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THE NATIONAL HOSPITAL INSURANCE FUND (ACCREDITATION) REGULATIONS, 2003
| 1. |
These Regulations may be cited as the National Hospital Insurance Fund (Accreditation) Regulations, 2003.
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| 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;
"District Health Management Board" means the District Health Management Board existing administratively under the Ministry of Health.
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| 3. |
(1) Every hospital or health care facility wishing to avail itself of the claims and benefits from the Fund shall apply to the Board for accreditation, registration and gazettement, by filling the prescribed Form.
| (2) |
The prescribed Form shall contain information on, such facilities and issues as are necessary for the delivery of the services for which the institution seeks accreditation, registration and gazettement.
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| (3) |
The information referred to in paragraph (2) shall include—
| (a) |
general information on the type of buildings, environmental, suitability, floor area and such other information etc;
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| (b) |
facilities such as wards, pharmacy, laboratory, theatres, ear, nose and throat clinic, dental services, drug store, service room and, toilets;
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| (c) |
servicing such as training school, ambulance, family planning, and maternal child health;
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| (d) |
equipment such as x-ray, standby generator, scanning machine, test equipment, incubator, radiological unit, wheelchair, stretcher and, trolley;
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| (f) |
bed capacity, including baby cots.
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| 4. |
(1) Upon receipt of the filled application form, the Board shall cause the institution to be examined by the District Health Management Board or such other body as the Board may deem appropriate, for the purposes of verifying the information in the application form, and determining whether or not to accredit the institution and its category for the purposes of ascertaining the daily claim rates to be applicable.
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| (2) |
No benefit shall be payable to a hospital or health care facility that is not accredited in accordance with these Regulations, except as may be provided for in the National Hospital Insurance Fund (Claims and Benefits) Regulations.
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| 5. |
An institution whose accreditation and registration is obtained through false or fraudulent information, or violates the provisions of the Act or any of the Regulations made there under, shall—
| (a) |
be de-registered by the Board;
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| (b) |
be liable to the penalty provided for by section 25 (4) of the Act
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| 6. |
(1) Where an institution has been de-registered under regulation 5, it may apply for fresh accreditation and registration, at the end of two years from the date the de-registration takes effect.
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| (2) |
An institution seeking accreditation under paragraph (1) may be accredited and registered under such terms and conditions, as the Board may deem appropriate.
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| 7. |
The Board shall, at least once every year, inspect every accredited institution to ensure compliance with the provisions of the Act and these Regulations:
Provided that for the purpose of this regulation, the Board may appoint, as its agent, any competent person, institution or authority, and such person, institution or authority shall have the same powers as those of an inspector under section 32 of the Act.
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| 8. |
The Board shall order for a comprehensive inspection report to be done on any institution applying for accreditation by the management.
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| 9. |
The Board shall order for a waiting period of two years by any medical institution applying for accreditation commencing from the date of approval by the Medical Practitioners and Dentist Board.
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THE NATIONAL HOSPITAL INSURANCE FUND (ACCREDITATION) REGULATIONS, 2003
| 1. |
These Regulations may be cited as the National Hospital Insurance Fund (Accreditation) Regulations, 2003.
|
| 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;
"District Health Management Board" means the District Health Management Board existing administratively under the Ministry of Health.
|
| 3. |
(1) Every hospital or health care facility wishing to avail itself of the claims and benefits from the Fund shall apply to the Board for accreditation, registration and gazettement, by filling the prescribed Form.
| (2) |
The prescribed Form shall contain information on, such facilities and issues as are necessary for the delivery of the services for which the institution seeks accreditation, registration and gazettement.
|
| (3) |
The information referred to in paragraph (2) shall include—
| (a) |
general information on the type of buildings, environmental, suitability, floor area and such other information etc;
|
| (b) |
facilities such as wards, pharmacy, laboratory, theatres, ear, nose and throat clinic, dental services, drug store, service room and, toilets;
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| (c) |
servicing such as training school, ambulance, family planning, and maternal child health;
|
| (d) |
equipment such as x-ray, standby generator, scanning machine, test equipment, incubator, radiological unit, wheelchair, stretcher and, trolley;
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| (f) |
bed capacity, including baby cots.
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| 4. |
(1) Upon receipt of the filled application form, the Board shall cause the institution to be examined by the District Health Management Board or such other body as the Board may deem appropriate, for the purposes of verifying the information in the application form, and determining whether or not to accredit the institution and its category for the purposes of ascertaining the daily claim rates to be applicable.
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| (2) |
No benefit shall be payable to a hospital or health care facility that is not accredited in accordance with these Regulations, except as may be provided for in the National Hospital Insurance Fund (Claims and Benefits) Regulations.
