The National Health Insurance Fund (Claims and Benefits) Regulations

Legal Notice 188 of 2003

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LAWS OF KENYA

NATIONAL HEALTH INSURANCE FUND ACT

THE NATIONAL HEALTH INSURANCE FUND (CLAIMS AND BENEFITS) REGULATIONS

LEGAL NOTICE 188 OF 2003

  • Published in Kenya Gazette Vol. CV—No. 120 on 5 December 2003
  • Commenced on 5 December 2003
  1. [Revised by 24th Annual Supplement (Legal Notice 221 of 2023) on 31 December 2022]
1.These Regulations may be cited as the National Health Insurance Fund (Claims and Benefits) Regulations.
2.In these Regulations, unless the context otherwise requires—"prescribed Form" means such form as the Board may, from time to time, prescribe for the purposes of these Regulations;"declared hospital" has the meaning assigned to it in the Act;"hospital and medical treatment" includes food and bed, drugs, laboratory tests and diagnostic services, surgical or medical procedures or equipment, medicines, physiotherapy, and doctor's fees for both in-patient and out-patients in declared hospitals.
3.A claim for the payment of any benefits shall be made in writing in the prescribed Form, and shall be submitted to the Board within ninety days or such longer period as the Board may allow, from the date of discharge from the hospital and medical treatment in respect of which it is made.
4.The Board may require such further evidence of identity and of entitlement as is in its opinion necessary to substantiate the claim for benefit, including production by the contributor of his card.
5.Where a claim is lodged in respect of hospital and medical treatment received by a spouse who was not named on the contributor's card at the time of its issue, no benefit shall be paid in respect of hospital and medical treatment received by that spouse within twenty-eight (28) days immediately following the date upon which the name of that spouse was entered on the card if at that date such contributor had more than one spouse.
6.The maximum rate of daily allowance, which may be paid in respect of any declared hospital specified in the Schedule to these Regulations, shall be the rate respectively specified in the Schedule.
7.The maximum rate of benefit payable in respect of hospital and medical treatment to a contributor paying standard contribution shall be the maximum rebate payable to that hospital.
8.The maximum rate of daily allowance to be paid by the Fund in respect of treatment in declared hospital or medical facility shall not exceed the rate approved for that hospital by notice in the Gazette.
9.The National Health Insurance (Claims and Benefits) Regulations (Sub. Leg.), are revoked.

SCHEDULE [r. 6]

DECLARED HOSPITAL AND APPROVED DAILY REBATE

Declared HospitalP.O. BoxTownApproved N.H.I.F Daily Rebate
A.I.C Kapsowar Hospital (Eldoret)130Eldoret800
A.I.C Kijabe Medical Centre20Kijabe1000
A.I.C Liten Cottage Hospital (Kericho)200Liten800
A.I.C Githumu Hospital41Thika700
Akemo Valley Maternity & Nursing Home38Nyangusu700
Alpha Nursing Home11Mago, Kaimosi400
Al-Shifaa Nursing Home704Garissa600
Alupe Hospital (Busia)33Busia600
Athi River Medical Services336Athi River600
Avenue Hospital Ltd.45280Nairobi800
Bakarani Maternity & Nursing Home (Mombasa)12335Mombasa400
