Are you over 18 years old with a family that depends on you but you have no source of income to cater for their health and basic needs?
If yes, then you are the biggest beneficiary in the new Social Health Insurance Fund (SHIF) which is set to replace the 57-year-old National Health Insurance Fund (NHIF).
This group has been categorised as indigent and the government will pay a premium on their behalf, funds which will be drawn from the exchequer.
In an interview with Nation, NHIF CEO Elijah Wachira explained that both the national and county governments will have a responsibility to take care of them as per the Social Health Insurance Act of 2023.
The Act details how Kenyans at the bottom of the pyramid otherwise referred to as Hustlers will be assessed to contribute to the fund.
These hustlers who do not earn anything, according to Wachira, will be subjected to a means testing tool to determine whether they will pay or not and the amount to be paid.
Wachira revealed that the hustlers will be clustered into two categories 1 and 2.
Those in level 1 are the mama mbogas whose cash inflows are irregular.
Here, a means of testing to establish their income will be used to determine the amount of premium they are going to contribute to the fund.
For a fact, he said, nobody will pay less than Sh300 which is a reduction from the current Sh500.
“After this is established, premium financing arrangements will be made so that they can pay in advance with the balance being paid to the aggregator on a monthly basis or in whatever frequency,” he said.
This will depend on how regularly their income comes through, he added.
Level 2 is for those who do not have any income at all.
The newly recruited Community Health Promoters will be tasked with conducting the assessments in each of the counties’ informal settlements to establish those who fall in the Level 2 category.
NHIF is set to be disbanded and replaced by the Social Health Insurance Act of 2023, which will establish a Social Health Authority, responsible for administering three distinct funds.
These funds are the Primary Health Care Fund, the Social Health Insurance Fund, and the Chronic Illness and Emergency Fund.
In the new Act, all salaried Kenyans will have 2.75 per cent of their income deducted on a monthly basis towards the fund.
Kenyans who wish to seek medical treatment abroad, Wachira noted, will have to follow the normal referral which is stipulated in the Act.
They will be required to go to Level 2, 3, 4, 5 and 6 hospitals where specialised treatment will be recommended.
Kenyans will also be registered under the chronic and critical illness fund to cushion in case one exhausts their premiums in the course of treatment.
