HOW TO REGISTER

It is the responsibility of the principal of the school to register

1 all the learners in the NEMIS database and issue them with
valid UPI numbers.
The process of registering a student with NHIF is automated.

2
Once a UPI number is generated, the system auto-registers
EDU AFYA the learner with NHIF and issues a unique member number.

INFORMATION PACK
3
Individual schools can view their learner’ NHIF numbers
through their respective NEMIS portals.

The Ministry of Education and the National Hospital Form Four learners shall be removed from the Scheme upon
Insurance Fund (NHIF) signed a contract on 13th April 2018 to
offer a Comprehensive Medical Insurance Cover for learners
4 completing their Kenya Certificate of Secondary Education
(KCSE) Examination.
enrolled in all public secondary schools during their
four-year study duration. As a result, the EDUAFYA Medical
Scheme was rolled out on 1st May 2018.

ACCESS TO BENEFITS
NEMIS/UPI number OR (in the case where a learner is yet to receive a
WHO IS ELIGIBLE? NEMIS/UPI number, a letter of introduction written by the respective
School Principal or the designate.
Any student enrolled in a public secondary school
1 and is fully registered in the National Education
Information System (NEMIS) portal.
The letter should contain the following information:
1. Name of learner / Age / Gender
2. Name of school
A public secondary school learner with a valid
2 Unique Personal Identifier (UPI) number generated
through the NEMIS database and is registered by
3. Admission number
The letter should be duly endorsed and signed by the School Principal
NHIF. or the designate.

3 A learner who is fully identified by their School

Principal.
Form One learners shall start benefitting from the Scheme
immediately after they are enrolled in their respective schools (There is
no waiting period for access to services for new members).
Nature of Service What is Covered Dental Cover This benefit caters for outpatient dental procedures, which
include, but are not limited to:
Out-patient • General Out-patient Services: Outpatient services are
provided by or on the order of a licensed clinician as a • Extraction
general practitioner. • Root canal
• Specialized Out-patient Services: Outpatient services are • Dental X-ray services
provided by or on the order of a clinician licensed as a • Accident-related inpatient dental cases will be covered
specialist or consultant and to whom a member has been under the standard inpatient surgical benefits to the full
referred to by a general practitioner/Primary Care clinician inpatient limit.
where a member was registered.
• Routine outpatient services are subject to policy terms Exclusions:
and conditions as per the Kenya essential package for
health (KEPH). The cover does not include the cost of replacement of old
• Referral for specialized services, which include the dentures, bridges, plates, and orthodontic treatment of
following: cosmetic nature
• Drug and Substance Abuse Rehabilitation Services
• Renal services and dialysis Optical Cover An optional benefit that caters for expenses related to eye
• Specialized radiological diagnostic services treatment, including the cost of:
• Chronic ailment services such as Diabetes and
Hypertension, Ultrasound, ECG, • Consultation
• Cancer medical care and treatment services, include • Eye testing
radiotherapy services, chemotherapy services or surgical • Prescription for ophthalmic treatment and prescription of
intervention subject to NHIF’s preauthorization. eyeglasses
• Accident-related inpatient optical cases will be covered
under the standard inpatient benefits to the full inpatient
INPATIENT Inpatient shall be on a referral basis from the outpatient Health limit.
Care Provider. This cover includes medical and surgical
conditions that require admission. Exclusions:

• It includes the following: • Correction of refractive errors and cost of glasses and
• Hospital accommodation charges frames
• Pre-hospitalization diagnostic services • Laser correction of eyesight, cosmetic antiglare and
• Doctor’s (physician, surgeon & anesthetist) fees. photochromatic lenses
• Nursing charges
• Drugs/medicines, dressings, and internal surgical Emergency Road Ambulance services for transportation and transfer of a student
appliances. Rescue for treatment from a place of incident or facilities. This is where
• Diagnostic, laboratory, or other medically necessary adequate care is not available to the next available NHIF-
services declared hospital or medical facility within the territorial limits
• Rehabilitation services of Kenya.
• Operating theatre services
• Radiological diagnostic e.g., x-ray services, CT scan, MRI,
ECG
• In-patient physiotherapy. Contacts:
• KEPI vaccines, tetanus vaccine, Rotavirus vaccine, anti-
Kenya Red Cross – Toll Free No: 1199
rabies, and snake venom
0700 395 395
Daycare surgery surgical procedures that do not require an
overnight stay. 0738 395 395
Emergency Air Emergency Air Rescue Services will be provided for Group Personal NHIF shall compensate a learner involved in an accident resulting
Rescue transportation and transfer of an injured student to an NHIF- Accident Cover in serious or permanent disability while at school or participating
declared facility within the territorial limits of Kenya where in a school-related activity.
adequate medical care is available.
A learner is not entitled to compensation if an accident is caused
by deliberate and willful misconduct.
Contacts:

