WIN Pamoja in a Kenyan company that is making it Convenient, Affordable and Secure for Diaspora to Signup for services in Kenya. WIN Pamoja means (“WIN” from the word “Winning” and “Pamoja” from the Kiswahili word “Together”).
Our business model and choice of products has been founded on feedback that we have gathered over the years from the Diaspora. Our first engagement with the community took place in October 2011 at the 1st Diaspora conference where we carried out our 1st Diaspora Survey. We have since continued to ask questions and to listen to Diaspora.
WIN Pamoja has offices in Nairobi, Kenya and are therefore able to "run errands” on behalf of the Diaspora including submitting Applications and connecting with the NHIF members.
Is WIN Pamoja an Insurance Company ?
No, WIN Pamoja NOT an Insurance company. WIN Pamoja is a Kenyan company that in offering a Platform through which Diaspora can connect to important services in Kenya. We are the Agent assigned to the Diaspora for NHIF memberships.
Who is listed on an NHIF Account ?
– Sponsors, Members and Dependents
Who can signup for this NHIF offer for the Diaspora ? – “The Sponsor”
Diaspora can signup to sponsor people in Kenya with NHIF membership.
Who can Diaspora sponsor ?
Diaspora can sponsor any family and friends living in Kenya.
Why are we sponsoring friends in Kenya ?
WIN Pamoja did multiple Diaspora surveys that revealed that Diaspora send medical funds to family friends and neighbors living in Kenya. It may therefore be more financially beneficial to offer them NHIF membership.
Who can be sponsored - “The Member”
You can sponsor any Kenyan, of any Age who is in any Health condition including those with pre-existing illnesses.
The person you sponsor will become the primary contact on the NHIF account.
About NHIF - The Product
What is this NHIF insurance
NHIF – which stands for National Hospital Insurance Fund.
“NHIF Sponsor” – This is the Diaspora that is financing payment of the NHIF membership.This NHIF membership is intended to insure Diaspora family and friends living in Kenya. The NHIF member lives in Kenya at time of initial enrollment. If the member relocates from Kenya, their membership is valid and is renewable every year. NHIF membership is NOT intended to insure Diaspora.
“NHIF member” – This is the family member that is considered the primary owner of the NHIF Account.
“NHIF Dependents” – These are the Spouse and Children (under 18 years) of the NHIF member. They can be added onto the NHIF membership for no additional cost. They are added onto the account by enrollment.
The “Underwriter” – This is National Hospital Insurance Fund (NHIF). This means that The NHIF memberships are issued by NHIF.
WIN Pamoja is the channel/platform through which the applications, annual renewals and Claims are submitted.
The NHIF membership must comply to the NHIF Terms and Conditions issued by both NHIF. More details are available on the National Hospital Insurance Fund (NHIF) website.
There is NO age limit for NHIF membership.
No medical checkup is required for NHIF members. Anyone can be enrolled in any Health condition including those with pre-existing illnesses.
Which other family members can be added to the NHIF account ? – “The Dependents”
Dependents include the NHIF member’s Spouse and Children (under 18 years).
The Dependents are enrolled onto the NHIF account for no additional cost.
Once enrolled, the Dependents are subject to 60-day Waiting Period. This means that Treatment is not covered during the 60-day Waiting Period.
To add dependents to your account, they must be formally enrolled through NHIF. This will require completing documentation and receiving a confirmation that the enrollment has been successfully completed.
Membership coverage under NHIF
What illnesses are covered - All illnesses are covered under NHIF. These include Cancer, Prostate, Hypertension, Diabetes and more.
What member Treatments and Tests are covered
Treatment and Tests covered include Dialysis, Surgeries, Chemotherapy and more.
Treatments are provided per agreed NHIF Terms and Conditions and are subject to maximum amounts within specific timelines.
More details of NHIF Treatment and services is available on NHIF Website.
What member Costs are covered - Costs of Treatment is covered by NHIF when treatment is performed under all of the following terms and conditions.
What Terms + Conditions that must be met - All illnesses are covered under NHIF. These include Cancer, Prostate, Hypertension, Diabetes and more.
The requestor of services must be a member of NHIF.
