National Health Insurance Fund Act
This Act may be cited as the National Health Insurance Fund Act.
AI-assisted research synopsis — verify against the official legal text below.
- Jurisdiction
- Kenya
- Instrument
- Act or statute
- Citation
- Cap. 255
- Version
- 31 Dec 2022
- Language
- en
- Official source
- View official record ↗
Source attribution: Source: Kenya Law
Statute overview
About this statute
This Act may be cited as the National Health Insurance Fund Act. Defines the wording: "has not attained the age of twenty-one years, has no income of his own and is living with the contributor." The Board must competitively recruit a person qualified under the law on certified secretaries in Kenya to serve as the Corporation Secretary of the Board. The Board must appoint a chief executive officer through a competitive process; the chief executive officer must manage day-to-day affairs, serve a three-year term (eligible for one final three-year re-appointment) and is an ex officio Board member. The Board may appoint the staff necessary for it to perform its functions, on terms and conditions it sets.
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Provisions of National Health Insurance Fund Act
Showing 51 of 51
Part I
PRELIMINARY
- 1 Verify source ↗
PRELIMINARY - 1. Short title
AI-assisted research summary: This Act may be cited as the National Health Insurance Fund Act.
Section 1. Short title Section This Act may be cited as the National Health Insurance Fund Act. [Act No. 1 of 2022 , s. 4.] - 2 Verify source ↗
PRELIMINARY - 2. Interpretation
AI-assisted research summary: Defines the wording: "has not attained the age of twenty-one years, has no income of his own and is living with the contributor."
Section 2. Interpretation Section has not attained the age of twenty-one years, has no income of his own and is living with the contributor;
Part II
ESTABLISHMENT AND MANAGEMENT OF THE FUND
- 10 Verify source ↗
ESTABLISHMENT AND MANAGEMENT OF THE FUND - 10. Chief Executive Officer
AI-assisted research summary: The Board must appoint a chief executive officer through a competitive process; the chief executive officer must manage day-to-day affairs, serve a three-year term (eligible for one final three-year re-appointment) and is an ex officio Board member.
Section 10. Chief Executive Officer Section 10(1) There shall be a chief executive officer of the Fund who shall be appointed by the Board, through a competitive process, on such terms and conditions as the Board may, with the advice of the Salaries and Remuneration Commission, determine. Section 10(2)(a) has at least a Master’s degree from a university recognized in Kenya; Section 10(2)(b) has at least ten years' experience at a senior management level with skills in health insurance, health financing, financial management, health economics, healthcare, administration, law or business administration; and Section 10(2)(c) meets the requirements of Chapter Six of the Constitution. Section 10(3) The chief executive officer shall, subject to the directions of the Board, be responsible for the day to day management of the affairs and staff of the Board. Section 10(4) The chief executive officer shall serve for a term of three years and shall be eligible for re-appointment for a further and final term of three years. Section 10(5) The chief executive officer shall be an ex officio member of the Board. [ Act No. 18 of 2014 , Sch., Act No. 1 of 2022 , s. 11.] - 10A Verify source ↗
ESTABLISHMENT AND MANAGEMENT OF THE FUND - 10A. Corporation Secretary
AI-assisted research summary: The Board must competitively recruit a person qualified under the law on certified secretaries in Kenya to serve as the Corporation Secretary of the Board.
Section 10A. Corporation Secretary Section 10A(1) The Board shall competitively recruit a person qualified in terms of the law governing the practice of certified secretaries in Kenya, to serve as the Corporation Secretary of the Board. Section 10A(2) A person is qualified for appointment as a corporation secretary under subsection (1) if the person has been a member of the Institute of Certified Public Secretaries for at least ten years and the person is in good standing with the Institute. Section 10A(3)(a) in consultation with the Chairperson of the Board, issue notices for meetings of the Board; Section 10A(3)(b) keep, in custody, the records of the deliberations, decisions and resolutions of the Board; Section 10A(3)(c) transmit decisions and resolutions of the Board to the Chief Executive Officer for execution, implementation and other relevant action; Section 10A(3)(d) provide guidance to the Board on their duties and responsibilities on matters relating to governance; and Section 10A(3)(e) perform such other duties as the Board may direct. - 11 Verify source ↗
ESTABLISHMENT AND MANAGEMENT OF THE FUND - 11. Staff of the Board
Section 11. Staff of the Board Section The Board may appoint such staff as are necessary for the proper discharge of its functions under this Act or any other written law, upon such terms and conditions of service as the Board may determine. [ Act No. 1 of 2022 , s. 13.] - 12 Verify source ↗
ESTABLISHMENT AND MANAGEMENT OF THE FUND - 12. Common seal of the Board
AI-assisted research summary: There is a common seal kept by the Corporation Secretary, used only on the Board's direction; the Chairperson and Chief Executive Officer authenticate the affixing of the seal and may authenticate documents and Board decisions; the Board must nominate a member to authenticate the seal when either officer is absent.
Section 12. Common seal of the Board Section 12(1) There shall be a common seal of the Board which shall be kept in the custody of the Corporation Secretary and shall not be used except on the direction of the Board. Section 12(2) The affixing of the common seal of the Board shall be authenticated by the signatures of the Chairperson and the Chief Executive Officer and any document required by law to be made under seal and all decisions of the Board may be authenticated by the signatures of the Chairperson and the Chief Executive Officer. Section 12(3) The Board shall, in the absence of either the Chairperson or the Chief Executive Officer, in any particular matter, nominate one member to authenticate the seal of the Board on behalf of either the Chairperson or the Chief Executive Officer. [ Act No. 1 of 2022 , s. 14.] - 13 Verify source ↗
ESTABLISHMENT AND MANAGEMENT OF THE FUND - 13. Protection from personal liability
AI-assisted research summary: Members, officers, employees and agents of the Board are exempt from personal liability for acts done bona fide in executing the Board's functions, powers or duties, subject to section 14.
Section 13. Protection from personal liability Section Subject to section 14 , no matter or thing done by a member of the Board or any officer, employee or agent of the Board shall, if the matter or thing is done bona fide for executing the functions, powers or duties of the Board under this Act, render the member, officer, employee or agent or any person acting on their directions personally liable to any action, claim or demand whatsoever. - 14 Verify source ↗
ESTABLISHMENT AND MANAGEMENT OF THE FUND - 14. Liability of the Board for damages
AI-assisted research summary: The Board remains liable to pay compensation or damages to any person for injuries to person, property, or interests caused by exercising powers under this Act or other written law, or by failure of works.
