1. The agency believes the new interventions will lay the necessary groundwork for the Universal Healthcare Coverage rollout.
Voluntary subscribers are understood to be beneficiaries who tend to be unemployed or are in self-employment or do not have a regular monthly salary from which their subscriptions are deducted.
They often pay Sh500 monthly premium.
Observers fear the new rules will alienate subscribers with low or no dependable income hence impeding their access to health insurance in a country where quality healthcare is beyond the reach of millions.
The rules were adopted by the agency's special full board meeting on December 17 last year.
For maternity services, the new rules require the voluntary subscribers to use the card only after six months post maturity for principal members or spouse declared at the point of registration.
The beneficiaries declared as dependants at registration will also have to wait for six months before they can enjoy the coverage.
For medical inpatients and outpatient dependants, the rules say they will be eligible for benefits after 30 days. The same waiting period applies to new spouses.
To access specialised services, the rules require new members to wait for six months while defaulters will have to first pay all the penalties, pay a one year upfront subscription and wait for a further 30 days.
For national scheme members, those in employment with mandatory deductions, only one spouse will be covered and up to five children.
Any additional dependent will attract additional premiums to be determined after actuarial evaluation.
Members covered under the health insurance subsidy, Inua Jamii, Linda Mama and Elderly persons with severe disability programmes are to be excepted from the new rules.