They must show their NHIF membership Card + Kenya Government issued Identification (Kenya ID / Passport) as evidence of their membership. These must be presented at the time when requesting service (NOT AFTER). The requestor information must be correctly listed on the NHIF account.
NHIF membership Fees must be current (paid).
NHIF account information should be up-to-date and accurate.
NHIF account must have no outstanding balances.
The location where services are being requested must be a listed NHIF accredited facility.
The member requesting service must NOT be within the 60-day Waiting Period.
The NHIF account must NOT be expired.
All NHIF Terms and Conditions must be met.
The NHIF membership is valid for 1-year.
The NHIF Terms and Conditionsare subject to change at anytime and without notice from NHIF.
Expired NHIF accounts
The membership is Valid for 1-year. This means that the account must be renewed within 1-year.
Renewal of Policies requires that APA Insurance receive your renewal application atleast 14 days prior to expiration. Failure to renew on time does not guarantee renewal.
Failure to renew before 1-year will Expire the NHIF membership
Membership Expiration - Failure to renew before 1-year will Expire the NHIF membership
Expired NHIF accounts are subject to penalties and fees
Expired Membership means that NHIF membership no longer valid. Treatment and costs will NOT be covered when the membership is expired.
Re-activating an Account - Re-activation (after expiration) of an NHIF account would involve re-payment of listed Penalties, Payment or Processing Fees as requested. A Waiting Period of 60 days may also be applied.
Annual Membership Renewals
Renewal Request must be received in WIN Pamoja atleast 30 days prior to Expiration date.
Reminder notices will be sent at 10 months to allow responses to WIN Pamoja atleast 30 days prior to the Expiration date.
About the Payment
Payments should be sent from the Sponsor’s (Diaspora) bank account to WIN Pamoja’s Bank Account in Kenya.
Payments MUST be sent through legally approved transmission channels.
No cash payments are acceptable. No Credit Card Payments are acceptable. No Payment Plans or monthly payments are acceptable.
“The NHIF member” must be living in Kenya during initial signup. If the NHIF member relocates out of Kenya, the NHIF membership is valid and can continues to be renewed annually.
60-day Waiting Period
A 60-day waiting period is applied for 1st time enrollments/re-enrollments into the NHIF database. This means that after the initial NHIF membership is issued (the NHIF membership is active), NHIF will begin to cover costs after 60 days. If the NHIF member seeks treatment during the initial 60 days, NHIF will not pay the costs. All costs will need to be paid by the NHIF member.
Sponsorship Costs for NHIF membership
Payment is paid for the full year. No partial or monthly payments are accepted.
What does it cost (The NHIF Membership) - Insurance costs is Ksh 6,000 (Kshs 500/- per month) per NHIF account per year.
What is the Administrative Fee - The Administrative Fee is Kshs 2,500 (estimate $3 per member account per year). This is also charged during annual renewals.
Dependents Enrollment - The member can add their Spouse and Children (under 18 years) for no additional cost. Enrollment is required to add new dependents.
Non-Cancellation and Non-refundable membership
This means that once the NHIF membership has been issued, the membership cannot be cancelled and no refunds can be paid back.
NHIF membership Costs
Membership allows for enrollment of Spouse and children (under 18 years) – for no additional cost.
Membership is per year.
Total sponsorship Payment is Kshs 8,500 per member account, per year.
NHIF Premium :
Kshs 6,000 (Kshs 500/- per account per month)
WIN Pamoja Processing Fees :
Kshs 2,500 (estimate $3 per account per month)
Kshs 8,500 per account, per year
Any pre-existing member fees will be paid from the funds.
During signup, Diaspora are requested to provide the Name of the Member and contact or representative that can be of assistance during enrollment.
WIN Pamoja will work with your listed representatives for the account setup.
WIN Pamoja does not disclose account information to the account representative.
Win Pamoja will partner with the representative to coordinate member account verification
However, member treatment or payment information is NOT shared with therepresentative.
*This Terms and Conditions from APA insurance are subject to change anytime without notice.
Open a WIN Pamoja Account
Open your WIN Account to get access to WIN Products and solutions