Section 14. Liability of the Board for damages Section The provisions of section 13 shall not relieve the Board of the liability to pay compensation or damages to any person for any injury to him, his property or any of his interests caused by the exercise of any power conferred by this Act or any other written law or by the failure, whether wholly or partially, of any works. - 3 Verify source ↗
ESTABLISHMENT AND MANAGEMENT OF THE FUND - 3. Establishment of the Fund
AI-assisted research summary: Establishes the National Health Insurance Fund and provides that it vests in, and is operated and managed by, the Board.
Section 3. Establishment of the Fund Section 3(1) There shall be established a Fund, to be known as the National Health Insurance Fund which shall vest in and be operated and managed by the Board. Section 3(2)(a) contributions under section 15 ; Section 3(2)(a)(i) contributions under section 15 ; Section 3(2)(a)(ii) such monies as may be appropriated by the National Assembly, for indigent and vulnerable persons; Section 3(2)(a)(iii) gifts, grants or donations; Section 3(2)(a)(iv) funds from the national government, county governments and their respective entities for the administration of the compulsory public service employee’s insurance benefit scheme or an employer who is not a national government, a county government or their respective entities, for the administration of employee benefits; and Section 3(2)(a)(v) contributions from post retirement funds for provision of medical cover to retired employees, where the contributor has elected to do so. Section 3(2)(b) out of the Fund, all benefits and other payments required by this Act to be paid out of the Fund. Section 3(3) The provisions of the First Schedule shall have effect with respect to the Fund. [ Act No. 1 of 2022 , s. 6.] - 4 Verify source ↗
ESTABLISHMENT AND MANAGEMENT OF THE FUND - 4. Establishment of Board
AI-assisted research summary: Section 4 establishes the Board membership and sets requirements for nominees and publication of names.
Section 4. Establishment of Board Section 4(1)(a) a Chairperson appointed by the President by virtue of his or her knowledge and experience in matters relating to insurance, financial management, economics, health or business administration; Section 4(1)(b) the Principal Secretary in the Ministry for the time being responsible for matters relating to health or a representative appointed in writing; Section 4(1)(c) the Principal Secretary in the Ministry for the time being responsible for matters relating to finance or a representative appointed in writing; Section 4(1)(d) one person nominated by the Kenya Medical Association; Section 4(1)(e) one person nominated by the Federation of Kenya Employers; Section 4(1)(f) one person nominated by the Central Organization of Trade Unions; Section 4(1)(g) two persons, not being Governors, nominated by the Council of County Governors; Section 4(1)(h) two persons, not being public officers, appointed by the Cabinet Secretary; and Section 4(1)(i) the Chief Executive Officer, who shall be an ex officio member of the Board. Section 4(1A) The persons nominated or appointed under paragraphs (e), (f), (g) and (h) shall have knowledge and experience in matters relating to finance, insurance, information, communication and technology, law, public health, business management, audit, economics or any other relevant field; Section 4(1B) The nominating body under paragraph (f) shall afford equal opportunity to men and women, youth, persons with disabilities and minorities and marginalized groups and ensure regional balance. Section 4(1C) The Cabinet Secretary responsible for matters relating to health shall publish the names of the persons nominated under paragraphs (d), (e), (f) and (g) in the Gazette . Section 4(2) Deleted by ActNo. 18 of 2014, Sch. Section 4(3)(a) suing and being sued; Section 4(3)(b) taking, purchasing or otherwise acquiring, holding, charging and disposing of movable and immovable property; Section 4(3)(c) borrowing or lending money; and Section 4(3)(d) doing or performing all such other things or acts for the proper performance of its functions in the furtherance of the provisions of this Act, which may lawfully be done or performed by a body corporate. - 5 Verify source ↗
ESTABLISHMENT AND MANAGEMENT OF THE FUND - 5. Objects and functions of the Board
AI-assisted research summary: Section 5 lists the Board's objects and functions, including receiving Fund contributions, making payments to empaneled providers, setting empanelment criteria, regulating contributions and benefits, protecting contributors' interests, advising and implementing national health insurance policy, facilitating Universal Health Coverage, administering employee benefits for employers, performing other conferred functions, and facilitating public participation.
Section 5. Objects and functions of the Board Section 5(1)(a) to receive all contributions and other payments required by this Act to be made to the Fund; Section 5(1)(b) to make payments out of the Fund to empaneled health care providers in accordance with the provisions of this Act; Section 5(1)(c) in consultation with the respective regulatory bodies specified under section 60 of the Health Act (Cap. 241), to set the criteria for the empanelment and contracting of health care providers for the purposes of this Act; Section 5(1)(d) to regulate the contributions payable to the Fund and the benefits and other payments to be made out of the Fund; Section 5(1)(e) to protect the interests of contributors to the Fund; Section 5(1)(f) to advise the Cabinet Secretary on the national policy to be followed with regard to national health insurance and to implement all Government policies relating thereto; Section 5(1)(g) to facilitate attainment of Universal Health Coverage with respect to health insurance; Section 5(1)(h) to administer employee benefits as provided under this Act on behalf of employers in respect of their employees; and Section 5(1)(i) to perform such other functions as are conferred on it by this Act or any other written law. Section 5(2) The Board shall facilitate public participation and stakeholder engagement in the carrying out of its functions under this Act. [Act No. 1 of 2022 , s. 8.] - 6 Verify source ↗
ESTABLISHMENT AND MANAGEMENT OF THE FUND - 6. Powers of Board
AI-assisted research summary: The Board has the power to manage, control and administer the Fund's assets; but the Board must not charge or dispose of any immovable property without the prior approval of the Cabinet Secretary.
Section 6. Powers of Board Section manage, control and administer the assets of the Fund in such manner and for such purpose as best promotes the objects for which the Fund is established: Provided that the Board shall not charge or dispose of any immovable property without the prior approval of the Cabinet Secretary; - 7 Verify source ↗
ESTABLISHMENT AND MANAGEMENT OF THE FUND - 7. Conduct of business and affairs of the Board
AI-assisted research summary: The Board's conduct and regulation of its business and affairs must follow the Second Schedule, and the Board may regulate its own procedure subject to that Schedule.
