SHIF Changes: Civil Servants Could Lose Enhanced Medical Cover

The recently gazetted Social Health Insurance Fund (SHIF) Act 2023, by Health Cabinet Secretary Susan Nakhumicha, does not contain enhanced covers previously enjoyed by civil servants and various government employees.

At least 73 public institutions, including civil servants, that benefited from National Health Insurance Fund's (NHIF) comprehensive coverage are now left in limbo. This change also affects thousands of retired public officers who relied on NHIF, given the age limits of private insurance schemes.

Government entities, civil servants, county governments, police, prisons, and other state agencies offering comprehensive cover through NHIF are excluded from the new SHIF scheme. 

The Kenya Medical Practitioners, Pharmacists, and Dentists Union (KMPDU) has expressed concern over this development, suggesting the omission of these enhanced covers was a well-planned move to create space for private insurance companies in the provision of health insurance to government employees.

Further NHIF's Chief Executive, Elijah Wachira, told the National Assembly Petitions Committee on November 30, that all contracts under EduAfya - a scheme benefiting secondary school students - will be terminated by December 31.

This, he said, was because it was not included in the new fund (SHIF). The comprehensive cover, initiated in 2018 by then-President Uhuru Kenyatta, served public secondary school students with a government-paid premium of Ksh1,350 per student.

Retired public servants are particularly a worried lot with fears of losing preferential access to affordable medical cover without age restrictions. Private insurers often charge higher premiums and impose exclusions based on medical conditions, negatively impacting retired individuals. 

Institutions such as Moi University are already expressing concerns about sustainability if NHIF's comprehensive cover is discontinued, emphasising the financial strain posed by private insurers.

Impact on Specific Sectors:

• NHIF Chief Executive, Elijah Wachira, hints at terminating EduAfya, a scheme benefiting secondary school students, as it's not included in the new fund.
• Various sectors, including civil servants, county government employees, police, prisons, NYS, and parastatals, could lose NHIF comprehensive cover.
• Institutions such as Moi University express worry about sustainability if NHIF's comprehensive cover is no longer available.
• The varsity says engaging private insurers may result in significantly higher annual premiums, impacting the financial viability of public institutions.

Details of NHIF Comprehensive Cover:

• NHIF's comprehensive package includes hospital stay, diagnosis, procedures, consultations, specialist fees, bed charges, nursing care, diagnostic tests, and prescribed medications.
• The enhanced premium, different from ordinary rates, allowed employees to access these services.

Criticism of the Changes:

• KMPDU suggests a well-planned move to create space for private insurance companies to take over health insurance services for government employees.
• The scheme's design may force government entities to turn to private insurers for comprehensive cover, critics argue. 

Retiree Concerns: 

• Retired public servants express concern about losing preferential access to affordable medical cover without age restrictions or disease profiling.
• Private insurers may charge higher premiums and impose exclusions based on medical conditions, affecting retired public servants.

Worry Over Fate of EduAfya

• The Ministry of Education funds EduAfya through the Free Day Secondary Education, directly paying premiums for all learners in public secondary schools.

• Launched through a presidential directive, the initiative contributes Ksh4 billion annually based on a premium of Ksh1,350 per student per year.

• EduAfya provides comprehensive medical insurance cover to students in public secondary schools registered under the National Education Management Information System.

• Access to medical services requires an NHIF membership card or a school-endorsed letter for students awaiting membership cards.

• Learners qualify for a wide range of medical services, including outpatient and inpatient care, day surgical services, local road ambulance, emergency air rescue and treatment abroad.
• NHIF CEO, Elijah Wachira, says that all service provider contracts under EduAfya will be terminated by December 31 leaving over 3.4 million learners without medical cover.
• The NHIF CEO says that by the end of the year, NHIF will cease existing, requiring the ministries of Health and Education to find a new service provider for EduAfya.