Compliance and Statutory

Everything You Need to Know About NHIF Cover Limits


The majority of Kenyans cannot access quality health care services due to financial instability. The National Hospital Insurance Fund(NHIF) is the body governed by providing health insurance in Kenya. Also, it has a directive to enable all Kenyans to access quality and affordable health care services. Therefore, NHIF came up with NHIF Cover limits to ensure that every Kenyan was covered. 

What are the NHIF Cover Limits?

The Kenya Essential Package for Health (KEPH) is modeled alongside NHIF to ensure there are different packages for everyone.

There are different types of NHIF Cover limits that are available. For instance, 

  • Inpatient cover
  • Outpatient cover
  • Maternity cover and reproductive health
  • Ex-Gratia Payments
  • Last expense cover
  • Group Life cover

As a result, there are those covers that are common among Kenyans as discussed below:

Inpatient Cover

This cover under the NHIF Cover limit includes all medical treatment and services provided by or on the order of a clinician to the member. Also, this happens when the member is admitted to NHIF accredited hospitals. The package covers the following:

  • Hospital bed charges
  • Nursing care 
  • Diagnostic
  • Laboratory
  • Operating theatre charges
  • Specialist’s consultation
  • All drugs and medications
  • Dressing charges


Outpatient cover

Out-patient service was launched under the National Scheme in July 2015. The NHIF cover limit is eligible to all NHIF members and their declared dependents at NHIF accredited hospitals. So, the essentials of the cover include:

  • Consultation 
  • Laboratory
  • Drug administration
  • Radiology 
  • Nursing services
  • Dental health services
  • Optical care
  • Physiotherapy services
  • Occupational therapy services
  • Minor surgery services
  • Referrals


Maternity and Reproductive Health Cover

Firstly, the maternity cover is fondly known as the “Linda Mama” Cover. The health scheme certainly, ensures pregnant women and infants have access to quality and affordable health services. Moreover, the overall aim of the Linda Mama Initiative by the Kenyan government is, “Achieve Universal cases to maternal and child health services and contribute toward’s the country’s progress towards UHC(Universal Health Care). Similarly, the cover is accepted in NHIF accredited hospitals. Further, the NHIF cover limit offers the following: 

  • All Ante Natal Services – Some of the services covered are, for example, antenatal profile where tests are done and the preventive services.
  • All Post Natal Services

Reproductive health cover on the other hand includes family planning services, excluding fertility treatments.


Final Thoughts on NHIF Cover Limits

To sum up, All Kenyans need to register and get  NHIF membership to reap the benefits of the health scheme. The NHIF cover limits are to ensure that every member is can access quality and affordable health care services, even more, satisfied.

Register with NHIF today and get covered!


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