Section 7. Conduct of business and affairs of the Board Section The conduct and regulation of the business and affairs of the Board shall be as provided in the and Second Schedule, but subject thereto, they may regulate its own procedure. - 8 Verify source ↗
ESTABLISHMENT AND MANAGEMENT OF THE FUND - 8. Delegation by the Board
AI-assisted research summary: The Board may, by resolution (generally or in a particular case), delegate to a committee or to any member, officer, employee or agent of the Board the exercise of its powers or the performance of its functions or duties under this Act.
Section 8. Delegation by the Board Section The Board may, by resolution either generally or in the any particular case, delegate to any committee of the Board or to any member, officer, employee or agent of the Board the exercise of any of the powers or the performance of any of the functions or duties of the Board under this Act. - 9 Verify source ↗
ESTABLISHMENT AND MANAGEMENT OF THE FUND - 9. Remuneration of members of the Board.
AI-assisted research summary: The Chairperson and members of the Board (other than the chief executive officer) are entitled to be paid sitting allowances or other remuneration from the Fund; the Board may determine the remuneration in consultation with the Salaries and Remuneration Commission.
Section 9. Remuneration of members of the Board. Section The Chairperson and members of the Board, other than the chief executive officer, shall be paid out of the moneys of the Fund such sitting allowances or other remuneration as the Board may, in consultation with the Salaries and Remuneration Commission, determine. [ Act No. 1 of 2022 , s. 10.]
Part III
CONTRIBUTIONS AND BENEFITS
- 14A Verify source ↗
CONTRIBUTIONS AND BENEFITS - 14A. Registration as a member of the Fund.
AI-assisted research summary: Persons aged eighteen or over who are not beneficiaries must register as members of the Fund.
Section 14A. Registration as a member of the Fund. Section 14A(1) A person who has attained the age of eighteen years and is not a beneficiary shall register as a member of the Fund. Section 14A(2) The Cabinet Secretary may, in consultation with the Board, make regulations for the better carrying out of subsection (1). [ Act No. 1 of 2022 , s. 15.] - 15 Verify source ↗
CONTRIBUTIONS AND BENEFITS - 15. Contributions to the Fund
AI-assisted research summary: Contributions to the Fund are mandatory; persons to whom the section applies and employers (including national and county governments and other employers) are liable to contribute; matching contributions by employers apply, with an exemption where an employer provides equivalent private health insurance; the Board (with the Cabinet Secretary) sets amounts and rates; contributions are payable to the Board on the ninth day of each month.
Section 15. Contributions to the Fund Section 15(1)(a) who is ordinarily resident in Kenya; and Section 15(1)(b) who has attained the age of 18 years; and Section 15(1)(c) whose total income, whether derived from salaried or self-employment, in the immediately preceding month, was not less than such amount as the Board, in consultation with the Cabinet Secretary, may prescribe, Section 15(1A)(a) the national government shall be liable as a contributor to the Fund in respect of all public officers, state officers and employees working in the national government and national government entities; Section 15(1A)(b) each county government shall be liable as a contributor to the Fund in respect of all public officers, state officers and employees working in the county government and county government entities; and Section 15(1A)(c) any other employer shall be liable as a contributor to the Fund in respect of its employees, subject to paragraph (2)(e). Section 15(1B) Subject to this Act, the national government shall be liable as a contributor to the Fund on behalf of the indigent and vulnerable persons identified as such by the relevant government body. Section 15(2)(a) in the case of a person whose income is derived from salaried employment, a standard contribution; or Section 15(2)(b) in the case of a contributor who is a sole beneficiary; and Section 15(2)(b)(i) in the case of a contributor who is a sole beneficiary; and Section 15(2)(b)(ii) in the case of a contributor who is not a sole beneficiary, Section 15(2)(c) in the case of an employer who is the national government or national government entity, a matching contribution, equal to that which their employee is liable to contribute under subsection (1)(c); Section 15(2)(d) in the case of an employer who is the or county county governments or county government entity, a matching contribution, equal to that which their employee is liable to contribute under subsection (1)(c); Section 15(2)(e) in the case of any other employer under subsection (1A)(c), a matching contribution equal to that which their employee is liable to contribute under subsection (1)(c), subject to subsection(2A) ; and Section 15(2)(f) in the case of the national government under subsection (1B), a special contribution, as the Board, in consultation with the Cabinet Secretary, may determine. Section 15(2A) An employer other than the national government or county governments or their entities liable to pay a matching contribution under section 15 may be exempted from paying such matching contribution, if that employer has procured a private health insurance cover for its employees and the benefits are equal to or better than the benefits that the employees are entitled to under this Act. Section 15(2B)(a) certifying that the respective employees have been insured by a private health insurer; Section 15(2B)(b) specifying the details of the cover and the benefits; and Section 15(2B)(c) specifying the validity period of the private health insurance cover. Section 15(2C)(a) shall determine an application under subsection (2B) within thirty days of receipt; and Section 15(2C)(b) may grant the exemption if the Board is satisfied that the private health insurance is adequate. Section 15(3) A contribution under subsection (2)(a) and (b) shall be at such rate, depending on the person’s total income, as the Board, in consultation with the Cabinet Secretary may determine. Section 15(3A) Subject to such guidelines as the Board may, from time to time issue, a person who wishes to receive an enhanced benefit under section 22 (3) may make additional voluntary contributions to the Scheme. Section 15(4) A person to whom this section applies shall pay the contribution to the Board on the ninth day of each month or on such later date as the Board, in consultation with the Cabinet Secretary, may prescribe. Section 15(5) The contributions made to the Fund under subsection (2) shall be mandatory. Section 15(6) The Cabinet Secretary shall, in consultation with the Board, make regulations for the better carrying out of this section. [ Act No. 1 of 2021 , Sch., Act No. 1 of 2022 , s. 16.] - 16 Verify source ↗
CONTRIBUTIONS AND BENEFITS - 16. Standard and matching contributions
AI-assisted research summary: Employers must deduct standard contributions from employees' pay and remit them to the Board; employers who are liable for matching contributions must pay them and must not deduct them from employees.