Baraka Maternity Nursing Home2705Nakuru400
Baringo District Hospital (Amenity Wards)21Kabarnet1000
Baringo District Hospital (Kabarnet)21Kabaranet600
Barnet Memorial Hospital490Kabarnet600
Bishop Kioko Catholic Hospital2240Machakos1000
Bismillahi Nursing Home429Isiolo400
Bondeni Maternity Hospital124Nakuru600
Bondo District Hospital89Bondo600
Bondo Medical Centre600Bondo600
Bosongo Rural Nursing Home2200Kisii600
Boya Rural Nursing Home1207Kisumu800
Buffalo Nursing and Maternity873Suna-Migori400
Bukaya Medical CentreImangaVia Mumias400
Bukura Community Maternity & Nursing Home93Bukura400
Bungoma District Hospital14Bungoma600
Bungoma Medical Centre1229Bungoma400
Busia District HospitalPrivate BagBusia600
Busia District Hospital (Amenity)Private BagBusia800
Butula Mission Hospital (Busia)Private BagBusia600
Catholic Hospital Wamba via Maralal281Wamba via Maralal800
Central Hospital, African Highland ProducePrivate BagKericho600
Central Hospital (Brooke Bond)57Kericho800
Central Maternity & Nursing Home1144Kakamega800
Central Memorial Hospital (Thika)1734Thika800
Changamwe Hospital Limited98631Mombasa400
Chania Maternity and Nursing Home3900Thika300
Charity Medical Centre1710Nyahururu400
Cherengany Nursing Home1881Kitale400
Chetambe Hills Nursing Home878webuye400
Chiromo Lane Medical Centre73749Nairobi600
Christa Marianne Hospital and Nursing Home335Kisii100
Chuka District Hospital8Chuka600
Chuka District Hospital, Amenity Wing8Chuka600
City Nursing Home (Nairobi)14591Nairobi800
City Park Hospital32009Nairobi400
Coast General Hospital (Mombasa)90231Mombasa1000
Consolota Hospital (Nyeri)25Nyeri1400
Consolota Hospital Chuka (Meru)33Meru600
Consolata Hospital Kyeni (Embu)6038Runyenjes800
Consolata Hospital Nkubu (Meru)205Meru1000
Consolata Hospital Nkubu (Meru)205Meru1000
Coptic Church Nursing21570Nairobi800
Daraja Mbili Nursing & Maternity Home716Kisumu600
Diani BEach Hospital Hospital5074Diani Beach800
District Bospital ManderaPrivate BagMandera600
Donyo Sabuk Maternity & Nursing Home3601Thika400
Dr. Vibhakers Maternity & Nursing Home90422Mombasa600
Dunga Maternity & Nursing Home1534Kisumu800
Eastleigh Nursing Home59328Nairobi400
Ediana Nursing Home56270Nairobi400
Egerton University Health Centre536Njoro600
Eldama Ravine District Hospital102Eldama Ravine600
Eldoret Hospital2234Eldoret1400
Elgon View Hospital8406Eldoret700
Elgon Provincial Medical Cottage1747Bungoma400
Embu Provincial Hospital33Embu1000
Emmaus Innercore Nursing Home78123Nairobi400
Emukaba Nursing Home1211Kakamega400
Equator Hospital, Luanda795Luanda, Vihiga600
Equator Nursing Home44995Nairobi400
Eshisiru Maternity and Nursing Home409Kakamega400
Evans Sunrise Medical Centre15464Nakuru700
Foreign Claims30443Nairobi1700
Friends Kaimosi HospitalPrivate BagTiriki800
Friends Lugulu Hospital40Webuye600
Gaichanjiru Catholic Hospital (Murang'a)483Thika1000
Galana Hospital47Malindi600
Gatundu District Hospital84Gatundu600
Getrude Garden Childre's Hopital (Nairobi)42325Nairobi1400
Gesusu Sub-District Hospital92Kisii600
Gatembe Nursing Home153Kisii800
Gilgil Hospital, NakuruP.O.Gilgil600
Glory Maternity & Nursing Home2398Kakamega800
Good Hope Medical Centre1267Nyahururu400
Greenview Nursing Home868Kericho600
Gucha Cottage Maternity &Nursing Home573Keroka400
