The National Health Insurance Fund’s(NHIF) limited medical cover for civil servants, as effected this year, has sent many of them back to the drawing board, with some seeking alternative insurance covers to boost their depleted limits.
Many civil servants have been forced to dig deeper into their pockets to afford medication after they hit their ceiling for the year-long before the year ends.
It had also emerged that some are opting for hospitalization even where there is an option of home-based care, so that the NHIF can pay the bill as inpatient, whose ceiling is higher.
NHIF has, since the introduction of the Comprehensive Medical Cover for Civil Servants in 2012, been affording workers in Job Groups A-K unlimited cover.
However, in July 2021, the Insurer announced its decision to revert to pay for service mode for all civil servants capping limits at Sh.70, 000 and Sh.700, 000 for outpatient and inpatient, respectively, to the agony of many.
Workers in Job Group L and above also had their limits reduced, in what the insurer termed as a move to cut on expenditure.
“I have agreed to have my son admitted at this facility because I was told that my family had exhausted the outpatient cover. I had no other funds or cover to enable me access medication,” noted Mary Kariuki at one of the private hospitals in Nyahururu.
Her sentiments were echoed by Gitau Ndirangu, who said the limits of Sh.70, 000 for his family members were a drop in the ocean, noting that he had to supplement the cover with a private insurer.
A hospital staff at a Nyahururu private hospital, while regretting the limits, divulged that patients were colluding with clinicians to afford the medication, albeit unlawful.
“Patients come here in need of medication, empty handed, they fail to understand the capped costs and have to negotiate their way into the cover, which we don’t advocate for,” regretted an administrator who sought anonymity.
Renal patients have also suffered the blow, with NHIF proposal to cut hospital reimbursements to Sh.6, 500 from Sh.9, 500 per dialysis session, taking effect.
Private companies have positioned themselves to take advantage of the desperate workers to offer as low as Sh.8, 000 per annum cover.
For instance, Britam’s Milele Health Plan of Shs.17, 000 annually, offers overseas treatment, health lifestyle and stress management support as well as chronic and congenital conditions covered to the full limit.
With a discounted premium of Sh.60, 000, Jubilee’s Johari health care offers a family a Sh.200, 000 hospital limit with maternity, inpatient and last expense covers.
CIC insurance too has Medisure cover for families and plans for the elderly members also offers covers between Shs300, 000 and Sh.5 million a year.