Section 16. Standard and matching contributions Section 16(1) A person liable to pay a standard contribution under section 15 shall pay such contribution through monthly deductions from his salary or other remuneration and the employer of such person shall be liable to deduct and to pay the contribution to the Board on behalf of and to the exclusion of that person. Section 16(1A) A person liable to pay a matching contribution under section 15 shall pay such contribution in their capacity as an employer and shall not deduct such contribution from the salary or other remuneration of the employee. Section 16(2)(a) in which he was not at any time the employer of that person (except where the employment is terminated in the month immediately preceding that month); or Section 16(2)(b) in which he was not the employer on the first day of that month, unless that contribution has not been paid before the day in that month when he becomes the employer, in which case he shall only become liable seven days after that day; Section 16(2)(c) deleted byAct No. 1 of 2022, s. 17. Section 16(3)(a) to deduct from the salary or other remuneration of any person employed by him, notwithstanding anything to the contrary in any other law, the amount of any standard contribution paid by him or to be paid by him within one month of such deduction, on behalf of that person. Section 16(3)(b) deleted byAct No. 1 of 2022, s. 17. Section 16(3)(c) deleted byAct No. 1 of 2022, s. 17. Section 16(4) No sum deducted from the salary or other remuneration of an employee by his or her employer in accordance with the provisions of this Act shall be recoverable from the employer by that person once the contribution has been remitted to the Fund. Section 16(5) If for any reason an employer is unable to ascertain whether any person employed by him is liable to pay the standard contribution for any month, he may apply to the Board for a decision, and, subject to the provisions of section 31 , any decision given by the Board thereon shall be final and binding on that employer. Section 16(6)(a) fails without lawful excuse to pay, within the time and in the manner prescribed by this Act in relation to him, any standard or matching contribution which he is liable as an employer to pay under this Act; or Section 16(6)(b) knowingly makes any deductions from the salary or other remuneration of any person employed by him, purporting to be a deduction in respect of any standard contribution, other than a deduction which he is authorised to make by this Act, - 17 Verify source ↗
CONTRIBUTIONS AND BENEFITS - 17. Persons to be treated as employers
AI-assisted research summary: The Board may, by regulations, designate a prescribed person as the contributor's employer for this Act and may provide for adjusting rights among employers, prescribed employers and employed persons.
Section 17. Persons to be treated as employers Section In relation to contributors who work under the general control or management of a person other their employer, immediate and in relation to any other case of employment for which it appears to the Board that special provision is needed, the Board may, in regulations, provide that for the purposes of this Act, the prescribed person shall be treated as their employer; and such regulations may provide for adjusting the rights between themselves of employers, persons prescribed as employers and employed persons. - 18 Verify source ↗
CONTRIBUTIONS AND BENEFITS - 18. Penalty for late payment of standard and matching contributions
AI-assisted research summary: If a liable person fails to remit a standard or matching contribution by the due date they must pay a penalty equal to the lending rate of interest on the contribution; employers must pay that penalty and related employee costs, employees are exempt while employed, and government accounting officers are personally liable for such costs when the employer is a government entity.
Section 18. Penalty for late payment of standard and matching contributions Section 18(1) If a standard or matching contribution which a person is liable to remit under section 16 , has not been remitted by the day on which the payment of the standard or matching contribution is due, the person shall be liable to pay a penalty equal to the lending rate of interest, of the amount of the contribution, as may published by the Central Bank of Kenya from time to time. Section 18(2)(a) that employer shall be liable to pay the penalty prescribed in subsection (1) and pay the costs incurred by the employee that would have been covered by the Fund when seeking treatment from a contracted health care provider during the period when the contribution is due; Section 18(2)(b) that employee shall not be liable to any penalty under this section for so long as he is employed by that employer; Section 18(2)(c) where an employer is a national government, county government or a national or county government entity, the respective accounting officer shall be personally liable for the costs that would have been covered by the Fund and incurred by the employee when seeking treatment from a contracted health care provider during the period when the contribution is due. Section 18(3) Where a contributor is outside Kenya on the day when a standard and matching contribution becomes payable by him, that contribution shall, for the purposes of this section, be deemed to become payable on the day of his return to Kenya. Section 18(4) In this section, the expressions "micro enterprise" and "small enterprise" have the meanings assigned thereto respectively in the Micro and Small Enterprises Act ( Cap. 499C ). [ Act No. 18 of 2014 , Sch. Act No. 1 of 2022 , s. 18.] - 19 Verify source ↗
CONTRIBUTIONS AND BENEFITS - 19. Special contributions
AI-assisted research summary: People required to pay a special contribution must pay it to the Board monthly (or on a later Board-specified date) in the prescribed manner and rate; late payments incur a penalty of ten percent per month which is recoverable and paid into the Fund.
Section 19. Special contributions Section 19(1) Every person liable to pay a special contribution under this Act shall pay the contribution to the Board on the first day of each month or on such later date as the Board may specify, in such manner and at such rate as may be prescribed. Section 19(2) If a special contribution which any person is liable to pay under this section is not paid on or before the day on which the payment is due, a penalty equal to ten percent of the amount of the contribution shall be payable by that person for each month or part thereof during which the contribution remains unpaid, and any such penalty shall be recoverable as a sum due to the Fund and when recovered shall be paid into the Fund. Section 19(3) Deleted byAct No. 1 of 2022, s. 19. [ Act No. 1 of 2022 , s. 19.] - 20 Verify source ↗
CONTRIBUTIONS AND BENEFITS - 20. Voluntary contributions
AI-assisted research summary: The Board may make regulations about voluntary contributions by unemployed persons, including manner, procedure and forms.
Section 20. Voluntary contributions Section The Board may make regulations in respect of voluntary contributions by unemployed persons, prescribing the manner of making such contributions, the procedure to be followed and the forms to be used. [ Act No. 1 of 2022 , s. 20.] - 21 Verify source ↗
CONTRIBUTIONS AND BENEFITS - 21. Mode of identification of beneficiaries and payment of contributions.
AI-assisted research summary: The Board must prescribe how beneficiaries are identified and may require persons liable to remit standard and matching contributions to provide information or documents; making false statements or refusing to produce required information without reasonable cause is prohibited.
