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NHISNHIS

National Health Insurance Scheme

Benefits Package

Over 95% of disease conditions that afflict us are covered by the NHIS.

Out Patient Services

    Consultations including reviews: Conditions treated at outpatient setting include the following:
  • Malaria, acute respiratory tract infection, diarrhoeal disease, skin disease and ulcers, hypertension, acute eye infection, rheumatism, anaemia, intestinal worms disorders, acute ear infection, typhoid fever, dental caries, diabetes mellitus, STIs, asthma and others (general and specialist)
  • Investigations, including laboratory investigations, x-rays
  • ultrasound scans for general and specialist out-patient services.
  • HIV/AIDS symptomatic treatment for opportunistic infections.
  • Out-patient/day surgical operations, including hernia repairs, incision and drainage of abscesses, and excision of lumps and haemorrhoidectomy.
  • Out-patient physiotherapy.
  • Medication, namely, prescription medicines on the National Health Insurance Scheme Medicines List, traditional medicines approved by the Food and Drugs Board and prescribed by accredited medical and traditional medicine practitioners.
  • Any other services approved by the Minister of Health.

In Patient Service

  • General and specialist in-patient care.
  • Investigations including laboratory investigations, x-rays and ultrasound scans for in-patient care.
  • Cervical and breast cancer treatment.
  • Diagnosis and complications from other cancers, e.g. anaemia or obstruction
  • Surgical operations, including appendicectomy (removal of the appendix).
  • In-patient physiotherapy.
  • Accommodation in general ward.
  • Feeding (where available).
  • Medication, namely, prescription medicines on the National Health Insurance Scheme Medicines List, traditional medicines approved by the Food and Drugs Board and prescribed by accredited medical and traditional medicines practitioners.
  • (Processing for) blood and blood products.

Oral Health

  • Pain relief, which includes incision and
  • drainage, tooth extraction and temporary relief.
  • Dental restoration, which includes simple amalgam
  • fillings and temporary dressing.

Eye Care Services

  • Refraction.
  • Visual fields.
  • Scan.
  • Keratometry (measuring the curvature of the anterior surface of the cornea).
  • Cataract removal.
  • Eye lid surgery.

Maternity Care

  • Antenatal care
  • Deliveries (normal and assisted)
  • Caesarean section
  • Post-natal care

Emergencies

All emergencies are covered. These are crisis health situations that demand urgent intervention and include:
  • Medical emergencies and surgical emergencies, including brain surgery or heart surgery due to accidents.
  • Paediatric emergencies.
  • Obstetric and Gynaecological emergencies including Caesarean sections.
  • Road Traffic Accidents.
  • Industrial and workplace accidents.

Exclusions

    The following health care services are not covered under the NHIS:
  • Rehabilitation other than physiotherapy.
  • Appliances and prosthesis including optical aids, hearing aids, orthopaedic aids and dentures.
  • Cosmetic surgeries and aesthetic treatment. However, reconstructive surgery, such as is performed on burns patients, is covered.
  • HIV antiretroviral medicines.
  • Assisted reproduction, e.g. artificial insemination and gynaecological hormone replacement therapy.
  • Echocardiography (a painless test that uses sound waves to create moving pictures of the heart to give information about the size and shape of the heart and how well it is working).
  • Photography (photographs taken in clinics/hospitals to give visual records of patients' condition and operations to track progress of treatment for medical files of the patient).
  • Angiography (a procedure where a dye is injected into the blood vessels and a photograph of the vessel is taken).
  • Orthoptics (diagnosis and treatment of defective eye movements and coordination).
  • Dialysis for chronic kidney failure.
  • Heart and brain surgery other than those resulting from accidents.
  • Cancer treatment other than cervical and breast cancer.
  • Organ transplantation.
  • Medicines that are not on the NHIS Medicines List.
  • Diagnosis and treatment abroad.
  • Medical examinations for purposes of employment, school admissions, visa applications, driving license etc.
  • VIP ward accommodation.
  • Mortuary services.
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