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| 5. |
An institution whose accreditation and registration is obtained through false or fraudulent information, or violates the provisions of the Act or any of the Regulations made there under, shall—
| (a) |
be de-registered by the Board;
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| (b) |
be liable to the penalty provided for by section 25 (4) of the Act
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| 6. |
(1) Where an institution has been de-registered under regulation 5, it may apply for fresh accreditation and registration, at the end of two years from the date the de-registration takes effect.
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| (2) |
An institution seeking accreditation under paragraph (1) may be accredited and registered under such terms and conditions, as the Board may deem appropriate.
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| 7. |
The Board shall, at least once every year, inspect every accredited institution to ensure compliance with the provisions of the Act and these Regulations:
Provided that for the purpose of this regulation, the Board may appoint, as its agent, any competent person, institution or authority, and such person, institution or authority shall have the same powers as those of an inspector under section 32 of the Act.
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| 8. |
The Board shall order for a comprehensive inspection report to be done on any institution applying for accreditation by the management.
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THE NATIONAL HOSPITAL INSURANCE FUND (CLAIMS AND BENEFITS) REGULATIONS, 2003
| 1. |
These Regulations may be cited as the National Hospital Insurance Fund (Claims and Benefits) Regulations, 2003.
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| 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.
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| 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 dischirge from the hospital and medical treatment in respect of which it is made.
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| 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.
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| 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.
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| 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.
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| 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.
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| 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.
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| 9. |
The National Hospital Insurance (Claims and Benefits) (Sub. Leg.) Regulations, are revoked.
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THE NATIONAL HOSPITAL INSURANCE FUND (STANDARD AND SPECIAL CONTRIBUTIONS) REGULATIONS, 2003
| 1. |
These Regulations may be cited as the National Hospital Insurance Fund (Standard and Special Contributions) Regulations.
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| 2. |
In these Regulations, except where the context otherwise requires—
“prescribed Form” means such as the Board may, from time to time, prescribe for the purposes of these Regulations;
“standard contributor” means a contributor under section 15(2)(a) of the Act;
“special contributor” means a contributor under section 15(2)(b) of the Act;
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| 3. |
| (1) |
A person whose total income whether derived from salaried or self employment in the immediately preceding month was not less than one thousand shillings shall contribute to the Fund.
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| (2) |
An application by any person to become a contributor to the Fund for any year shall be made in writing, in the prescribed Form.
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| (3) |
The rate of contribution shall be graduated from a minimum of thirty shillings for contributors earning one thousand shillings per month to a maximum of three hundred and twenty shillings per month for contributors earning fifteen thousand shillings and above.
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| (4) |
In determining the income of a special contributor, the Board may require and inspect, such evidence and documentation as it may deem necessary.
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| 4. |
The Board may require an applicant under regulation (3) (2) to submit in respect of himself, his named spouse or named dependants, such evidence of identity, age, income, medical or mental conditions 4s may, in the Board's opinion, be necessary to determine the application to become a contributor.
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| 5. |
| (1) |
A standard contributor shall, through his or her employer, submit to the Fund, on the first day of the month following the one in which the deduction was made, his or her prescribed contribution.
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| (2) |
An employer shall deduct the prescribed contribution from each employee and submit it to the Fund on the first day of the month following the one deduction is made.
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| (3) |
The contribution referred to in this regulation shall be remitted in such manner as the Board may, from time to time, notify the employer.
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| 6. |
Where as a result of late or delayed submission of standard contribution by an employer a contributor is unable to claim or obtain the benefits stipulated by the National Hospital Insurance Fund (Claims and Benefits) Regulations, the employer shall be liable to the contributor to the extent of the denied benefit and any other injury or inconvenience arising therefrom:
Provided that the liability stipulated in this regulation shall be without prejudice to any other liability and or penalty provided for in the Act.
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THE NATIONAL HOSPITAL INSURANCE FUND (STANDARD AND SPECIAL CONTRIBUTIONS) REGULATIONS, 2003
| 1. |
These Regulations may be cited as the National Hospital Insurance Fund (Standard and Special Contributions) Regulations.
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| 2. |
In these Regulations, except where the context otherwise requires—
“prescribed Form” means such as the Board may, from time to time, prescribe for the purposes of these Regulations;
“standard contributor” means a contributor under section 15(2)(a) of the Act;
“special contributor” means a contributor under section 15(2)(b) of the Act;
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| 3. |
The rate of contribution shall be graduated as follows-
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Gross income (KSh.)
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Contributions (KSh.)
