COMMUNITY HEALTH INSURANCE

KARUDEC Community Health insurance; is a membership scheme designed to help community members of our catchment area and beyond to access quality and affordable Health services. The scheme was officially launched in April, 2018.

Its purpose is to enable people to pay for their health care collectively through their existing groups, families and individuals in advance instead of waiting until they fall sick, thus the motto “affordable pay for better health”

CHI Vision: Improved quality health care of the community.

 CHI Mission: Provision of affordable and accessible health and spiritual care services to communities offered by a competent health care provider.

Values:
Dignity: We believe that human beings are made in the image of God and deserve respect and love.
 Equity: We seek to treat people without discrimination.
Christian principles: We uphold principles of faithfulness, accountability, commitment, justice and peace among all stakeholders.
 Professionalism: We love and cherish the qualification, competence and skills expected of a professional.
 Team work: We believe that together we achieve more.

Objectives:

  1. 1. To improve access to quality and affordable health and spiritual care for the members/beneficiaries.
  2. 2. To improve the health of the members/ beneficiaries.
  3. 3. To improve the quality of health care provided by the SELECTED PROVID

Membership:
Eligible members to join CHI shall be from any of the following:
Existing village SACCO groups, Existing farmer’s groups, Existing catering groups, Existing business groups, Existing religious groups, Staff of different organizations, Students and pupils, And any other formal group
Criteria for Joining CHI

  1. Must be a member of an existing group.
  2. For group membership, there shall be a minimum number of atleast 25 members.
  3. Eligible members shall be between the ages of 1day-above years.
  4. Submission of national ID or other legal document for proper identification.
  5. Payment of full bi-annual and annual premium.

Process registration to Join CHI

Prior to joining, every individual group member, house hold, individual’s demographic information with GPS co-ordinates will be recorded onto the electronic Health Management Information System for KARUDEC Community Health insurance.

The system shall capture every member’s basic data, digital photograph and finger print.

This system enables us to identify scheme members, where they live and mapping up the pattern of diseases in the community for corrective interventions.

Below are the steps taken to Join CHI:
Step 1: An existing group decides to join the scheme after sensitization by authorized persons or staff of KARUDEC.
Step 2:
All members of the group shall register on the CHI electronic system with 100% pay of their annual subscription through their leader.
 Step 4:
Group subscription records to be updated on the CHI database.
Step 5:
Verification and identification of eligible scheme members shall take a period of 2 weeks which includes processing of their cards before they start benefiting from the scheme.
 

Health Benefit Package:

Currently the cost of joining CHI at Kagando hospital is UGX 25,000 including registration fees per year per member

Members pay the co-pay fee as shown below per visit, these costs can be changed when necessary/periodically.

6.2. Proposed Kagando Hospital Health Services Costing for the FY 2019/2020

Cost of various health care services at Kagando hospital CHI member Non-CHI Comment
Consultation & treatment (Adults 12 years & above)-OPD 5,000 40,000
consultation & treatment (Children below 12 years ) 5,000 35,000
OPD, Dental, EYE, ( Non-cosmetic) consultation & treatment 5,000 35,000 If it is tooth extraction  only
Admissions; a client shall be charged 60% of the total amount billed

Unlimited outpatient services include:

  • General consultations.
  • Pediatric immunizations.
  • Prenatal/Antenatal care.
  • Recommended Laboratory investigations covered under CHI.
  • Prescribed drugs covered under CHI.
  • Preventive care including health education and available health products.
  • Minor accidents and emergency cover.

Limited outpatient coverage for members: Complete physical examinations at

  • Birth to1year           Coverage as per routine
  • Above 1 year           Once every year

The following services are not covered under benefit packages

  • Services not offered at the contracting health care provider
  • Chronic care treatments
  • Cosmetic and plastic surgery
  • Any conditions arising from: drunkenness; drug addiction, and intentional self-injury (attempted suicide, induced abortion)