Does NHIF Cover Ultrasound? (All You Need to Know)

The National Hospital Insurance Fund (NHIF) as a state corporation by the Kenyan government is mandated with providing affordable health insurance to Kenyans including maternity. However, NHIF has some limits which leaves some people wondering if it covers ultrasound scans.

Does NHIF Cover Ultrasound Scans?

Under NHIF, the maternity cover that caters for pregnant women together with their newly born children is known as Linda Mama. This covers an array of basic health care. The aim of this maternity cover which applies to all ladies who have subscribed to the plan is to achieve universal cases to maternal and child health care and move towards Kenya’s Universal Health Care (UHC).

NHIF has some limits on its maternity cover and if you are wondering does NHIF cover ultrasound; it is good to note that it does not cover those scans. It is thus important to plan accordingly and have between Ksh. 900 to Ksh. 4000 depending on the hospital or facility you are going to take your ultrasound scan.

Any woman who has an active NHIF card is already covered during pregnancy and delivery with the majority of the services catered for. Linda Mama is meant for women who cannot afford the basic NHIF cover that goes for Kshs. 500 per month for self employed Kenyans. The amount varies for employed Kenyans depending on job group.

NHIF Maternity and Reproductive Health Cover Limits

Some of the services covered by NHIF in the maternity cover in accredited health facilities include:

  • Inpatient services including bed
  • Normal delivery or Caesarian surgery cost
  • Health care of the newborn baby immediately after delivery

Services usually not covered by NHIF maternity cover;

  • ANC profile tests
  • Mineral supplements
  • Ultrasound Scans
  • Some drugs
  • NUN milk (where administered to baby)
  • Subsequent vaccinations (in private hospitals)
  • Family planning

The above can be compared to the fact that NHIF does not cover dental and optical services.

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Ultrasound Scan Cost in Kenya

An ultrasound generates high-frequency sound waves (which cannot be heard by the human ear), which are reflected by internal human body organs including bone, tissue, and even a body.  A probe or transducer is used to create the waves and the baby or organs can then be viewed on a screen.

The cost of the ultrasound scan in Kenya for expectant mothers depends on the hospital selected or health imaging facility but usually ranges between Ksh. 1000 to Ksh. 4000. The other factor is the type of ultrasound machine used since some can produce high-quality, precise, and coloured images.

During pregnancy, one is likely to go through 3- 4 ultrasound scans depending on a doctor’s recommendation to monitor the growth of the fetus. After 20 weeks during gestation, one can do a gender ultrasound scan to determine the sex of the baby. When going for this scan we recommend seeking the services of a facility having a high-quality ultrasound machine that produces more accurate results and also coloured images.

When going for an ultrasound scan, always contact the health service provider in advance to know the cost and any other requirements. It is very important to know what NHIF covers in private hospitals as each facility has different terms.

How much does NHIF Cover during Maternity

If you have an NHIF cover (card) and are wondering how much does NHIF cover during maternity, the total cost of your maternity will depend on the hospital facility you chose.

For some private hospitals like Jacaranda Maternity, the normal delivery cost is between Ksh. 18000 to 25000 and NHIF usually covers Ksh. 10,000, Caesarian section delivery is Ksh. 41000 and 55000 and NHIF covers KES 30000 at the time of publishing this post. In other private hospitals, one can pay as little as Ksh. 4000 for normal delivery and NHIF covers the rest.

The variation in cost usually occurs due to various factors because some women need to be induced for labor while others are not induced among others. It is thus very important to discuss with your health care provider /hospital/doctor before the due date to prepare accordingly.

It is also good to remember that delivery in Public Hospitals is free of charge according to the ministry’s directive and the mother is only expected to carry supplies for them and the baby such as basin and clothes.

Other Uses of an Ultrasound Scan

Apart from obstetrics (pregnancy ultrasound scans), the other uses of an ultrasound machine or scan include:

  • Pelvis scans
  • Abdomen scans
  • Scanning small Body Parts like Thyroid gland, Breasts, Scrotum,  and Orbital Scan
  • Musculoskeletal Scan (Muscles and joints)
  • Echocardiography ( Heart examinations)
  • Doppler Examinations (Scanning of Blood Vessels)

It is thus important to note that NHIF does not cover for any of these ultrasound scans unless otherwise stated by your health service provider or doctor.

Closing Remarks

I hope I have answered your question, does NHIF cover ultrasound. It is good to be aware that NHIF does not cover ultrasound scans and thus it is good to be prepared especially financially when going for an ultrasound scan.


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