Civil servants to lose enhanced medical cover in new SHIF plan

Written by on 4 December 2023

Anxiety has gripped public servants who have been enjoying National Health Insurance Fund (NHIF) comprehensive cover as the State rolls out a new scheme.

At least 73 public institutions, among them civil servants, that have been enjoying comprehensive medical cover offered by NHIF have now been left hanging in the balance following the enactment of the new social health scheme.

Also affected are millions of retired public officers and civil servants who have been relying on the scheme as almost all private medical insurance schemes do not offer them insurance due to age limit.

Comprehensive cover

Fears have also emerged that some powerful individuals within the government could be preparing ground for some private insurance firms to replace the comprehensive cover that has hitherto been offered by NHIF.

The Social Health Insurance Fund (SHIF) Act 2023 recently gazetted by Health Cabinet Secretary Susan Nakhumicha has removed the provision for enhanced covers that civil servants, public officers and employees of various government agencies have been enjoying over the years.

The exclusion of the comprehensive cover from SHIF has ignited furore from civil servants, universities, doctors and retired public officers who have been enjoying the package.

Last Thursday, NHIF Chief Executive Elijah Wachira gave the clearest indication of what awaits government agencies that have been enjoying the NHIF enhanced cover when he disclosed that the government will scrap EduAfya, a scheme that has benefited millions of secondary school students.

Appearing before the National Assembly’s Petitions Committee, Wachira told MPs service provider contracts under EduAfya will be terminated by the end of the year since the scheme is not included in the new fund that replaces NHIF.

Introduced in May 2018 by then President Uhuru Kenyatta, the Ministry of Education contracted NHIF to offer a unique comprehensive medical insurance cover for public secondary school students.

Through the cover, the government paid a premium of Sh1,350 per student, with NHIF pocketing Sh9.5 billion from the government over the last four years.

Other sectors that have been enjoying NHIF comprehensive cover include all civil servants, county government and assembly employees, public universities, National Police Service, Kenya Prisons Service, NYS and several parastatals.

Inclusive services

Notable universities and parastatals whose employees have been enjoying the enhanced scheme include Moi, Alupe, Bomet, Kenyatta, Nairobi, National Defence, JKUAT, Egerton, Kisii, Dedan Kimathi and Maseno and Kenyatta National Hospital, Wildlife Research Institute, Nyayo Tea Zones Development Corporation, Kenya Power Pensions Fund, Water Resources Authority, Lapset Corridor Development Authority, Kenya Veterinary Board, Coast Water Works Development Agency and National Social Security Fund (NSSF), among others.

According to information posted on the NHIF website, Comprehensive hospitals offer all-inclusive services of all the packages to enhanced scheme members without pay (walk in and walk out).

The comprehensive package comprised hospital stay with health care diagnosis; procedure and treatment including consultations and specialist doctor’s fees; bed charges; nursing care; diagnostic laboratory and radiology investigations; and prescribed medications and dressings.

For employees of an institution to enjoy the NHIF comprehensive cover, the employer was only required to pay an enhanced premium different from the ordinary rates. Once SHIF comes into operation, all government employees enjoying such special services will lose out as they have not been included in the new scheme.

The Kenya Medical Practitioners, Pharmacists and Dentists Union (KMPDU) has now raised the alarm, claiming that some unnamed individuals in the government could be out to terminate the enhanced insurance schemes being offered by NHIF in order to pave the way for some private insurance firms.

“From the look of everything, it is a well-choreographed scheme to create room for private insurance companies to take over the provision of comprehensive health insurances services to civil servants and other employees working for government agencies,” KMPDU Secretary General David Bhimji Atellah told People Daily.

According to Dr Atellah, the scheme seems to have been hatched almost three years ago when the Insurance Regulatory Authority stopped NHIF from offering commercial insurance services.

Following the directive in 2020, the police, civil servants and some parastatals were forced to seek alternative medical insurance cover as NHIF was to consign itself to the core mandate of only collecting contributions from members in both the formal and informal sectors of the economy and social insurance schemes.

The move saw NHIF lose billions of shillings in premiums from the organisations to which it has been offering commercial insurance schemes.

Dr Atellah says SHIF has been designed in such a way that would force civil servants, county governments and assemblies, police, prisons, NYS, parastatal and other State agencies interested in offering a comprehensive cover to their employees to resort to private insurance firms.

“Those who drafted the Bill and subsequent regulations must have had this in mind…to create opportunity for private insurance companies to make a killing from government and State institutions desirous to offer comprehensive packages to their employees,”Dr Atella told People Daily.

Age bias

In a petition to the National Assembly Committee on Health, former Parliamentarians Association (FOPA) and Kenya Association of Retired Officers (KARO) said the latest move would deny their members preferential access at affordable premiums that maintain their dignity and cushions.

“It is important to note that if the enhanced schemes are scrapped, retired presidents and other retired VIPs will no longer have affordable medical cover that does not discriminate based on age, pre-existing conditions, and other restrictions,” says FOPA chairman Dr Humphrey Kimani  Njuguna.

Dr Njuguna says NHIF comprehensive package has been providing medical insurance to retired public servants without age restrictions and disease profiling which allows for cross-subsidization and favourable premiums.

“Most private insurances profile the retired public servants as high-risk and subsequently charge them high premiums coupled with many exclusions because of their medical conditions to curb utilization and enhance profits,” says Dr Njuguna.

A petition by Moi University says the facility decided to engage the national insurer for the enhanced package on realization that private medical insurers provided comparable service at three times the price quoted by NHIF for annual premiums.

“Under the existing arrangement with NHIF, the university pays an annual premium of about Sh230 million while comparable schemes offered by private insurers are in the range of Sh500 million. Sustainability of University operations will be severely affected in the event that NHIF Comprehensive Cover is no longer available,” says University Vice Chancellor Prof Isaac Kosgey.

Prof Kosgey says that under the prevailing economic situation, there is no comparable alternative for public institutions, Moi University included, to engage with.

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