Section 21. Mode of identification of beneficiaries and payment of contributions. Section 21(1) The Board shall prescribe the mode of identification of a beneficiary, taking into account the existing legal framework for national registration. Section 21(2) The Board may require a person who is liable to remit a payment for a standard and matching contribution under section 16 to furnish such information or particulars, or to produce such documents, as the Board deems necessary for that purpose. Section 21(3)(a) knowingly makes any false statement relating to a matter affecting his or her liability to remit a standard or matching contribution under section 16 ; or Section 21(3)(b) being required under subsection (2) to furnish information or particulars, or produce a document, refuses or neglects to do so without reasonable cause, Section 21(4)(a) a record of remittance of the contributions; or Section 21(4)(b) in the case of a standard contribution, a record of the contributor’s monthly pay-slip that the contribution has been deducted from his or her salary. - 21A Verify source ↗
CONTRIBUTIONS AND BENEFITS - 21A. Establishment of a centralized healthcare provider management system
AI-assisted research summary: Creates a centralized healthcare provider management system; the Board must cause it to be developed, empaneled providers must install and use it for claims, payments and data collection, and the Board may publish guidelines on its use.
Section 21A. Establishment of a centralized healthcare provider management system Section 21A(1) The Board shall cause to be developed a centralized healthcare provider management system. Section 21A(2) The centralized healthcare provider management system shall be installed and used by all empaneled providers for the purpose of management of claims, payments and data collection. Section 21A(3) The Board may publish guidelines on the use of the centralized healthcare provider management system by empaneled and contracted health care providers. [ Act No. 1 of 2022 , s. 22.] - 22 Verify source ↗
CONTRIBUTIONS AND BENEFITS - 22. Payment of benefits
AI-assisted research summary: The Board must pay benefits from the Fund to empaneled or contracted health care providers for expenses incurred in providing health services to the number of beneficiaries determined by the Board; the Board also sets and reviews tariffs, prescribes limits and conditions in regulations, and must use approved mechanisms and services; the Fund and private insurers have specified payment liabilities.
Section 22. Payment of benefits Section 22(1) The Board shall pay from the Fund, a benefit to an empaneled or contracted health care provider for an expense incurred by the provider, for the provision of health care services through the centralized healthcare provider management, to the number of beneficiaries determined by the Board. Section 22(2) Deleted byAct No. 1 of 2022, s. 23. Section 22(3)(a) primary angioplasty; Section 22(3)(b) thrombolysis; Section 22(3)(c) thrombolysis and rescue angioplasty; or Section 22(3)(d) such other treatment as the Board may determine. Section 22(3A) The benefits payable from the Fund shall be subject to such limits, and conditions as the Board may prescribe in regulations. Section 22(3B) The Board shall determine and approve the applicable tariffs payable to the Fund under section 15 (3A) and payable out of the Fund under subsection (1), to empaneled contracted health care providers for an expense incurred by the provider for the provision of healthcare services to the number of beneficiaries determined by the Board. Section 22(3C) The Board shall, every two years, carry out a review of the applicable tariffs payable to the Fund under section 15 and payable out of the Fund to empaneled contracted health care providers. Section 22(3D) The Board shall use the approved risk spreading mechanism, approved claims administration services on benefits of outpatient, inpatient and on employees’ benefits scheme as provided for under sections 3 (2)(a)(iv) and (v), 15 , 22 and 43 . Section 22(4) Deleted byAct No. 1 of 2022, s. 23. Section 22(5)(a) the private health insurance shall be liable for payment up to the limits the beneficiary is covered; Section 22(5)(b) the Fund shall pay the daily rebate, for inpatient; and Section 22(5)(c) the Fund shall cover the outstanding bill where private insurance cover’s limits for various benefits have been exhausted subject to the Fund’s applicable limits with respect to each benefit. - 22A Verify source ↗
CONTRIBUTIONS AND BENEFITS - 22A. Non-withdrawal of benefits
AI-assisted research summary: The Board must not withdraw benefits from a person undergoing treatment for a chronic illness; the Board must make regulations to ensure the Fund meets costs for contributors' inpatient services at empaneled providers, and the Fund shall meet those costs.
Section 22A. Non-withdrawal of benefits Section 22A(1) The Board shall not withdraw the benefits of a person undergoing treatment for a chronic illness. Section 22A(2) The Board shall, in making regulations for determining benefits under the Fund ensure that the Fund shall meet the costs of a contributor accessing inpatient services at any empaneled health care provider. [Act No. 1 of 2022 , s. 24.] - 23 Verify source ↗
CONTRIBUTIONS AND BENEFITS - 23. Statements of account.
AI-assisted research summary: The Board must, upon request, provide a statement of accounts to a contributor or a person liable to remit under section 16 regarding their contributions; the Board must also make regulations to carry this section into effect.
Section 23. Statements of account. Section 23(1) The Board shall upon request avail a statement of accounts to a contributor, or a person who is liable to remit under section 16 , with regard to their contributions. Section 23(2) The Board shall make regulations for the better carrying out of the provisions of this section. [ Act No. 1 of 2022 , s. 25.] - 24 Verify source ↗
CONTRIBUTIONS AND BENEFITS - 24.[Repealed byAct No. 1 of 2022, s. 26.]
AI-assisted research summary: Section 24 has been repealed.
Section 24.[Repealed byAct No. 1 of 2022, s. 26.] - 25 Verify source ↗
CONTRIBUTIONS AND BENEFITS - 25. Offences relating to benefits
AI-assisted research summary: It is an offence for any person to knowingly make a false statement to obtain payment of a benefit under the Act; on conviction the person may be fined up to one million shillings or imprisoned up to sixty months, or both. The Board must notify names of suspended hospitals and removed health care providers; suspended or removed institutions are not entitled to Fund benefits.
