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NHIF EDUAFYA SERVICES, KENYA

Hillary Kangwana

NHIF, KENYA

EDUAFYA SERVICES

Overview

Brochure- SECO AFYA

The Ministry of Education and NHIF signed a contract on 13th April 2018 to offer a unique Comprehensive Medical Insurance Cover for Public Secondary School Students during the duration of Study. Download EduAfya Bochure

Who is eligible?

  1. Any student in a public Secondary School and is under National Education Information System (NEMIS).
  2. Any student who is in a Public Secondary School and in NEMIS database and Registered by NHIF.
  3. Only the Student shall be covered under the scheme and not a Dependent or Parent.

How to Register

  1. Be a student registered on NEMIS for public school students then the data is shared by Ministry of Health to NHIF
  2. Biometric registration will be done physically by NHIF at the respective schools

Benefit Package

NATURE OF SERVICE

WHAT IS COVERED

Out-patient
  1. General Out-patient Services: Outpatient services provided by or on the order of a clinician/ physician who is licensed as a general practitioner.
  2. Specialized Out-patient Services: Outpatient services provided by or on the order of a physician who is licensed as a specialist or consultant and to whom a Member has been referred to by a general practitioner/Primary Care clinician where a member was registered.
  3. This caters for all routine outpatient services as per Kenya essential package for health subject to policy terms and conditions.
  4. Referral for specialized services which includes the following:
    1. Drug and Substance Abuse Rehabilitation Services
    2. Renal services and dialysis
    3. Specialized radiological diagnostic services
    4. Chronic ailment services such Diabetes and Hypertension, Ultrasound, ECG,
    5. Cancer medical care and treatment services which includes radiotherapy services, chemotherapy services or surgical intervention subject to preauthorization by the fund
Dental Cover This benefit caters for outpatient dental procedures, which include but not limited to:
  1. Extraction
  2. Root canal
  3. Dental X-ray Services
  4. Accident related inpatient Dental cases will be covered under the standard inpatient surgical benefits to the full inpatient limit.
Optical Cover An optional benefit that caters for expenses related to eye treatment, including the cost of:
  1. Consultation
  2. Eye testing
  3. Prescription for ophthalmic treatment and prescription of eye glasses
  4. Accident related inpatient optical cases will be covered under the standard inpatient benefits to the full inpatient limit.
Inpatient Inpatient shall be on a referral basis from the selected outpatient Health Care Provider. This cover includes medical and surgical conditions which require admission. It includes the following:
  1. Hospital accommodation charges
  2. Pre-hospitalization diagnostic services
  3. Doctor’s (physician, surgeon & anesthetist) fees.
  4. Nursing charges
  5. Drugs/medicines, dressings and internal surgical appliances.
  6. Diagnostic, laboratory or other medically necessary services
  7. Rehabilitation services
  8. Operating theater services
  9. Radiological diagnostic e.g. x-ray services, CT scan, MRI,ECG
  10. In-patient physiotherapy.
  11. Day care surgery surgical procedures that do not require overnight stay.
Emergency Road Rescue Ambulance services for transportation and transfer of a sick member for treatment from a place of incident or facilities where adequate care is not available to the next available NHIF accredited hospital or medical facility within the territorial limits of Kenya.
Emergency Air Rescue Emergency Air Rescue Services will be provided for transportation and transfer of an injured member to an NHIF accredited facility within the territorial limits of Kenya where adequate medical care is available.
Overseas Treatment Treatment costs arising from a condition that warrants treatment overseas because the treatment is not available in Kenya will be covered subject to preauthorization from NHIF.
Group Life Group personal accident cover and last expense

Terms and conditions apply

NHIF SPECIALIZED OUTPATIENT REFERRALS

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