NHIF Vs SHIF: 12 Benefits Of New Medical Scheme Set To Take Effect From October 1

• The government has urged Kenyans to register for SHIF, yet many are not well-versed in the facts and advantages of the new medical scheme
• According to the Ministry of Health, SHIF has numerous benefits, including overseas treatment where SHA will negotiate partner with foreign hospitals and negotiate treatment costs
• Additionally, SHA has incorporated emergency services, assisted devices, screening, and dental services

Nancy Odindo, a journalist at TUKO.co.ke, brings over three years of experience covering politics, news, and feature stories across digital and print media in Kenya.

Starting October 1, Kenyans, including their dependents, will need to transition to the Social Health Authority (SHA) as the National Health Insurance Fund (NHIF) will no longer be available.

However, many Kenyans remain unfamiliar with the new provisions of the upcoming Social Health Insurance Fund (SHIF).

What you need to know about SHA

The SHA comprises three funds: the Primary Healthcare Fund (PHCF), the Social Health Insurance Fund (SHIF), and the Emergency, Chronic, and Critical Illness Fund (ECCIF).

Together, these funds ensure comprehensive healthcare coverage, addressing prevention, promotion, curative, rehabilitative, and palliative care.

Why should Kenyans embrace SHA?

1. Overall Access

Under the new health fund, Kenyans can access primary health services and emergency treatment simply by registering as members, unlike the NHIF, which requires full payment for services.

2. Outpatient Care

SHA provides a wider range of outpatient services focused on comprehensive care, benefiting those managing chronic conditions and preventive care.

All SHA members can access outpatient services under the Primary Healthcare Fund, including essential diagnostics for Diabetes, Hypertension, Sickle Cell, and COPD/Asthma.

In contrast, NHIF outpatient services are only available to members with up-to-date payments and have a limited scope for chronic conditions.

3. Inpatient care

The per-day rate is standardised across hospitals based on their KEPH level, with a 12% increase in rates for all facilities. This approach improves access by offering higher reimbursement amounts for hospitals previously classified as "high-cost."

In NHIF, the coverage includes disease management during hospital admissions in ward beds, critical care units, or palliative care units.

4. Overseas Treatment

SHA will partner with foreign healthcare providers and negotiate treatment costs, allowing for more comprehensive coverage for members receiving care abroad.

In contrast, NHIF reimburses up to KSh 500,000 for overseas treatment, but this is subject to approval.

5. Optical Services

The new plan includes eye health education, counselling, eye examinations, basic treatments, and corrective eyeglasses, enhancing long-term benefits for eye health. Previously, NHIF only covered eye surgical procedures.

6. Mental Health Services

Under SHA, the out-of-pocket cost for rehabilitation and substance abuse treatment has been reduced by KSh 7,200, with the new tariff set at KSh 67,200. Mental health admissions will be reimbursed according to a higher inpatient rebate than what NHIF offered:

Level 4: KSh 3,360

Level 5: KSh 3,920

Level 6: KSh 4,480

7. Hematology and Oncology Services

SHA offers an expanded range of services, including the management of sickle cell disease and therapeutic apheresis for affected patients. It also covers cancer diagnosis and staging.

In contrast, NHIF's coverage focused on cancer management through chemotherapy, radiation therapy, hormonal therapy, and immunotherapy when necessary.

8. Maternity, Newborn, and Child Health Services

As the per Ministry of Health guidelines, the scope of antenatal care visits has been expanded to include Anti-D serum for rhesus-negative mothers and one ultrasound.

Postnatal care has also increased to six visits, enhancing maternal and newborn health by allowing for better monitoring and timely interventions during the postpartum period.

In contrast, NHIF limited antenatal care visits to four and postnatal care visits to two.

Linda Mama Package

The reimbursement for normal deliveries has been raised to KSh 10,000, while C-section deliveries are now reimbursed at KSh 30,000.

This ensures health facilities receive higher payments for 88% of deliveries that were previously covered under the Linda Mama rates.

In NHIF, Linda Mama services were reimbursed at KSh 2,500 to KSh 5,000 for both normal and C-section deliveries in government hospitals and KSh 3,500 to KSh 17,000 in private and faith-based hospitals, leading to additional co-pays for mothers in some facilities.

Services in SHA that NHIF does not offer

9. Screening services

SHA will provide targeted screening for common health conditions and cancers, including colon, cervical, and prostate cancers. This coverage will be introduced in the second year of implementation, depending on the Fund's maturity.

10. Dental services

SHA introduces dental services, covering consultation, preventive care, and restorative treatments such as extractions, scaling, and infection management. This coverage will be rolled out in the second year of implementation, depending on the Fund's maturity.

11. Assistive devices

Patients with permanent physical or sensory disabilities will receive necessary assistive devices, with coverage also extending to progressive chronic conditions.

12. Emergency treatment

SHA includes coverage for resuscitation and stabilisation of critical conditions, providing immediate care to stabilise patients in life-threatening situations. This service is available to all Kenyans, regardless of registration or premium payment status.

How can one register for SHA?

The Social Health Insurance Fund (SHIF) registration deadline is September 30.

According to SHA, members can register through various methods: self-registration by dialling the USSD code *147# on their mobile phones and following the prompts, self-registration via the SHA portal, or assisted registration through a community health promoter (CHP).

To register for SHIF, individuals must provide a national ID, alien ID for foreign residents, or refugee ID for refugees.

Children will need a birth certificate as a basic document for registration. Additional requirements include personal details such as marital status, employment status, address, and contact information.

Proofreading by Mercy Nyambura Guthua, journalist and copy editor at TUKO.co.ke

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