Section 25. Offences relating to benefits Section 25(1) Any person who, for the purpose of obtaining the payment of any benefit under this Act, knowingly makes any false statement, whether orally or in writing, commits an offence and is liable on conviction to a fine not exceeding one million shillings or to imprisonment for a term not exceeding sixty months, or to both. Section 25(2)(a) with intent to obtain the payment of any benefit under this Act, impersonates any person whether living or dead; Section 25(2)(b) deleted by ActNo. 1 of 2022, s. 27; Section 25(2)(c) deleted by ActNo. 1 of 2022, s. 27; Section 25(3) Deleted by ActNo. 1 of 2022, s. 27; Section 25(4)(i) a fine not exceeding five hundred thousand shillings; Section 25(4)(ii) removal from the register of empaneled and contracted health care providers. Section 25(5) The Board shall cause the name of every hospital suspended under subsection (3)(ii) of this section to be notified in the Gazette and such institution shall not, during the suspension, be entitled to any benefit from the Fund. Section 25(6) The Board shall cause the name of every health care provider removed from the register under subsection (4)(ii) to be notified in the Gazette , at least two newspapers of national circulation and at the official website of the Fund. Section 25(7) A health care provider which has been removed from the register under section (4)(ii) shall not be entitled to receive any benefit from the Fund. [Act No. 1 of 2022 , s. 27.] - 26 Verify source ↗
CONTRIBUTIONS AND BENEFITS - 26. Regulations on contributions.
AI-assisted research summary: Section 26. Regulations on contributions.
Section 26. Regulations on contributions. Section any matters incidental to the payment and collection of any contributions under this Act; - 27 Verify source ↗
CONTRIBUTIONS AND BENEFITS - 27. Regulations relating to benefits
AI-assisted research summary: Regulations may prescribe any conditions or limitations under which a benefit is to be paid.
Section 27. Regulations relating to benefits Section any conditions or limitations subject to which any benefit shall be paid; - 28 Verify source ↗
CONTRIBUTIONS AND BENEFITS - 28. Modification of Act in special cases
AI-assisted research summary: Modification of the Act in special cases relating to persons who are or have been outside Kenya while contributors to the Fund.
Section 28. Modification of Act in special cases Section to persons who are or have been outside Kenya while contributors to the Fund; - 29 Verify source ↗
CONTRIBUTIONS AND BENEFITS - 29. General provision as to regulations
AI-assisted research summary: The Board has authority to make regulations under the Act prescribing required matters, the particulars and evidence to be furnished, procedural requirements, and related provisions; regulations may make different provisions for different cases, impose conditions and exceptions, and contain incidental or supplementary provisions.
Section 29. General provision as to regulations Section 29(1)(a) prescribing anything required to be prescribed under this Act; Section 29(1)(b) prescribing the particulars, information, proof or evidence to be furnished as to any question or matter arising under this Act, including any question or matter relevant to the payment of contributions by or in respect of any person, or the making or validity of any claim or application for the payment of any benefit under this Act. Section 29(1)(c) prescribing, in respect of any action required or permitted to be taken under this Act, the time and manner of taking that action, the procedure to be followed and the forms to be used. Section 29(2) Any regulations made under this Act may make different provisions in respect of different cases or classes of cases and for different purposes of this Act, may impose conditions and make exceptions, and may contain such incidental or supplementary provisions as appear to the Board to be expedient for the purposes of the regulations. Section 29(3)(a) the purpose and objective of the delegation under this Act is to enable the Board to make regulations for better carrying into effect the provisions of this Act; Section 29(3)(b) the authority of the Board to make regulations under this Act will be limited to bringing into effect the provisions of this Act and fulfilment of the objectives specified under this section. Section 29(4)(a) the Statutory Instruments Act ( Cap. 2A ); Section 29(4)(b) the Interpretation and General Provisions Act ( Cap. 2 ); Section 29(4)(c) the general rules of international law as specified under Article 2(5) of the Constitution; and Section 29(4)(d) any treaty and convention ratified by Kenya under Article 2(6) of the Constitution. - 30 Verify source ↗
CONTRIBUTIONS AND BENEFITS - 30. Empanelment of Healthcare Providers
AI-assisted research summary: The Board must publish the list of empaneled health care providers in the Gazette after consulting relevant regulatory bodies; it may set conditions, revoke empanelment, must notify providers of intended revocation in writing with reasons, providers may respond within seven days, seek review, and appeal to the High Court; revoked names must be published in the Gazette and three national newspapers.
Section 30. Empanelment of Healthcare Providers Section 30(1) The Board shall, in consultation with the relevant regulatory bodies specifiedunder section 60 of the Health Act (Cap. 241), publish in the Gazette , the list of empaneled health care providers for the purposes of this Act. Section 30(2)(a) the Board may publish such conditions in the Gazette or in such other manner considers it necessary; and Section 30(2)(b) a health care provider shall not charge any fees to any contributor under this Act which is contrary to such condition. Section 30(3) The Board may, at any time, revoke any empanelment under this section. Section 30(4) Where the Board intends to revoke the empanelment of a health care provider under subsection (3), the Board shall notify the health care provider of the intended revocation, in writing, setting out the reasons for revocation of empanelment. Section 30(5) A health care provider may, upon receiving a notification under subsection (4) submit a written response to the notification within seven days. Section 30(6) A health care provider whose empanelment has been revoked under this section may apply to the Board for the review of the revocation in the first instance and, if dissatisfied by the decision of the Board upon review, appeal to the High Court against the revocation. Section 30(7) The Board shall cause the name of every health care provider whose empanelment is revoked to be published in the Gazette and in at least three newspapers with nationwide circulation. [ Act No. 1 of 2022 , s. 31.] - 31 Verify source ↗
CONTRIBUTIONS AND BENEFITS - 31. Determination of claims and questions
AI-assisted research summary: The Board may make regulations (in consultation with the Cabinet Secretary) to decide questions arising under the Act, including claims for benefits; regulations may enable appeals and references to the High Court, and the Chief Justice has power to make rules of court for such references and appeals.
Section 31. Determination of claims and questions Section 31(1) Subject to the provisions of this Act, the Board, in consultation with the Cabinet Secretary, may make regulations for the determination by the Board or by any officer thereof, or by a person or body of persons appointed or constituted in accordance with the regulations, of any question arising under or in connection with this Act, including any claim for a benefit, and subject to the provisions of the regulations, a decision in accordance therewith shall be final. Section 31(2)(a) for enabling appeals to be brought from the decisions of any officer, person or body of persons to any other person or body appointed or constituted in accordance with the regulations to hear such appeals; Section 31(2)(b) for the reference to the High Court for decision on any question of law arising in connection with the determination of any question by any officer, person or body of persons and for appeals to the High Court from the decision of any such officer, person or body on any such question of law; and the Chief Justice shall have power to make rules of court for regulating such references and appeals, for empowering the court to make orders as to the costs of such references and appeals, and for limiting the time within which such appeals may be brought. - 32 Verify source ↗
CONTRIBUTIONS AND BENEFITS - 32. Inspection
AI-assisted research summary: Inspectors may enter premises to check compliance, must produce appointment certificates when required, and inspectors who give false information commit an offence punishable by a fine (up to ten million shillings), imprisonment (up to 60 months), or both.