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<5,9996,000 to 7,9998,000 to 11,99912,000 to 14,99915,000 to 19,99920,000 to 24,99925,000 to 29,99930,000 to 49,99950,000 to 99,999Over 100,000Self employed (special)
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1503004005006007508501,0001,5002,000500
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(L.N 107/2010)
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| 4. |
The Board may require an applicant under regulation (3) (2) to submit in respect of himself, his named spouse or named dependants, such evidence of identity, age, income, medical or mental conditions 4s may, in the Board's opinion, be necessary to determine the application to become a contributor.
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| 5. |
| (1) |
A standard contributor shall, through his or her employer, submit to the Fund, on the first day of the month following the one in which the deduction was made, his or her prescribed contribution.
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| (2) |
An employer shall deduct the prescribed contribution from each employee and submit it to the Fund on the first day of the month following the one deduction is made.
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| (3) |
The contribution referred to in this regulation shall be remitted in such manner as the Board may, from time to time, notify the employer.
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| 6. |
Where as a result of late or delayed submission of standard contribution by an employer a contributor is unable to claim or obtain the benefits stipulated by the National Hospital Insurance Fund (Claims and Benefits) Regulations, the employer shall be liable to the contributor to the extent of the denied benefit and any other injury or inconvenience arising therefrom:
Provided that the liability stipulated in this regulation shall be without prejudice to any other liability and or penalty provided for in the Act.
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THE NATIONAL HOSPITAL INSURANCE FUND (STANDARD AND SPECIAL CONTRIBUTIONS) REGULATIONS, 2003
| 1. |
These Regulations may be cited as the National Hospital Insurance Fund (Standard and Special Contributions) Regulations.
|
| 2. |
In these Regulations, except where the context otherwise requires—
“prescribed Form” means such as the Board may, from time to time, prescribe for the purposes of these Regulations;
“standard contributor” means a contributor under section 15(2)(a) of the Act;
“special contributor” means a contributor under section 15(2)(b) of the Act;
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| 3. |
The rate of contribution shall be graduated as follows -
Gross Income (KSh.)
Proposed Premiums (KSh.)
Self-employed (Special) 500
(L.N 14/2015)
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| 4. |
The Board may require an applicant under regulation (3) (2) to submit in respect of himself, his named spouse or named dependants, such evidence of identity, age, income, medical or mental conditions 4s may, in the Board's opinion, be necessary to determine the application to become a contributor.
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| 5. |
| (1) |
A standard contributor shall, through his or her employer, submit to the Fund, on the first day of the month following the one in which the deduction was made, his or her prescribed contribution.
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| (2) |
An employer shall deduct the prescribed contribution from each employee and submit it to the Fund on the first day of the month following the one deduction is made.
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| (3) |
The contribution referred to in this regulation shall be remitted in such manner as the Board may, from time to time, notify the employer.
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| 6. |
Where as a result of late or delayed submission of standard contribution by an employer a contributor is unable to claim or obtain the benefits stipulated by the National Hospital Insurance Fund (Claims and Benefits) Regulations, the employer shall be liable to the contributor to the extent of the denied benefit and any other injury or inconvenience arising therefrom:
Provided that the liability stipulated in this regulation shall be without prejudice to any other liability and or penalty provided for in the Act.
|
THE NATIONAL HOSPITAL INSURANCE FUND (STANDARD AND SPECIAL CONTRIBUTIONS) REGULATIONS, 2003
| 1. |
These Regulations may be cited as the National Hospital Insurance Fund (Standard and Special Contributions) Regulations.
|
| 2. |
In these Regulations, except where the context otherwise requires—
“prescribed Form” means such as the Board may, from time to time, prescribe for the purposes of these Regulations;
“standard contributor” means a contributor under section 15(2)(a) of the Act;
“special contributor” means a contributor under section 15(2)(b) of the Act;
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| 3. |
The rate of contribution shall be graduated as follows -
Gross Income (KSh.)
Proposed Premiums (KSh.)
Self-employed (Special) 500
(L.N 14/2015)
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| 4. |
The Board may require an applicant under regulation (3) (2) to submit in respect of himself, his named spouse or named dependants, such evidence of identity, age, income, medical or mental conditions 4s may, in the Board's opinion, be necessary to determine the application to become a contributor.
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| 5. |
| (1) |
A standard contributor shall, through his or her employer, submit to the Fund, on the ninth day of the month following the one in which the deduction was made, his or her prescribed contribution.
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| (2) |
An employer shall deduct the prescribed contribution from each employee and submit it to the Fund on the ninth day of the month following the one deduction is made.
