NHIF Dental Cover - Applicable Fees Charged, Dental Hospitals, and Limit

The journey to universal healthcare coverage is an intricate dance, balancing the scales of affordability and quality of service. And when it comes to dental care, the challenge even gets trickier. After all, how often have you visited a dentist? The National Health Insurance Fund (NHIF) seeks to streamline this for Kenyans. In this article, we will delve into the NHIF dental coverage, including the applicable fees charged, dental hospitals, and coverage limits

Let us now get started.

What is NHIF?

Founded in 1966 under the Ministry of Health, the National Health Insurance Fund (NHIF) underwent significant transformations to enhance its efficiency and effectiveness. Governed by NHIF Act No. 9 of 1998, it metamorphosed from just another department in the Ministry of Health to a fully-fledged State Corporation.

Who can join NHIF?

If you're a Kenyan and have crossed the threshold of 18 years, congratulations! You're eligible to be an NHIF member. With a whopping 95 branches, numerous satellite offices, and a presence in the 47 Huduma Centers, getting to one should be a breeze.

Ever wondered about the importance of regular dental checkups? Well, many in the rural locales of Kenya haven't either. With the prohibitive costs of dental care and limited knowledge, many have often turned to traditional remedies or sought services from unqualified practitioners. But what if there was an affordable solution within their grasp?

NHIF Dental Cover Rates

Rates for NHIF dental services oscillate based on your cover plan. Self-employed? The NHIF super cover beckons with a monthly contribution of 500 Kenyan shillings, or Ksh 6000 annually. However, government employees have variable rates pegged on their job groups. Here's a thought - could this scaling based on job groups be the key to equity in healthcare contributions?

What's the Limit?

There's a ceiling to this goodness, though. NHIF dental cover graciously caps your annual dental expenses at 50,000 Kenya shillings. Haven't exhausted your limit by the year's end? Well, unfortunately, there's no carry-over bonus; it resets.

Dental Services on Offer

NHIF dental cover encompasses a wide range of dental services to cater to the diverse needs of its members. Some of the services covered include:

Orthodontics

Orthodontics involves aligning crooked teeth. NHIF dental cover includes dental braces as long as the service is available and it falls within the cover limit.

Paediatric Dentistry

This category deals with children's dental health, including procedures like uprooting milk teeth and fixing cavities.

Endodontics

Endodontics, commonly known as root canal treatment, is covered by NHIF dental insurance. It involves the removal of infected pulp and nerve inside a tooth.

Filling

Filling is a restorative procedure to repair missing tooth structures due to decay or trauma, and NHIF covers this service.

Dentures

NHIF dental cover includes partial and complete dentures and removable artificial teeth designed to replace natural ones.

Extractions

Extraction involves teeth removal, and NHIF provides coverage for this dental procedure.

Surgical Extractions

A specialized surgical extraction may sometimes be required when certain tooth parts remain in the gum. NHIF caters to these more complex extractions.

Anesthetics Fees and Theatre Charges

The cost incurred for dental surgical processes, including anesthesia and theatre charges, is covered by NHIF.

Teeth Cleaning, Polishing, and Scaling

Routine dental maintenance procedures such as teeth cleaning, polishing, and full mouth scaling are painless and essential for preventing dental issues. NHIF covers these services.

Teeth Whitening

NHIF dental cover extends to teeth whitening procedures to remove stains and discolorations.

Where Can You Access These Services?

NHIF allows its members to select two hospitals for outpatient services, but you can use your cover in other hospitals in case of emergencies. You can also change your chosen hospitals if you relocate. Some of these hospitals include:

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Who's Covered?

NHIF isn't just about you. Your family matters, too! Are the principal member, their spouse, and up to five children under 21 (or 25 if they're in school) covered and have a differently-abled child? NHIF ensures they remain under the cover beyond 25 years. Civil servants have the luxury of adding more dependents, albeit with some extra contributions.

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Final Thoughts

The NHIF dental cover isn't just another insurance package; it's a statement of intent. It's a testament to the belief that quality dental care shouldn't be the preserve of the affluent. With its expansive cover, NHIF is rewriting the narrative, ensuring that every smile and laugh remains undiminished. So, have you scheduled your next dental checkup? Because with NHIF, there's no reason not to.