Your request has been submitted successfully.
NHIF Comprehensive cover for Civil Servants
PROVISION OF THE COMPREHENSIVE MEDICAL INSURANCE SCHEME FOR CIVIL SERVANTS FOR THE FINANCIAL YEAR 2021/2022
Reference is made to the Contract for provision of the Comprehensive Medical Insurance Scheme for Civil Servants (CMICS) for the Financial Year (FY) 2021/2022 administered by the National Hospital Insurance Fund (NHIF). The Contract shall be executed for a period of one (1) year with effect from 1st July, 2021. The Scheme covers National Government employees in Ministries and State Departments, officers seconded to the County Governments and staff of Nairobi Metropolitan Services.
The key highlights of the renewed Contract provisions for the period 1st July, 2021 to 30th June, 2022 are as follows:
i. Beneficiaries comprise of principal member, declared spouse and up to five (5) children of 0 to 2lyears of age and /or up to 25 years if dependent on the principal member and enrolled in post-secondary education while age limits shall not apply to a child with disability who is wholly dependant on the principal member;
ii. All Officers in Civil Service Grade (CSG) 17 — 10 (Job Group A-K) who have been on capitation model of payment since the year 2012 have been assigned limits and placed on fee for service model during the Contract Period from 1st July, 2021 to 30th June, 2022;
iii. All scheme members in CSG 17-10 (Job Group A-K) and CSG 9-4 (Job Group L-T) and their beneficiaries will access both outpatient, inpatient, dental and optical services in NHIF declared and recognized health care facilities across the country. The list of the facilities will be accessed from the websites of NHIF, Ministry of
Public Service and Gender, Nairobi Metropolitan Services and Council of Governors;
iv. All Scheme members will access medical services on shared family limits as
indicated in table 1.
Table 1: Comprehensive Medical Insurance Scheme for Civil Servants Benefits Limits of liability in Kenya Shillings
| Civil Service Grade (CSG) (Job Group – JG) | In Patient | Out Patient | Dental / Maternity | Optical | Charged within Inpatients limit |
| CSG 17-13 (A-G) | 700,000 | 70,000 | 50,000 | ||
| CSG 12 (H) | 700,000 | 70,000 | 50,000 | 40,000 | 100,000 |
| CSG 11 (3) | 700,000 | 70,000 | 50,000 | 40,000 | 150,000 |
| CSG 10 (K) | 700,000 | 70,000 | 50,000 | 40,000 | 150,000 |
| CSG 9 | (L) | 1,000,000 | 100,000 | 50,000 | 40,000 |
| CSG 8 | (M-N) | 1,500,000 | 200,000 | 50,000 | 40,000 |
| CSG 7 | (P) | 1,750,000 | 225,000 | 50,000 | 40,000 |
| CSG 6-4 (Q, R, S, T) | 2,500,000 | 350,000 | 50,000 | 40,000 | 200,000 |
v. In order to ensure prudent utilization of the assigned shared family limits as
indicated in table 1, high end health care facilities in various counties will be
accessed only on referral basis and emergency situations. The list of the referral
facilities is available in the NHIF website;
vi. NHIF shall within three (3) months of the commencement date of the contract undertake biometric registration of principal members and thereafter continuously register beneficiaries at the point of service to improve the scheme’s efficiency and effectiveness;
vii. Specialized services and inpatient discharges will be subject to authorization by
the NHIF to ensure appropriateness and safety of specific treatment, sustainability of the scheme and realization of value for money.;
viii. All Civil Servants promoted within the Contract period shall continue to access
similar shared family limits until expiry of the Contract on 30th June, 2022;
ix. Where a Principal Member retires within the contract period, he and his dependants shall continue to access the benefits under medical insurance cover until the lapse of the period of insurance subject to payment of statutory contributions amounting to Kshs. Five hundred (500/=) per month;
In case of the death of a Principal Member within the contract period, his
dependants shall continue to access the benefits under medical insurance cover until the lapse of the period of insurance subject to payment of statutory contributions amounting to Kshs. Five hundred (500/=) per month;
xi. For any assistance on the CMISCS, members are encouraged to contact directly
xii. In addition, contacts on the Scheme can be made on the NHIF 24-hour toll free
number: 0800720601 and use *155# to update mobile phone numbers in order to receive NHIF alerts on utilization and authorizations.
The purpose of this circular is to request you to bring the contents to the attention of all the staff in your respective Ministry/ State Department/ Institution for information and implementation.
Mary W. Kimonye (Mrs.), MBS PRINCIPAL SECRETARY
Copy to: The Head of Public Service
Executive Office of the President NAIROBI
The Cabinet Secretary
Ministry of Public Service and Gender NAIROBI
The Chief Executive Officer National Hospital Insurance Fund NAIROBI
