The National Health Insurance Fund (NHIF) has been experiencing a number of operational challenges including some attempts by non-contributing members to access health care services by using invalid membership cards.

According to the rules and procedures, members who are not contributing to the Fund for past three consecutive months, are not eligible to access medical services provided by the Fund. However, since around 95 per cent of contributing members of the NHIF are drawn out of the public sector, enforcement of this requirement has been a big challenge.

The challenge of non-qualifying beneficiaries has been largely attributed by the failure of some employers to comply with contribution remittance requirements as stipulated in the NHIF Act No 8 of 1999, which obliges each registered employer to remit contributions on monthly basis.

The Fund introduced online membership verification system (OMVS) whereby each member or beneficiary of the scheme is mandatorily verified online prior to accessing medical services. This measure has reduced contribution arrears, fraud among beneficiaries, and increased compliance level up to 95 per cent by employers compared to less than 60 per cent, which was recorded before this measure.