Gucha District Hospital6Ogembo600
Guru Nanak Ramgarhia Sikh Hospital33071Nairobi1400
H.H. Agan Khan Khan Dispensary & Maternity Hospital, Kisumu530Kisumu1400
H.H. Aga Khan Hospital, Mombasa83013Mombasa1400
H.H. Aga Khan Hospital, Nairobi30270Nairobi1400
Hema Hospital2Kisii800
Hola District Hospital38Hola600
Holy Family Hospital Nangina57Funyula800
Homa Bay District Hospital52Homa Bay600
Homa Bay District Hospital (Amenity Ward)52Homa Bay800
Home Confinement30443Nairobi400
Huruma Nursing & Matenity Home72934Nairobi400
Immaculate Heart of Mary Hospital7Thika800
Inder Nursing Home31416Narobi1000
Isana Maternity & Nursing Home2482Kisii400
Ishiara District Hospital, Embu125Ishiara600
Isiolo District Hospital3Isiolo600
Isiolo District Hospital (Amenity)42Isiolo800
Iten District Hospital332Iten800
Iten District Hospital Hospital (Elgeyo Marakwet)0Iten600
Itiero Maternity & Nursing Home874Kisii400
J.K.U.A.T. Hospital62000Nairobi600
Jalaram Nursing & Maternity Home990Kisumu800
Jamaa Home & Maternity Hospital, Nairobi17153Nairobi600
Jamii Maternity Nursing Home1230Karatina800
Jocham Hospital88984Mombasa1000
Jordan Hospital1143Kitui400
Joy Kim Nursing Home1050Embu700
Kajiado District Hospital31Kajiado600
Kamiti Hospital40061Nairobi600
Kanan Medical Centre1029Nyahururu600
Kangundo District Hospital1002Kangundo600
Kapenguria District Hospital63Kapenguria600
Kapkatet District HospitalPrivate BagKericho600
Kapsabet District Hospital5Kapsabet600
Kapsabet District Hospital (Amenity)5Kapsabet800
Kapsabet Nursing Home332Kapsabet400
Karatina District Hospital133Karatina600
Karatina Maternity & Nursing Home16Karatina600
Kasarani Nursing & Maternity Home31524Nairobi600
Kathiana Hospital, MachakosPrivate BagKathiana600
Kayole Hospital67617Nairobi800
Kendu Mission Hospital, Kendu Bay20Kendu Bay1000
Kenyatta National Hospital, Amenity Wing20723Nairobi2000
Kenyatta National Hospital , General Ward20725Nairobi1000
Kenyatta National Hospital, Maternity Ward20723Nairobi800
Kericho District Hospital11Kericho600
Kericho Nursing Home Limited510Kericho800
Kerugoya District Hospital24Kerugoya600
Kerugoya District Hospital, Amenity24Kerugoya800
Ketri, Alupe Hospital399Busia400
Kiambu Cottage Hospital1241Kiambu300
Kiambu District Hospital39Kiambu600
Kiambu District Hospital, Amenity Wing39Kiambu800
Kibos Road Maternity & Nursing Home283Kisumu600
Kikoko Mission Hospital, Machakos122Nunguni600
Kikuyu Nursing Home305Kikuyu800
Kilifi District Hospital9Kilifi600
Kilimanjaro Maternity & Nursing Home43920Nairobi600
Kima Mission Hospital410Kisumu800
Kimilili Medical Centre320Kimilili400
Kiminini Cottage Hospital3936Kitale400
Kinango Hospital, Kwale84Kinango600
Kipchimchim Mission Hospital31Kericho600
Kipini District HospitalPrivate bagKipini600
Kiriaini Consolata Hospital, Murang'a239Kiriaini800
Kirinyaga Nursing Home598Kerugoya400
Kisii District Hospital92Kisii600
Kisumu District Hospital1818Kisimu600
Kisumu District Hospital, Amenity1818Kitale800
Kitale District Hospital98Kitale600
Kitale District Hospital, Amenity98Kitale800
Kitale Nursing Home1825Kitale600
Kitui District Hospital22Kitui600
Komarock Nursing Home19749Nairobi400
Koru Nursing Home151Koru800
Kwale District Hospital9030Kwale600
Lady Griggs Maternity Hospital90231Mombasa1000
