Saturday, April 19, 2014

Social Health Insurance Benefit

nssf8Objectives
  • Meeting legal requirements of NSSF Act 28 of 1997
  • Supporting Government’s efforts to increase access to healthcare services
  • Providing medical support to the insured and his/her dependants
  • Providing relief to the employers on employees’ medical expenses
Coverage

Insured person, spouse and up to four children
Children include biological and legally adopted below 18 or 21 years if in full time education

Qualifying Conditions
  • At least 3 months contributions
  • 3 months access of service after stoppage of contributions
  • 6% deduction of pensions for pensioners willing to join after retirement
Benefits Services Covered

nssf9

Exclusions
  • The following medical services are not covered by SHIB
  • Diseases or services covered under Maternity Benefits
  • Free services/treatment provided by the Government such as immunization,Tuberculosis and Leprosy, Cancer, HIV/AIDS, Epidemics, Mental illness,Diabetes Mellitus.
  • Injuries where a third party is involved such as a road accident where the vehicle is covered by insurance.
  • Cosmetics and cosmetic surgery.
  • Services/treatment for self-infl icted diseases/injuries like alcohol, drug and tobacco abuse, attempted suicide and criminal abortion.
  • Physiotherapy services at home.
  • Psychiatric diseases, except during acute illness within 7 day of care.
  • Medical examination for employment, schooling and travel purposes.
  • Treatment due to diseases/condition arising from participating in an experimental study.
  • Therapeutic trials.
  • Expensive specialized investigative procedures like MRI and DNA Typing.
  • Services/treatment for injuries/conditions arising from active participation in riots, demonstration, unrest and civil strife
Limitations of Medical Services
  • Emergency services for mobile members (traveling on duty) Outpatient - not more than 4 times/year and Inpatient (48 hours) - not more than 2 times a year
  • Hospitalization for a maximum period of 42 days of inpatient care per family per year
Enrolment of Members

Enrolment for SHIB beneficiaries is carried out through NSSF Field Offices. The insured person should submit properly fi lled enrolment form (Form SHIB 3) in triplicate together with marriage Certificate, birth Certificates for the children, 3 Passport size photographs for each, beneficiary and any other document as may be requested by the Fund.

For the purpose of making payment by the Capitation system, each beneficiary should enroll to only one Accredited Medical Provider within one year.