Over the past weeks two major concerns touching on NHIF have been raised; one with Consumer Federation of Kenya and the other by Chimega Chimega on Twitter. We have since contacted NHIF to speak to us regarding the two issues raised and we were lucky to speak with Mr. Reuben Mutwiri, the Senior Benefits Officer in the Department of Quality and Standards. But first let me introduce the concerns.
On November 23rd 2013 Consumer Federation of Kenya posted an update on their Facebook Page that would bother any contributor of NHIF medical policy. They wrote:
ANALOGUE NHIF – Strange that although insurance fund data is accessible by hospitals, claimant must have their card over and above the national identity card. The irony is that the card has the same details – name and ID number of the contributor yet hospitals have been illegaly instructed not to proceed members claims without their NHIF physical card. Analogue National Hospital Insurance Fund
If it indeed it were true that NHIF had issued any instructions to hospitals not to process claims if the claimant did not have the NHIF card then most people could be in big trouble. Judging from the comments in that post, most NHIF contributors do not have NHIF cards even two to six years down the line.
Personal experience on this attest to the fact that it is not rosy to obtain an NHIF card. As a family we joined NHIF in June 2012 and we were asked to collect the card after one month. In November same year when my wife was to deliver, the card was not ready. However NHIF assured us that we will be served as the hospitals have contributors’ details in their systems. True to their word, we got excellent high class service at Nakuru Nursing Home befitting VIP; we are yet to get the NHIF card.
What could have happened if NHIF issued instructions to Nakuru Nursing Home not to process our claim if we did not have the card? As a family we could have been required to raise over Kshs 60,000 in medical bills for the three days my wife spent at the hospital. To make it worse, the delivery was close to four weeks earlier than the EDD. That aside, no one plans to fall sick when a church mouse is richer and this is why people take health insurance covers including NHIF. Issuance of instructions not to process payment without cards that NHIF does not promptly give contributors could save NHIF a lot of money on claims but at the same time they could have received a better share of uproar from disfranchised contributors.
Mr. Mutwiri has however clarified that there are no instructions from NHIF for hospitals not to process claims in absence of NHIF cards. A situation that can lead to an hospital not to process a claim for a contributor who does not have the NHIF card is when the hospital has doubts about the identity of the policy holder. Mr. Mutwiri has also said that NHIF has thousands of unclaimed cards simply because most contributors do not take it upon themselves to go back to the NHIF offices where they made their applications to collect their cards.
We asked Mr. Mutwiri if NHIF has any plans to issue applicants with cards within minutes instead of months. Mr. Mutwiri told us that indeed NHIF already implemented such a system but the reason that leads to a number of cards not being processed same day are the background checks needed. But if a contributor has satisfactory reasons to collect the card within minutes, the same contributor will be given priority and be able to collect his/her card in less than two minutes.
The second concern raised by Chimega Chimega on Twitter about NHIF is the seeming increase of contribution amount from Kshs 320 a month to Kshs 2000 a month. Chimega tweeted:
NhIF 2K then 12% salo NSSF,PAYE @Ukenyatta unatumaliza tukiona..
— chimega chimega (@mchimega) November 28, 2013
Mr. Mutwirir has explained that NHIF has not increased contribution amount yet. What could have affected Chimega is an erroneous deduction by his employer. Mr. Mutwiri recommends for Chimega to follow up with his employer in regards to the deduction just as advised by John-pius Kamau:
— John-pius Kamau (@piuskamau09) November 29, 2013
Although Mr. Mutwiri has assured us that NHIF have integrated systems and reliable process for applications, processing of claims and issuance of NHIF cards, the fact that a number of applicants do not have the cards several years down the line means NHIF needs to work further into improving the applications. Whatever background verification that NHIF do before issuing cards that make prompt issuance of a cards difficult need to be ironed out.
Also the fact that NHIF have thousands of uncollected cards, that in reality applicants do not need as most people still get the required services without the cards, means they should either have a way of calling or sending text messages to contributors to collect their cards or better still do away with the cards. As Cofek pointed out, the cards basically have the details already captured in National IDs.
This argument extends to all other government institutions that require membership cards. I do not believe that an individual needs to have more than the National ID unless the National ID does not provide a means for proper identification.