In order for a Hospital Claim to be processed, the following are required:-

1. Fill NHIF 8 (Claim form) correctly.
2. Original NHIF card and a clear photocopy.
3. Certificates of contribution paid (CCP), if applicable and MUST cover the period of hospitalisation.
4. Carbon copy of FINAL INVOICE indicating DOA and DOD and should bear the hospital seal and indicate the amount of rebate given to the contributor.
   Note: For G.O.K hospitals without seal, the receipt and invoice should bear hospital rubber stamp.
5. Contributor to produce of Identity document and that of spouse in case the spouse was the patient and attach their photocopies to the claim. The identity document number quoted should be the one attached e.g. National ID, Passport or Aliens certificate.
6. In case 90 days have elapsed from the date the patient was discharged, a letter must be written by authorised hospital official explaining the reasons behind the delay in submitting the claims.
7. The claim covers contributors, their spouses and children as below:-
   • Below 18 years of age.
   • Between 18-21 years and are fully dependant on the contributor.
   • Over 18years and attending full time course, evidence of attendance of school should should be attached.
   • Over 18 years but mentally or physically sick and fully dependant on the contributor, a doctors letter to explain the nature of sickness or disability should be attached.
     Note: A copy of birth certificate or birth notification should be attached for the above to prove age and relationship to the contributor. Letter of authority for use of card for dependants over 18 years must be given by the Branch Manager.
8. Alterations on hospital documents should be counter-signed and rubber-stamped by the hospital.
9. All cards for self-employed persons must be accompanied by contribution receipts and must cover the month of hospitalisation. In case of late contribution, a receipt for penalty should also be attached.
10. The hospital must send to NHIF office, Nhif 36 within 24 hours of admission and NHIF 37 on 6 th day of admission for those still in admission (through email, fax or hand delivery)

NHIF OUTPATIENT COVER DETAILS

The NHIF Out-patient services, under the National Scheme, also dubbed ‘The Supa Cover’ are available to all members and their declared dependants at their preferred out-patient hospital.

Members can choose, change, or confirm their existing out-patient hospital every quarter by dialing the USSD *155# or by downloading My NHIF App available on mobile app stores or through our self-help portal on the website.

The NHIF specialized services are a comprehensively covered range of pre-defined services designed to help in the attainment of Universal Health Coverage for our beneficiaries. They include:

a) Radiological Services package

It includes coverage for Magnetic Resonance Imaging (MRI) and Computerized Tomography (CT) scan, and Ultra Sound.

b) Cancer Package / Oncology Package

It includes coverage of Chemotherapy, Radiotherapy, and Brachytherapy for cervix and prostate cancer. For up to 10 sessions annually.

c) Renal Dialysis and Kidney Transplant Package

It includes coverage of Dialysis up to twice per week, kidney transplant package where the donor is covered as well.

d) Surgical Package

It includes coverage of minor, major, and specialized package.

e) Maternity Package

It includes coverage of normal and caesarian deliveries in Category A and B hospitals.

Services Covered Under The Out-Patient Package

NHIF has so far contracted various health facilities spread across all counties to provide comprehensive out-patient benefits to the members across the country under the national scheme. These benefits are for both In-patient and Out-patient services as follows:

1) Out-patient cover

– General Consultation
– Diagnostics and treatment of common ailments
– Laboratory and investigation
– Prescribed Drugs administration and dispensing
– Management of chronic ailments (HIV/AIDS, Diabetes, Asthma, Hypertension, cancer)
– Health and wellness education/healthcare counselling such as Screening for conditions e.g Cervical and prostate cancer.
– Treatment of sexually transmitted diseases
– Radiology Services
– Family planning/midwifery/ante/post-natal services
– Physiotherapy Services
– Referral for specialized services

2) Inpatient Cover offered in hospitals classified in categories A,B, & C covers the following:-

– Consultation
– Hospital daily charges
– Nursing care
– Prescribed diagnostic laboratory or other medically necessary services
– Physician’s, surgeon’s, anesthetics’ or physiotherapist’s fees
– Operating theatre charges
– Specialist consultations or visits
– Prescribed drugs/medications and dressings

3) Maternity Cover

– Consultation and treatment for both mother and child
– Child birth including caesarian section deliveries
– Family planning services

4) Renal dialysis package

5) Drugs and substance abuse rehabilitation package