Lady Tharau Hospital456Kakamega700
Laikipia Maternity and Nursing Home168Nanyuki400
Laisamis Catholic Hospital74Isiolo400
Lamu District Hospital45Lamu600
Lamu Nursing Home359Limuru800
Lodwar District HospitalPrivate BagLodwar600
Loitoktok District HospitalPrivate BagLoitoktok600
Loikitang Hospital, LodwarP.O.Loitang600
Londiani District Hospital54Londiani600
Longisa District Hospital393Bomet600
Lumboka Memorial Hospital260Bungoma600
Lumino Maternity & Nursing Home908Mumias600
Lumino Maternity & Nursing Home310Vihiga400
Maasai Nursing Home237Narok400
Machakos Healthcare Centre826Machakos400
Machakos Nursing Home, Machakos456Machakos800
Madina Nursing Home78370Nairobi800
Magadi Soda Company Hospital, Magadi10Magadi800
Makindu District Hospital81Makindu600
Makueni Hospital, Machakos95Makueni600
Makupa Maternity & Nursing Home99996Mombasa800
Makutano Maternity Nursing Home Meru1435Meru400
Malindi District Hospital4Malindi600
Mandera Nursing Home52Mandera400
Maralal District Hospital12Maralal600
Maria Immaculate Hospital57216Nairobi600
Maria Maternity & Nursing Home34736Nairobi400
Mariakani Cottage Hospital Limited12535Nairobi400
Marie Stopes Hospital (K) Ltd.887Murang'a300
Maries Stopes Hospital (K) Ltd.84771Mombasa500
Marsabit District HospitalPrivate BagMoyale600
Marura Nursing Home75520Nairobi400
Mary Help of the Sick Mission Hospital792Thika800
Mary Immaculate Hospital369Mweiga800
Mary Immaculate Maternity and Dispensary, Mombasa98435Mombasa600
Mary Immaculate Ndundu Health Center550Ruiru4000
Masaba Hospital53648Nairobi800
Masaba Nursing Home, Nairobi53648Nairobi400
Maseno Hospital116Maseno800
Masogo Maternity & Nursing Home366Oyugis600
Matasia Health Clinic185Kiserian400
Matata Nursing & Maternity Home27Oyugis800
Mater Misericordiae Hospital, Nairobi30325Nairobi1400
Mathare Mental Hospital (General Ward)40663Nairobi800
Mathare Mental Hospital (Extension)129Gilgil600
Matuu Nursing Home2695Matuu400
Maua Methodist Hospital, Meru63Maua1000
Mbagathi District Hospital20725Nairobi1000
Menengai Nursing and Maternity Home2811Nakuru800
Mercy Hospital, Eldama Ravine10Eldama-Ravine1000
Meru District Hospital8Meru600
Meru District Hospital, Amenity8Meru800
Metro Politan Hospital33080Nairobi600
Mewa Medical Care98591Mombasa800
Midhill Materniy & Nursing Home21138Nairobi400
Migori District Hospital200Suna-Migori600
Milimani Maternity & Nursing Home, Meru326Meru700
Milimani Maternity and Nursing Home441Kisumu400
Misikhu Mission Hospital129Webuye1000
Mlaleo Health Centre40951Mombasa400
Moi National Referral & Teaching Hospital (General Ward), Eldoret3Eldoret1400
Moi National Referral & Teaching Hospital (Amenity), Eldoret3Eldoret2000
Moi's Bridge Maternit and Nursing Home482Moi's Bridge600
Molo District Hospital156Molo600
Mombasa Hospital Association90294Mombasa1400
Mother and Child Maternity &Nursing Home12658Nairobi400
Mount View Maternity and Nursing Home544Voi400
Moyale District HospitalPrivate BagMoyale600
Msambweni District Hospital8Msambweni600
Mt. ELgon Hospital, Kitale339Kitale600
Mt. Kenya Hospital201Nyeri800
Mt. Longonot Maternity and Nursing Home1840Naivasha400
Muhoroni Nursing & Maternity4138Kisumu400
Mukurwe-ini Sub District Hospital27Nyeri600
Mumias Maternity and Nursing Home534Mumias600
Murang'a District Hospital69Murang'a600
