What is National Health Insurance Fund (NHIF)?
The National Health Insurance Fund (NHIF) is a Social Health Insurance Institution established under the National Health Insurance Act, Cap 395 with the main objective of ensuring accessibility of health care services to people. It is a Government entity that operates under the Ministry of Health Community Development, Gender, Elderly and Children (MHCDGEC). The management of the Fund is vested to the Board of Directors while its day to day operations are overseen by the Director General. The Fund considers health insurance as a societal affair rather than an individual need and thus operates under the principles of risk sharing and solidarity among members.
Despite the compulsory enrollment arrangement to public servants, the Fund has expanded its coverage to include other groups like Councilors, private companies, education institutions, private individuals, children under the age of 18, farmers in cooperatives as well as organized registered groups like Machinga and Bodaboda groups. The Fund is also administering the Bunge Health Insurance Scheme and covers Members of the Zanzibar House of Representatives.
Core Functions of NHIF
- Register members and issue identity cards;
- Collect contributions;
- Certify health service providers for provision of health care services to members;
- Reimbursement of health service providers’ claims;
- Invest the excess funds collected in order to earn income;
- Carry out Actuarial Assessment and Valuation; and
- Provide health insurance education to the public.
Calculation of PAYE
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The National Health Insurance Fund (NHIF) has an attractive benefits package that is offered to its beneficiaries through accredited health facilities countrywide. This package has a total of eleven (11) benefits that are offered to beneficiaries as per Standard Treatment Guidelines issued by the Ministry of Health alongside the Fund`s regulations. The package includes:-
This covers for costs related to Consultations.
Medicines and medical supplies
The Fund covers for the costs relating to medicines prescribed in Generic names and medical consumables as per the National Essential Medicines List (NEMLIT) and additional medicine list recommended (to NHIF) by experts and stakeholders.
The Fund covers for the costs of Investigations and Diagnostic tests as per the Investigation List in the benefits package. There are 321 Investigations including Ultrasound, Echocardiography, CT-Scan, MRI and Ultrasound.
Includes Minor, Major and Specialized surgical services performed from Health centres to Referral level hospitals.
Inpatient Care Services including ICU and HDU
The Fund covers for the daily admission costs depending on the level of the facility and the agreed daily rates as per the Fee Schedule, Investigations, Medicines and Medical Consumables dispensed while the member is admitted.
Physiotherapy and rehabilitation services
This is provided to inpatients and outpatients where the facility has specialists for the related services.
Eye and Optical Services
NHIF covers the costs for optical services to all beneficiaries. ( Treatment of Eye diseases and refraction for visual defects.
The Fund also pays for visual corrective spectacles to the principle member (one pair for a period of 3 years).
Dental and Oral health Services
This is provided to inpatients and outpatients where the facility has specialists for the same. This includes dental conservation surgeries (Carries and dental filling), gum diseases, dental extractions, root canal treatment, Orthodontics and denture
Retirees Health Benefits –
Comprehensive Medical Services are offered to the Retired principle members and their spouses, for their entire lives.
The Fund provides supportive orthopaedic and medical appliances including White Cane for blind people, Neck and Thoracic Spine Collars, Hearing Aids, Lumbar Cossets and Braces, Walking Crutches and leg orthopaedic Supports, (ankle, knee and above knee orthopaedic supports).
The benefit package contains a wide range of Outpatient and Inpatient Services. These services include 354 Investigations, 51 Ordinary Procedures,52 Specialized Procedures, 94 Minor Surgeries, 210 Major Surgeries, 148 Super Specialized Surgeries,16 Medical and Orthopaedic appliances, 522 types of Medicines, 40 Cancer Medicines, 17 Immunosuppressant and Immunostimulants and 40 Medical Supplies.
Special approval services (read more on its page)
These are services that are offered through a special permit, these include:
- Cancer chemotherapy for cancer patients
- Immunosuppressant medicines for patients, who have organ transplants,
- Haemodialysis and erythropoietin for patients with renal failure,
- Reading glasses and special radiological imaging such as CT scan and MRI
- Medical and Orthopaedic appliances
- Complex Implants
- Advanced Cardiac Services
- Some selected Medicines
- EMG needle
- Orthodontic Services
- Radiotherapy services
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