Section 32. Inspection Section 32(1)(a) any premises or places where an inspector reasonably believes that any persons are employed (excluding a private dwelling not used for the purpose of trade or business); or Section 32(1)(b) any empaneled and contracted health care provider, for the purposes of ascertaining whether this Act is being or has been complied with, and the inspector shall, for the purposes of such inspection, have power to enter any such premises or place at all reasonable times, and to examine every person whom he finds therein. Section 32(2)(a) standard and matching contributions are or have been payable, or have been duly paid, by or in respect of any person; or Section 32(2)(b) any benefit is or was payable to or in respect of any person; or Section 32(2)(c) in the case of an empaneled health care provider, whether the conditions, if any, attached to the empanelment or contracting have been met. Section 32(3)(a) wilfully delays or obstructs an inspector in the exercise of his powers under this section; or Section 32(3)(b) refuses or neglects to answer any question or to furnish any information or to produce any document when required to do so under this section, Section 32(4) Every inspector shall, before entering any premises or other place liable to inspection under this section, if so required by the occupier or other person authorised by him, produce a certificate of his appointment signed by or under the authority of the Board. Section 32(5) Where any hospital is liable to be inspected by a public officer for the purposes of enforcing any law other than this Act, the Board may make arrangements for any of the powers and duties of inspectors under this section to he exercised or performed by the public officer and where such arrangement is made, that public officer shall have all the powers of an inspector under this section. Section 32(6) Any inspector who, without any lawful excuse, gives false information in respect of the existence or non-existence of any fact in any hospital or other premises or places inspected under this section, commits an offence and is liable on conviction to a fine not exceeding ten million shillings, or to imprisonment for a term not exceeding sixty months or to both. [ Act No. 1 of 2022 , s. 33.]
Part IV
FINANCIAL PROVISIONS
- 33 Verify source ↗
FINANCIAL PROVISIONS - 33. Financial year
AI-assisted research summary: The Fund's financial year is the twelve‑month period starting on 1st July each year.
Section 33. Financial year Section The financial year of the Fund shall be the period of twelve months commencing on the 1st July in every year. - 34 Verify source ↗
FINANCIAL PROVISIONS - 34. Investment funds
AI-assisted research summary: Permitted investments include reputable bank deposits (on advice of the Central Bank of Kenya) and government securities approved by the National Treasury; investments made under this section must be held in the name of the Board.
Section 34. Investment funds Section 34(1)(a) in such investment in a reputable bank on the advice of the Central Bank of Kenya, being an investment in which trust funds, or part thereof, are authorised by law to be invested; Section 34(1)(aa) in government securities as may be approved by the National Treasury. Section 34(1)(b) deleted byAct No. 1 of 2022, s. 34. Section 34(2) All investments made under this section shall be held in the name of the Board. [ Act No. 1 of 2022 , s. 34.] - 35 Verify source ↗
FINANCIAL PROVISIONS - 35. Annual estimates
AI-assisted research summary: The Board must prepare annual revenue and expenditure estimates at least four months before each financial year and the estimates must cover specified categories such as staff pay, pensions, contributors' medical claims, maintenance, equipment replacement and reserve funds.
Section 35. Annual estimates Section 35(1) At least four months before the commencement of each financial year, the Board shall cause to be prepared estimates of the revenue and expenditure of the Board for that year. Section 35(2)(a) for the payment of the salaries, allowances and other charges in respect of the staff of the Board; Section 35(2)(b) for the payment of the pensions, gratuities and other charges in respect of retirement benefits to staff of the Board; Section 35(2)(c) for the payment of all the claims and benefits of the contributors in respect of medical and health care expenses incurred by them or their named dependants pursuant to the provisions of this Act; Section 35(2)(d) for the proper maintenance of the buildings and grounds of the Board; Section 35(2)(e) for the proper maintenance, repair and replacement of the equipment and other movable property of the Board; Section 35(2)(f) for the creation of such reserve funds to meet future or contingent liabilities in respect of retirement benefits, insurance or replacement of buildings or equipment or in respect of such other matters as the Board may deem fit. Section 35(3) The annual estimates shall be submitted for approval by the Board before the commencement of the financial year to which they relate: Provided that once approved, the sum provided in the estimates shall not be increased without the prior consent of the Board. Provided that once approved, the sum provided in the estimates shall not be increased without the prior consent of the Board. Section 35(4) No expenditure shall be incurred for the purposes of the Board except in accordance with the annual estimates approved under subsection (3) or in pursuance of an authorisation of the Board. - 36 Verify source ↗
FINANCIAL PROVISIONS - 36. Expenses of administering the Fund
AI-assisted research summary: Sums to meet the Fund's expenditure for a financial year shall be paid out of the Fund, and the Board may determine the manner (in consultation with the Cabinet Secretary) and may estimate the sums in accordance with section 35.
Section 36. Expenses of administering the Fund Section There shall be paid out of the Fund and in such manner as the Board, in consultation with the Cabinet Secretary may determine, such sum as the Board may estimate to be its expenditure in respect of any financial year in accordance with the provisions of section 35 . [ Act No. 1 of 2022 , s. 35.] - 37 Verify source ↗
FINANCIAL PROVISIONS - 37. Accounts and audit
AI-assisted research summary: The Board must keep all proper books and records of account for the Fund.
Section 37. Accounts and audit Section 37(1) The Board shall cause to be kept all proper books and records of account of the income, expenditure, assets and liabilities of the Fund. Section 37(2) The accounts of the Board shall be audited and reported upon in accordance with the Public Finance Management Act ( Cap. 412A ) and the Public Audit Act ( Cap. 412B ). [ Act No. 1 of 2022 , s. 36.]
Part V
MISCELLANEOUS PROVISIONS
- 38 Verify source ↗
MISCELLANEOUS PROVISIONS - 38. Annual Reports
AI-assisted research summary: The Board must prepare and submit an annual report within three months after the end of each financial year; the Cabinet Secretary must transmit that report to Parliament within three months of its submission.
