National Hospital Insurance Fund in hot soup over claims delay

Monday, October 18th, 2021 00:00 |
Interior Principal Secretary Dr Karanja Kibicho when he appeared before the National Assembly’s Committee on Administration and National Security in Nairobi, last week. Photo/PD/Samuel Kariuki

National Hospital Insurance Fund (NHIF) is on the spot over delayed payment of claims for police officers and prison warders. 

Interior Principal Secretary Karanja Kibicho accused NHIF of violating the group life contract and comprehensive medical cover they signed up for police and prison officers.

His sentiments came after it emerged that NHIF had failed to provide insurance cover to the 131,816 police and warders under the cover.

Kibicho, who together with NHIF chief executive Peter Kamunya appeared before the National Assembly’s Committee on Administration and National Security last week, said issues the officers are raising are the same ones that forced them to change insurance service provider from Pioneer Insurance Company in January.

Kibicho told MPs that the contract signed between the ministry and National Treasury with NHIF allows claims to be paid in less than 48 hours of death of an officer.

NHIF took over the mandate to cover police and warders early this year after the contract with Pioneer Insurance Company, a private entity, came to an end on December 31, 2020, after six years.

 “We had a number of issues with the then service provider like delays in paying claims.

That is why we changed the cover. The contract we have with NHIF states that claims must be processed and paid within 48 hours.

But this has not happened. We must be guided by the contract and see where it has been violated,” said Kibicho.

Service provider

During the session, Kibicho asked the committee to recommend an amendment to the law to exempt police and prison warders from “certain conditions” under the Work Injury Benefits Act just like Kenya Defence Forces.

Complaints by Kibicho come barely a year after NHIF was allowed to provide group life cover worth Sh2.3 billion and comprehensive medical cover worth Sh4.6 billion to the officers. 

But Kamunya said the delays in claim payment has been occasioned by failure to provide documentation of the next of kin of fallen officers.

“We want the claims settled in under 24 hours and even in six hours,” said Dr Kamunya.

His sentiments, however, did not go down well with the committee members, who accused NHIF of not being serious to ensure the claims are settled.

Led by chairperson and Limuru MP Peter Mwathi, the legislators said it was unfortunate that compensation for officers who die in the line of duty are taking forever.

Mwathi said it was shocking to learn that NHIF does not have a contact person over the weekend to attend to inquiries for those insured and who need services.

“The officers are taking longer to be attended to in hospitals,” Mwathi said.

Kitui Central MP Makali Mulu said it is regrettable that NHIF is offering poor services to the officers, as they have been taking forever to pay their claims whenever they die.

“The officers suffer whenever they visit hospitals to get treatment. We need to get to the root cause of this issue,” Mulu added. 

Suna West MP Peter Masara said it is evident that NHIF is not prepared to handle the task of insuring police officers.

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