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 HEALTHCARE SERVICES |
| (i) General consultation, diagnosis and treatment;(ii) Prescribed laboratory, and basic radiological examinations including x- rays, and ultra-sound investigative services;(iii) Prescribed drug administration and dispensing;(iv) Management of acute and chronic ailments including STIs (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, and 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 haemorrhage, 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 |
| DIALYSIS HEALTHCARE SERVICES |
(ii) Cost of the temporary catheter, plus the catheter insertion/removal.
| (iii) Nursing and dialysis services, and routine laboratory investigations. (iv) Dispense medications and maintenance drugs, counselling and follow-up. |
| RADIOLOGY HEALTH CARE SERVICES |
| (i) MRI, and CT scans; and(ii) Reviewing and interpretation of radiological images and giving the diagnostic opinion and providing 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 HEALTHCARE SERVICES |
| Administration of─(i) Chemotherapy, Radiotherapy, and Brachytherapy;(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 the nearest NHIF-declared hospital. |
| OVERSEAS HEALTHCARE SERVICES |
| Medical and Surgical treatment procedures are not locally available and have been cleared for overseas treatment in accordance with these Regulations and the MOH guidelines provisions. |