Section 38. Annual Reports Section 38(1) The Board shall, within three months after the end of each financial year, prepare and submit to the Cabinet Secretary a report of the operations of the Board for the immediately preceding year. Section 38(2) The Cabinet Secretary shall, within three months of submission of the report under subsection (1), transmit the report to Parliament. [ Act No. 1 of 2022 , s. 37.] - 39 Verify source ↗
MISCELLANEOUS PROVISIONS - 39. Administrative regulations
AI-assisted research summary: The Board may make regulations about staff terms and conditions and Board meetings; regulations shall not be published in the Gazette and must be brought to the attention of all persons affected.
Section 39. Administrative regulations Section 39(1)(a) the settlement of the terms and conditions of service, including the appointment, dismissal, remuneration and retirement benefits of the members of the staff of the Board; and Section 39(1)(b) the constitution and procedure of meetings of the Board and the establishment, composition and terms of reference of committees of the Board. Section 39(2) Regulations made by the Board under this section shall not be published in the Gazette but shall be brought to the attention of all persons affected thereby. - 40 Verify source ↗
MISCELLANEOUS PROVISIONS - 40. Exemption from stamp duty
AI-assisted research summary: The Board and any person acting on its behalf are exempt from paying stamp duty under the Stamp Duty Act in relation to instruments, benefit payments, or refunds of contributions under this Act.
Section 40. Exemption from stamp duty Section No duty shall be chargeable under the Stamp Duty Act ( Cap.480 ) in respect of any instrument executed by any person on behalf of or in favour of the Board or in respect of the payment of any benefit or in refunding any contribution under this Act in any case where, but for this exemption, the Board or any person acting on its behalf would be liable to pay such duty. - 41 Verify source ↗
MISCELLANEOUS PROVISIONS - 41.[Repealed byAct No. 1 of 2022, s. 38.]
AI-assisted research summary: Section 41 has been repealed by Act No. 1 of 2022, s. 38.
Section 41.[Repealed byAct No. 1 of 2022, s. 38.] - 42 Verify source ↗
MISCELLANEOUS PROVISIONS - 42. Proceedings to recover sums due to the Board
AI-assisted research summary: Courts may order convicted persons to pay sums to the Board; the Board may recover sums as civil debts; inspectors or officers may start proceedings; Fund assets are protected from attachment.
Section 42. Proceedings to recover sums due to the Board Section 42(1) The court before which any person is convicted of an offence under this Act may, without prejudice to any civil remedy, order such person to pay to the Board, as the case may be, the amount of any standard contribution or any other sum, together with any penalty found to be due from such person to the Board and any sum so ordered shall be recoverable as a fine and paid into the Fund. Section 42(2) All sums due to the Board shall be recoverable as debts due to the Board, and without prejudice to any other remedy, may be recovered by the Board summarily as a civil debt. Section 42(3) All criminal and civil proceedings under this Act may, without prejudice to any other power in that behalf, be instituted by any inspector or other officer of the Board. Section 42(4) All sums recovered by legal proceedings in respect of monies which should have been paid into the Fund shall, when recovered, be paid into the Fund. Section 42(5) Despite any other written law, the assets of the Fund shall not be liable to attachment under any process of law. [ Act No. 1 of 2022 , s. 39.] - 43 Verify source ↗
MISCELLANEOUS PROVISIONS - 43. Recovery of compensation or damages
AI-assisted research summary: If a contributor to the Fund recovers compensation or damages for an injury or illness, they are not entitled to benefits for treatment to the extent those sums are recoverable, and any benefits paid must be repaid to the Board; however the contributor still retains the right to recover compensation or damages.
Section 43. Recovery of compensation or damages Section Where a contributor to the Fund is entitled, whether under the Work Injury Benefits Act (Cap. 236) or otherwise, to recover compensation or damages in respect of any injury or illness, he shall not, to the extent to which such compensation or damages are recoverable, be entitled to any benefits in respect of any treatment undergone by him as a result of such injury or illness, and any benefits paid in respect of such treatment, shall to the extent to which such compensation or damages have been recovered, be repaid to the Board; Provided that the payment of any benefits as aforesaid shall not preclude the right of the contributor to recover any compensation or damages. [ Act No. 1 of 2022 , s. 40.] - 44 Verify source ↗
MISCELLANEOUS PROVISIONS - 44. Evidence
AI-assisted research summary: A copy or extract certified as a true copy by the Chief Executive of the Board, or a person authorised by him, shall be received in evidence as prima facie proof of the truth of its contents in any proceedings under this Act.
Section 44. Evidence Section In any proceedings under this Act, a copy of any entry in the accounts of, or any extract from the records or register of the Fund, shall, if stated to be a true copy by a certificate purporting to be signed by the Chief Executive of the Board, or a person authorized in that behalf by him, be received in evidence as prima facie evidence of the truth of the contents thereof. - 45 Verify source ↗
MISCELLANEOUS PROVISIONS - 45. General penally
AI-assisted research summary: A person convicted of an offence under this Act is liable to a fine up to one million shillings or, if a natural person, imprisonment up to two years, or both.
Section 45. General penally Section A person convicted of an offence under this Act for which no other penalty is prescribed shall be liable to a fine not exceeding one million shillings or, in the case of a natural person, to imprisonment for a term not exceeding two years, or to both. [ Act No. 1 of 2022 , s. 41.] - 45A Verify source ↗
MISCELLANEOUS PROVISIONS - 45A. Application ofCap. 487.
AI-assisted research summary: The provisions of the Insurance Act apply to the Fund only for risk spreading and claims administration services.
Section 45A. Application ofCap. 487. Section The provisions of the Insurance Act shall apply to the Fund only in respect to risk spreading and claims administration services. [ Act No. 1 of 2022 , s. 42.] - 45B Verify source ↗
MISCELLANEOUS PROVISIONS - 45B. Application of Cap. 197
AI-assisted research summary: The provisions of the Retirement Benefits Act (Cap. 197) apply to the Fund only for post-retirement medical contributions under section 3 (2)(a)(v).
Section 45B. Application of Cap. 197 Section The provisions of the Retirement Benefits Act (Cap. 197) shall apply to the Fund only with respect to post-retirement medical contributions under section 3 (2)(a)(v). [ Act No. 1 of 2022 , s. 42.]
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