New Consolidated NHIF List of benefits, Services to members

SERVICES RENDERED BY EMPANELLED AND CONTRACTED HEALTHCARE PROVIDERS

A new Centralized Health Care Provider Management System referred to as Consolidated NHIF has been rolled out. Here is a list of services to be provided:

OUT-PATIENT HEALTH CARE SERVICES
(i)         General consultation, diagnosis and treatment;

(ii)         Prescribed laboratory, and basic radiological examinations including x- rays, ultra-sound investigative services;

(iii)         Prescribed drug administration and dispensing;

(iv)         Management of acute and chronic ailments including STI’s

(v)         Management of endemic/local diseases;

(vi)         Daycare procedures

(vii)         Oral Health services including dental care needed for relief of pain and infections and tooth extractions;

(viii)         Family planning, Antenatal and postnatal services as defined in the MOH- MCH/RH policy guidelines;

(ix)         Immunization as per the KEPI schedule;

(x)         Anti-snake venom and anti-rabies;

(xi)         Health education and wellness support as needed.

IN-PATIENT HEALTH CARE SERVICES
(i)         Pre-admission evaluation;

(ii)         Hospital accommodation charges, meals and nursing care;

(iii)         Bedside services including physiotherapy, occupational therapy, imaging, oxygen supply, medical consumables;

(iv)         Administration of blood and blood products; derivatives and components, artificial blood products, and biological serum.

(v)         Intra admission consultation and reviews by both general and specialist consultants;

(vi)         Laboratory investigations and medical imaging (X-rays, ultrasounds, E.C.G);

(vii)         Infection preventions and control, sanitation package where offered; and

(viii)         Intra-admission and post discharge medication or follow up within the treatment plan.

MATERNITY HEALTH CARE SERVICES
(i)      Labor, delivery by ways of normal delivery, assisted delivery and caesarean

 

 

section as necessitated;, aftercare for the mother together with the newborn;

(ii)             Midwifery, including episiotomy care and nursing care;

(iii)              operating, recovery, maternity ward and other treatment room charges including meals and special diets;

(iv)             Prescribed medicines, including anti-D immunoglobulin injection where indicated;

(v)             Diagnostic laboratory tests;

(vi)             Administration of blood and blood products; derivatives and components, artificial blood products, and biological serum;

(vii)              Medical supplies and equipment, including oxygen;

(viii)              Professional fees related to the delivery and lactation/nutritional consultations;

(ix)             Immunization for the newborn including OPV zero and BCG vaccines and post discharge medication;

(x)             Take-home items; Medical supplies, appliances, medical equipment, and any covered items billed by the hospital for use at home; and

(xi)              Management of intra-admission postpartum infections and hemorrhage, birth traumas and conditions related to childbirth will be covered within the package.

SURGICAL HEALTH CARE SERVICES
(i)             Pre-operative admission and care;

(ii)             Minor, major and specialized surgical procedures including transplants;

(iii)              Administration of blood and blood products; derivatives and components, artificial blood products, and biological serum;

(iv)             Management of complications following the surgical procedure;

(v)             all additional medical or surgical service required during the postoperative period because of complications which do not require additional trips to the operating room;

(vi)              postoperative visits – follow-up visits during the postoperative period that are related to recovery;

(vii)              post-procedure pain management;

(viii)              supplies – except for those identified as exclusions; and

(ix)             miscellaneous services – items such as dressing changes; local incisional care; removal of operative pack; removal of cutaneous sutures and staples, lines, wires, tubes, drains, casts, and splints; insertion, irrigation and removal of urinary catheters, routine peripheral intravenous lines, nasogastric and rectal tubes; and changes and removal of tracheostomy tubes.

DIALYSIS HEALTH CARE SERVICES
(i)      Registration, triaging, Consultation and Specialists reviews.

 

 

(ii)      Cost of the temporary catheter, plus the catheter insertion/removal.

(iii)         Nursing and dialysis services, routine laboratory investigations.

(iv)         Dispense medications and maintenance drugs, counselling and follow up.

RADIOLOGY HEALTH CARE SERVICES
(i)             MRI, CT scans; and

(ii)             Reviewing and interpretation of radiological images and giving the diagnostic opinion and provide the referring physician with a detailed report of the imaging findings for treatment planning;

MENTAL & BEHAVIOURAL HEALTH CARE SERVICES
(i)         Common mental disorders (including depression and anxiety);

(ii)         Severe mental disorders (including psychosis, schizophrenia and bipolar disorder);

(iii)         Neurological disorders (such as epilepsy and dementia);

(iv)         Childhood disorders; and

(v)         Drugs and substance abuse disorders.

ONCOLOGY HEALTH CARE SERVICES
Administration of─

(i)         Chemotherapy, Radiotherapy, Brachy therapy;

(ii)         Consumables, premeds and post meds;

(iii)         Routine laboratory investigations;

(iv)         Blood and Blood products;

(v)         Treatment planning;

(vi)         PET-CT scan;

(vii)         Radioiodine therapy;

(viii)         Bone scan and radio nucleoid scans.

ROAD EVACUATION HEALTH CARE SERVICES
On site evacuation via road ambulances: Transportation & transfer of a sick beneficiary for treatment to nearest NHIF declared hospital.
OVERSEAS HEALTH CARE SERVICES
Medical and Surgical treatment procedures not locally available and have been cleared for overseas treatment in accordance with these Regulations and the MOH guidelines provisions.

 

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