Table 4.

NHIF Reimbursement Rates²⁸

Provider payment method	Benefit covered	Reimbursement rate
Capitation	Outpatient services for national scheme, sponsored scheme and civil servants of job groups A–K (outpatient services include consultation, treatment, basic diagnostic tests: laboratory and X-ray; day care surgery and drugs under the Kenya Essential Drug List of 2010)	1,400 KES per beneficiary per year
Case-based payment	Maternity package (national and sponsored schemes)	Normal delivery 10,000 KES
		Caesarean section 30,000 KES
	Free maternity program	Normal delivery and caesarean section 5,000 KES
	Renal dialysis	9,500 KES per session twice weekly
		Includes pre-dialysis, intra-dialysis session, and post-dialysis care
	Surgical package	Major surgeries: 80,000 KES (levels three and four) 130,000 KES (levels five and six)
		Minor surgeries: 30,000 KES (levels three and four) 40,000 KES (levels five and six)
Fee-for-Service	Radiology package	Magnetic resonance imaging capped at 15,000 KES
		Computed tomography scan capped at 8,000 KES
	Dental	Capped at 40,000 KES
	Optical	Capped at 50,000 KES
	Maternity for managed schemes	Capped at 200,000 KES
	Outpatient services for civil servants of job groups L and above	Job group L capped at 100,000 KES
		Job group M capped at 150,000 KES
		Job group N capped at 200,000 KES
		Job group P capped at 225,000 KES
		Job group Q capped at 250,000 KES
		Job groups R, S, T capped at 350,000 KES
	Inpatient services for civil servants of job groups L and above	Job group L capped at 1,000,000 KES
		Job group M capped at 1,250,000 KES
		Job group N capped at 1,500,000 KES
		Job group P capped at 1,750,000 KES
		Job group Q capped at 2,000,000 KES
		Job groups R, S, T capped at 2,250,000 KES
Rebate (per diem)	Covers admitted medical and surgical conditions	2,000–4,000 KES per day (no copayments in public facilities)

A job group represents seniority and corresponding salary scales where a higher alphabet represents more seniority