National Hospital Insurance Fund New Requirement to add your Spouse on the Cover

Kenyans covered under the National Hospital Insurance Fund scheme will now be required to present proof of marriage before including them on their cover.  This new requirement is intended to cap numerous cases of fraud where certain individuals would include even their girlfriends and or distant relatives in pretense to be married. As much as this seems like a reasonable step in curbing rampant fraud cases within it’s scheme; it however spells doom for thousands of couples who have been living together as husband and wife but do not have valid marriage certificates under the law.

The Kenya National Hospital Insurance Fund has by any means been all over the media for all the bad reasons, ranging from corruption to unusable terms that most contributors find difficult to get any form of relief. And as it appears, this latest move has caught many NHIF contributors, seeking to include their spouses in the cover, by surprise. Contributors were shocked when asked to produce a marriage certificate while seeking to include their spouses as beneficiaries. Gone are the days when all you needed to produce was the National Identity Card of the beneficiary.

According to the new regulation, for one’s spouse to be included in the scheme, copies of the contributor’s identification card, the spouse’s ID, marriage certificate or an affidavit from a magistrates’ court must be produced. Looks like affidavit from lawyers are no longer admissible as well. In fact, the National Hospital Insurance Fund has specifically stated that an affidavit showing proof of marriage should not be from a lawyer but from a magistrate’s court.

So for those living in Kenya’s popularly known as ‘come we stay’ arrangements will need to come up with an alternative way to have cover. The most visible one would require each party to have their own cards.

Just recently, the NHIF saved Sh1.9 billion after a crackdown on hospitals making fake claims. It paid Sh11.6 billion for the six months to December, from Sh13.5 billion in the first half of 2017. Majority of these claims were mainly from overrated procedures. For instance, hospitals would bill NHIF for three dialysis sessions yet it performed only one or charge for Cesarean-section births for normal deliveries.


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