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| (3) |
The contribution referred to in this regulation shall be remitted in such manner as the Board may, from time to time, notify the employer.
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| 6. |
Where as a result of late or delayed submission of standard contribution by an employer a contributor is unable to claim or obtain the benefits stipulated by the National Hospital Insurance Fund (Claims and Benefits) Regulations, the employer shall be liable to the contributor to the extent of the denied benefit and any other injury or inconvenience arising therefrom:
Provided that the liability stipulated in this regulation shall be without prejudice to any other liability and or penalty provided for in the Act.
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THE NATIONAL HOSPITAL INSURANCE FUND (VOLUNTARY CONTRIBUTIONS) REGULATIONS, 2003
| 1. |
These Regulations may be cited as. the National Hospital Insurance Fund (Voluntary Contributions) Regulations, 2003.
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| 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 purpose of these Regulations;
"declared hospital" has the meaning assigned to it in the Act.
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| 3. |
| (1) |
Any person liable as a contributor under section 15 (1) of the Act may apply to the Board to be a voluntary contributor so as to cover such other dependants as would otherwise not be entitled to the benefits under the standard or special contributions paid by the contributor.
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| (2) |
The application referred to in paragraph (1) for any year shall be in writing in the prescribed. Form.
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| 4. |
In determining whether to accept or reject an application under regulation 3, the Board may call for such evidence as may, in the Board's opinion, be necessary including evidence relating to—
| (a) |
the applicant's relationship to the person or persons to be covered as a dependant or dependants;
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| (b) |
the identity, age, and income of the dependant; or
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| (c) |
the medical condition of the dependant.
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| 5. |
In determining the rate of contribution, the Board may take into account—
| (a) |
whether or not the voluntary contributor is already a contributor under standard or special contribution in accordance with the Act;
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| (b) |
the contributor's appropriate rate of contribution as either standard or special contribution to the Fund; and
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| (c) |
the financial implication on the contributor's total income:
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Provided that the minimum rate of contribution shall be the sum of one hundred and sixty shillings (160) per month.
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| 6. |
Prior to the acceptance of an application to become a contributor under these Regulations, the applicant shall be notified of the fact that-
| (a) |
an election to become a voluntary contributor for any dependant is irrevocable; and
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| (b) |
the person on whose behalf a voluntary contribution is paid shall be registered as the contributor on the National Hospital Insurance Card.
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| 7. |
A voluntary contributor shall pay the contribution to the Board on the first day of each month.
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| 8. |
The National Hospital Insurance (Voluntary Contributions)(Sub. Leg.) Regulations are revoked.
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THE NATIONAL HOSPITAL INSURANCE FUND (VOLUNTARY CONTRIBUTIONS) REGULATIONS, 2003
| 1. |
These Regulations may be cited as. the National Hospital Insurance Fund (Voluntary Contributions) Regulations, 2003.
|
| 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 purpose of these Regulations;
"declared hospital" has the meaning assigned to it in the Act.
|
| 3. |
| (1) |
Any person liable as a contributor under section 15 (1) of the Act may apply to the Board to be a voluntary contributor so as to cover such other dependants as would otherwise not be entitled to the benefits under the standard or special contributions paid by the contributor.
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| (2) |
The application referred to in paragraph (1) for any year shall be in writing in the prescribed. Form.
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| 4. |
In determining whether to accept or reject an application under regulation 3, the Board may call for such evidence as may, in the Board's opinion, be necessary including evidence relating to—
| (a) |
the applicant's relationship to the person or persons to be covered as a dependant or dependants;
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| (b) |
the identity, age, and income of the dependant; or
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| (c) |
the medical condition of the dependant.
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| 5. |
In determining the rate of contribution, the Board may take into account—
| (a) |
whether or not the voluntary contributor is already a contributor under standard or special contribution in accordance with the Act;
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| (b) |
the contributor's appropriate rate of contribution as either standard or special contribution to the Fund; and
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| (c) |
the financial implication on the contributor's total income:
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Provided that the minimum rate of contribution shall be the sum of one hundred and sixty shillings (160) per month.
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| 6. |
Prior to the acceptance of an application to become a contributor under these Regulations, the applicant shall be notified of the fact that-
| (a) |
an election to become a voluntary contributor for any dependant is irrevocable; and
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| (b) |
the person on whose behalf a voluntary contribution is paid shall be registered as the contributor on the National Hospital Insurance Card.
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| 7. |
A voluntary contributor shall pay the contribution to the Board on the ninth day of each month.
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| 8. |
The National Hospital Insurance (Voluntary Contributions)(Sub. Leg.) Regulations are revoked.
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