Muriranja District HospitalPrivate BagMurang'a600
Muthale Mission Hospital, Kitui532Kitui600
Mutomo Mission Hospital, Mutomo16Kitui600
Mwea Medical Centre187Wanguru800
Mwea Mission Hospital, Yala8Khwisero800
Mwingi Hospital, Kitui8Kitui600
Nairobi Equator Hospital44995Nairobi400
Nairobi Hospital, Nairobi30026Nairobi1400
Nairobi West Hospital43375Nairobi1000
Nairobi women's Hospital10552Nairobi700
Naivasha District Hospital141Naivasha600
Nakuru Maternity and Nursing Home1769Nakuru1000
Nakuru Prison Hospital Nakuru14Nakuru600
Nakuru War Memorial Hospital, Nakuru240Nakuru1000
Nala Maternity & Nursing Home560Kakamega400
Nandi Hills District Hospital84Nandi600
Nanyuki Cottage Hospital, Nanyuki95Nanyuki800
Nanyuki District Hospital66Nanyuki400
Nanyuki Maternity and Nursing Home20Nanyuki400
Narock District Hospital11Narok600
National Spinal Injury Hospital20906Nairobi1000
Nazareth Hospital, Riara Ridge49682Nairobi1000
New Busia Maternity and Nursing Home418Busia400
New Mvita Nursing Home81477Mombasa400
New Ngei Road Maternity & Nursing Home754Machakos400
Ngao Hospital, Tana RiverP.OTarasaa600
Ngong Hills Maternity572Ngong400
Nightingale Maternity & Nursing Home1971Kisumu800
North Kinangop Catholic Hospital88North-Kinangop800
Nyahururu District86Nyahururu600
Nyambane District Hospital481Maua600
Nyamira Adventist Medical Center285Nyamira400
Nyamira District Hospital, Kisii3Nyamira600
Nyamira District Hospital, Kisii (Amenity)Private BagNyamira800
Nyamira Maternity & Nursing Home143Nyamira600
Nyangena Hospital3492Kisii600
Nyar Alego Nursing Home76Siaya400
Nyasiongo Maternity and Nursing Home358Nyasiongo400
Nyeri Nursing Home (2001) Limited1205Nyeri800
Nyeri Prison Hospital, Nyeri27Nyeri600
Nyeri Provincial General Hospital27Nyeri1000
Nyina wa Mumbi Maternity Hospital21283Nairobi600
Ojele Memorial Hospital355Suna-Migori600
Ol'Kalou District Hopital221Ol'Kalou600
Ol'Kalou District Hospital (Amenity)221Ol'Kalou800
Ortum Mission Hospital, Kitale1312Kitale800
Oruba Nursing and Maternity Home Ltd.162Suna800
Outspan Hospital2058Nyeri800
Owens Maternity and Nursing Home134Bondo400
P.C.E.A Hospital, Tumutumu KaratinaPrivate BagKaratina800
P.C.E.A Hospital, Kikuyu45Kikuyu1000
P.C.E.A Orthopeadic Centre1010Kikuyu1000
P.C.E.A Chogoria Hospital, Meru35Chogoria1000
Pacifica Hospital2902Eldoret800
Pandya Memorial Hospital, Mombasa90434Mombasa1400
Parkroad Nursing Home, Nairobi19850Nairobi600
Pastor Machage Memorial Hospital388Suna-Migori600
Pine Breeze Hospital3116Nakuru1000
Plateau Mission Hospital, Eldoret724Eldoret600
Poly-Clinic Hospital1503Naivasha300
Port Reitz Chest Hospital90502Mombasa600
Port Victoria Sub-District Hospital19Port Victoria600
Prime Care Hospital75209Nairobi400
Provincial General Hospital Annex, Nakuru675Nakuru1000
Provincial General Hospital (Machakos)19Machakos1000
Provincial General Hospital, Garissa23Garissa1000
Provincial General Hospital, Kakamega15Kakamega1000
Provincial General Hospital, Kisumu849Kisumu1000
Pumwani Maternity Hospital, Nairobi30108Nairobi800
Pwani Maternity and Nursing Home114Kilifi400
Rachuonyo District Hospital42Oyugis600
Ram Memorial Hospital554Kisii700
Rift Valley Provincial General Hospital, Nakuru71Nakuru1000
S.S. League M.P.Shah Hospital, Nairobi14497Nairobi1400
