Only 1,434 police officers and prison warders out of 122,708 will be allowed to seek direct treatment in private hospitals in a new Sh4.6 billion medical deal that takes effect today.
The deal was signed with the National Hospital Insurance Fund (NHIF).
A majority of the officers – totalling 121,274 – who fall between job group A and L, will access treatment in government hospitals and faith-based health facilities and will only go to private hospitals on referral.
NHIF takes over from AoN insurance brokers which has been insuring the police officers at Sh4.6 billion even in private hospitals.
The new scheme has been categorised into three groups.
One category covers police officers from job group R to T, which has only 122 officers and they will get Sh3.5 million for inpatient and Sh500,000 for outpatient.
They will get treatment in government hospitals, mission hospitals and private hospitals.
The other category, M to Q, has about 1,322 officers who will also get treatment in government hospitals, mission and private hospitals.
They will get between Sh2.8 million and Sh3.3 million for inpatient and between Sh350,000 and Sh450,000 for outpatient services respectively.
Officers in job group A to L will get unlimited inpatient and outpatient services in identified government hospitals.
Officers in all job groups, irrespective of their positions, will get Sh100,000 optical and Sh60,000 dental cover.
The officers will also benefit from in vitro fertilisation treatment services.
NHIF chief executive Geoffrey Mwangi termed this an extra benefit since it is not under the national scheme but only the civil servants can have the services. “Fertility services are very expensive and only civil servants can benefit because it is covered under premium,” said Mr Mwangi.
The cover shall also include injury or illness arising from an operation while on duty.
Officers suffering from HIV and Aids, STDs, and chronic and congenital diseases will be covered up to full limits.
According to the agreement, all treatment costs arising from a condition that warrants treatment overseas because due to unavailability in Kenya, will be covered in full.
NHIF will also meet the pre-tests costs for organ donor identification for cases involving cornea, small bowel, kidney, pancreas, liver, heart and lung up to a maximum of two days.
The potential donor shall be a paid-up registered member of NHIF. “The national health insurer shall also pay travel and accommodation costs for the patient’s donor subject to pre-authorisation. Travel and accommodation for a person accompanying a patient for overseas treatment will be covered subject to pre-authorisation,” states the deal.
Mr Mwangi said the cover is extended to officers who may be caught up in acts of terrorism unless they are directly involved. “Prosthetic devices needed as part of treatment, which includes external artificial body part, such as prosthetic limb or prosthetic ear will be provided,” he said.