NHIF introduces changes in health insurance packages

Dodoma. The National Health Insurance Fund (NHIF) has unveiled changes of health insurance packages in attempt to make the services more accessible to individuals and families.

The Minister for Health Jenista Mhagama announced the modifications on Tuesday, introducing two packages named Ngorongoro Afya and Serengeti Afya, while ceasing the Najali, Timiza, and Wekeza schemes.

She said the Ngorongoro Afya package provides 445 services, with annual contributions starting at Sh240,000 per beneficiary, while Serengeti Afya covers 1,815 services, with contributions beginning at Sh660,000 per year.

For children, the Toto Afya Kadi package features flexible options based on the registration method. Under group registration, the annual contribution is Sh50,400 per child while for individual registration, the cost is Sh150,000 per child annually.

The children package is further divided into three tiers depending on the premiums.

The first tier requires contributions worth Sh658,000 per year, with inpatient limit of Sh22 million and outpatient limit of Sh3 million.

The second tier costs Sh237,000 per year, with inpatient cover of up to Sh8 million and outpatient limit of Sh2 million.

The third tier involves contributions of Sh150,000 per individual child per year, covering up to Sh2 million for inpatient services and Sh1 million for outpatient treatment.

Speaking during the launch of the packages, Ms Mhagama directed NHIF to engage all relevant stakeholders to ensure the new packages align with the goals of the Universal Health Coverage (UHC) and address public concerns.

“We must ensure all key stakeholders are involved to gather input from various groups. This will help us design packages that meet citizens’ needs and strengthen the health sector,” she said.

She acknowledged past challenges faced by NHIF, including service delays, late payments and fraud. She expressed confidence that the new systems would address the issues and restore public trust in the fund.

“I urge NHIF to continuously improve its systems to reflect the current realities, enhance monitoring, and ensure members receive quality services as intended,” she added.

She further warned against collusion between NHIF staff and service providers, promising stern action against those found engaging in fraudulent activities.

Digital systems

Highlighting the role of technology, Ms Mhagama noted that NHIF’s new digital systems are designed to eliminate inefficiencies in claims processing and fraud detection.

“The systems must foster a conducive environment for Universal Health Coverage. All stakeholders should collaborate to refine the packages and address concerns,” she said.

NHIF director general Irene Isaka revealed that the new systems were developed by local experts at a cost of Sh445 million, saving Sh3.5 billion compared to outsourcing. She added that members can now register online, pay contributions via mobile platforms, and monitor card usage in real-time.

“For instance, a child insured for Sh50,400 can access services worth Sh400,000. Parents will also receive updates on the remaining balance via SMS,” she explained.

The claims processing system has been significantly upgraded, reducing the time to handle 1,000 claims to 40 minutes, compared to the previous capacity of 800 claims per day.

Chairperson of the Parliamentary Standing Committee on Health and AIDS, Mr Elibariki Kingu, urged NHIF to address delays in payments to service providers, which have disrupted hospital operations and delayed staff salaries.

“Adjustments should ensure that costs meet the needs of both private and government hospitals,” he said.

Tanzania Insurance Regulatory Authority (TIRA) representative, Mr Edgar Gabriel, commended NHIF for introducing measures aimed at combating fraud and enhancing service delivery.