Sabatia Eye Hospital214Wodanga700
Sagam Community Hospital888Yala700
Sally Nursing Home307Sare400
Sega Cottage Hospital145Sega400
Sega Mission Hospital4Sega600
Shalom Hospital1513Machakos800
Sharlom Maternity and Nursing Home83460Mombasa600
Sher Agencies Hospital729Naivasha400
Shimo la Tewa Hospital, Mombasa90152Mombasa600
Siaya District HospitalPrivate BagSiaya600
Siaya District Hospital (Amenity Ward)144Siaya800
Siaya Medical Centre1120Siaya800
Siloam Hospital2181Kericho600
Sinai Mt. Hospital52874Nairobi600
Sister Fridas Medical Centre696Kitale600
Sololo Mission Hospital, SololoViaIsiolo600
Sot Nursing Home258Bomet400
South "B" Nursing Home49255Nairobi400
St. Anne Hospital Egoji, Meru24Meru600
St. Annes Maternity Home, Nairobi54337Nairobi400
St. Clares Mission Hospital, Kaplong4Sotik1000
St.Elizabeth Hospital, Mukumu127Mukumu1000
St. Elizabeth Hospital Lwak18Nyilima600
St. James Hospital46024Nairobi800
St. James Medical Centre10275Nairobi600
St. John Health Clinic51754Nairobi400
St. Joseph's Hospital, Kilgoris40Kilgoris800
St. Joseph's Hospital, Nyabondo341Sondu800
St. Joseph's Mission Hospital, Migori250Migori800
St. Joseph's Nursing and Maternity Home713Molo400
St. Leonards Maternity and Nursing Home128Kericho800
St. Lucies Hospital125Chuka400
St. Luke Hospital Kaloleni, Mombasa16Kaloleni800
St. Luke's Maternity and Nursing Home1431Thika600
St. Mary's Hospital, Mumias250Mumias1000
St. Matia Mulumba Hospital3365Thika800
St. Michael Nursing Home2271Embu600
St. Monica's Hospital523Kisumu800
St.Teresa Maternity and Cottage Hospital2095Meru600
St. Theresa's Maternity and Nursing Home12Asembo Bay300
St. Camillus Mission Hospital119Karungu1000
St. Joseph Cottolengo Hospital1426Meru600
St. Martins Cottage Hospital4477Kitale400
St. Theresa Maternity Home1370Kikuyu700
Star Children Hospital4516Kisumu400
Star Hospital677Malindi700
Suba District Hospital50Mbita600
Sulmac Cottage Hospital314Naivasha400
Suna Nursing and Maternity977Suna-Migori400
Tabaka Mission Hospital, Kisii955Kisii1000
Tambach District HospitalPrivate BagTambach600
Tanaka Nursing Home485Busia400
Taveta District Hospital31Taveta600
Tawfig'Muslim Health Centre629Malindi400
Teminas Hospital561Suna-Migori400
Tenwek Hospital Bomet (Sotik)39Bomet1400
Teso District Hospital99Amagoro600
The Kitui Hospital (Kitui)44Kitui400
The Radiant Health Clinic (Nairobi)31278Nairobi600
Thika District Hospital227Thika600
Thika Family Hospital4577Thika600
Thika Nursing Home, Thika429Thika600
Tigania Hospital, Meru553Meru800
Tigoni District Hospital124Tigoni600
Tumbe Hospital, KwaleP.O.Kwale600
Uasin Gishu Memorial Hospital, Eldoret180Eldoret1400
Valley Hospital Limited16243Nakuru800
Vicktoria Hospital, Kisumu49Kisumu1000
Vihiga District Hospital1069Maragoli600
Voi District Hospital18Voi600
Wajir District Hospital, Wajir29Garissa600
Walon Hospital561Rongo400
Waso Medical Services & Nursing Home265Isiolo600
Webuye District Hospital25Webuye600
Webuye Nursing Home1122Webuye400
Western Maternity and Nursing Home168Matunda-Kita300
Westlands Cottage Hospital28367Nairobi800
Wesu District Hospital1022Wundanyi600
Whitestone Hospital4711Kisumu800
Woodlands Hospital, Meru497Meru1000
Yala Sub-district Hospital302Yala600
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31 December 2022 this version