Amref Flying Doctors - 0206 992000

Requirements: -
0730 811000 | 0709 962000
Overseas Treatment costs arise from a condition that warrants treatment
• Duly filled claim form;
Treatment not available in Kenya. Access is subject to preauthorisation from • Sick off sheets;
NHIF and the Director of Medical Services. • Police abstract in case of an accident;
• Medical reports;
• Discharge summary; and
Scope of cover • Copy of birth certificate.
*Terms and conditions apply
• Treatment costs
• Costs of travel and accommodation for the patient and
one person accompanying the patient
• On recommendation by a referring doctor, medical
personnel accompanying a patient shall be covered for a
period not exceeding two days.
GENERAL EXCLUSIONS
Last Expense NHIF shall, upon the death of a student, pay to the next of kin
the amount specified in the limits upon receipt of the following This insurance cover excludes:
documents:

• Duly filled claim form;

• Copy of burial permit; and
1 Cosmetic or beauty treatment and/or surgery
• Copy of birth certificate.

2
Group Life Cover NHIF shall, upon the death of a student, pay to the next of kin
the amount specified in the limits upon receipt of the following
Laser eye surgery, frames, and lenses
documents:
Massage (except where certified as a necessary
• Duly filled claim form;
• Original burial permit;
3 part of treatment following an accident or illness).
• Original death certificate, and
• Original birth certificate. Treatment of any injury, disease or illness arising
Last Expense/ How to access last expense/group life cover: 4 from a specified exclusion.
Group Life Cover
• The forms are available at the NEMIS portal or NHIF
service outlet
• The School Principal duly fills and signs part (I) of the form,
then the County Director of Education (CDE) fills in and
signs the second part (II).
• The duly filled form is forwarded to the office of the
Director of Secondary Education based at the Ministry of
Education Headquarters.
 FREQUENTLY ASKED QUESTIONS
1. What happens to learners who transfer schools? 9. How do I verify that my UPI is active with NHIF?
As long as the learner is transferring to another public secondary This can be done by sending your UPI to 21101 on your
school, the cover is valid. However, the learner will be exited from the mobile phone
cover if they transfer to a private school.
10. Why is my UPI not active when queried by hospitals?
2. Can a learner whose parent(s) have other medical insurance covers It is because your registration by the school in NEMIS is
benefit from Eduafya? incomplete. So get in touch with your principal and ask
Yes. All learners in public secondary schools are eligible for Eduafya them to complete Step Two of your biodata in NEMIS.
cover even if their parents have alternative medical insurance.
11. Is one only allowed to access services in the facilities
3. Does a learner require to use an introduction letter? chosen by the school?
One of the requirements to access services is an introduction letter by During the school holidays, the service is portable.
the School Principal or any other designate. However, identification in facilities far away from school
may be challenging if your UPI is not active when queried.
4. How do healthcare providers identify learners?
Facilities identify learners using the UPI and a letter of introduction 12. How are the last expense and group life cover
from the School Principal or any other designate. claimed?
The next of kin needs to fill in the appropriate claim form,
5. What happens if a healthcare provider does not have specific attach all requested documents, and submit them to the
services or drugs required? Ministry of Education. Failure to attach all documents will
The facility will be required to refer a learner to the next facility, which result in a delay in the processing of claims.
can handle the learner's condition.
13. Is evacuation by air included?
6. How does a healthcare provider handle a learner without a NEMIS All evacuations are included, although they must seek
number? NHIF's advice.
The facility will not turn away a learner who does not have a UPI.
However, the facility will contact NHIF to verify the learner's details to 14. Can one be treated in private facilities?
provide services. Yes, although treatment in high cost private and Level 5
hospitals is subject to pre-authorisation by NHIF.
7. Does the cover work during the school holidays?
Yes. The cover is for four (4) years or as long as one remains a public 15. Can one student use the UPI number of another
secondary school learner. student from the same school?
No! This is illegal and fraudulent, and if discovered, punitive
8. How shall a student access services during holidays? action will be taken.
The learner or the guardian shall be required to provide the UPI at the
facility if they need to access services during the school holidays.