The government has introduced wide-ranging reforms to the Community-Based Health Insurance (CBHI) scheme, popularly known as Mutuelle de Santé, expanding medical coverage, revising premium contributions and changing how health facilities are financed.
The reforms were introduced through a Prime Minister’s order issued on February 24 and subsequent announcements by institutions including the Ministry of Health and the Rwanda Social Security Board (RSSB).
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They come as Mutuelle marks 25 years of expanding access to affordable healthcare.
Expanded medical coverage
Several specialised services that were previously uncovered have been added to the Mutuelle benefits package. Health Minister Dr Sabin Nsanzimana announced that orthopaedic services and neurosurgical procedures, including brain surgery, are now covered under the scheme.
The expanded coverage also includes kidney transplants, cancer diagnosis and treatment, interventional cardiology, minimally invasive surgery, hip and knee replacements, blood products, as well as an expanded list of essential medicines.
Authorities say the changes respond to the rising burden of complex and non-communicable diseases, which have increasingly forced patients to pay out of pocket or rely on public fundraising.
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New premium structure
The reforms introduce a new income-based contribution system that classifies contributors into five levels, replacing the previous flat contributions of between Rwf3,000 and Rwf7,000.
People with no income fall under Level One and are assigned an annual premium of Rwf4,000, which is fully subsidised by the government. This group represents about 7 per cent of the population. Level Two includes individuals earning below Rwf30,000 per month.
They pay Rwf4,000 per year, with a government subsidy of Rwf1,000, and account for roughly 23 per cent of the population.
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Those earning between Rwf30,000 and Rwf60,000 per month are classified under Level Three and pay Rwf5,000 annually without any subsidy.
This category represents about 35 per cent of the population. Level Four covers individuals earning between Rwf60,000 and Rwf120,000 per month, who contribute Rwf8,000 per year without government support and make up around 27 per cent of the population.
Level Five includes individuals earning above Rwf120,000 per month. They pay Rwf20,000 per year and account for about 8 per cent of contributors.
In an interview with The New Times, Minister of Local Government Dominique Habimana said the income thresholds were carefully considered to ensure affordability.
He said anyone who feels wrongly classified can seek a review at their cell office, adding that families with many members but limited income may be placed in a category they can reasonably afford following verification by local authorities.
The same income levels apply across rural and urban areas. While the cost of living is generally higher in towns and cities, the minister noted that urban households typically have greater income-earning opportunities.
Expanded contribution base
The revised framework also broadens the pool of institutions financing the scheme. Banks are now required to contribute 2 per cent of their annual profit before tax, while companies offering motor insurance services must contribute 5 per cent.
Telecommunications companies, which previously transitioned gradually from 2.5 to 3 per cent, will now contribute a flat 3 per cent of annual turnover. Fuel companies will continue to pay Rwf20 per litre sold, although the levy now applies only to petrol and gas oil.
Some earlier revenue sources have been removed, including a 10 per cent levy on gaming companies and district-level contributions based on agricultural land size.
State support for vulnerable groups has been revised upward, with the Ministry of Finance allocating Rwf4,000 per year for Level One beneficiaries and Rwf1,000 for those in Level Two.
Co-payments have been standardised at Rwf200 for visits to health centres and 10 per cent of the bill at hospitals, with indigent persons exempted.
Dynamic social registry
A central pillar of the reforms is a dynamic social registry system known as Imibereho, which tracks household income and assets.
According to Minister Habimana, the system draws data from several government sources, including civil registration records, banking and tax information from the Rwanda Revenue Authority, land records and data on subsidised agricultural inputs.
Because the registry is dynamic, household contributions can change over time. A family paying Rwf5,000 in one year may move to a higher or lower category the following year depending on changes in income or economic shocks such as natural disasters. Local government authorities also play a role in reviewing classifications.
"This approach aligns with the government’s policy of supporting households to graduate from poverty, which may result in reclassification into a different category,” Habimana said.
New payment model for health facilities
The reforms introduce a new Capitation Payment Model for healthcare facilities, under which providers are paid in advance for services planned for Mutuelle members.
This replaces the Fee-for-Service model, where the RSSB reimbursed facilities after services had been delivered.
According to the RSSB, the new system will ensure consistent availability of medicines and essential medical supplies at primary healthcare facilities by providing funding upfront.
It is also expected to address delays linked to invoicing and verification that previously disrupted service delivery.
The Minister of Health said the model is intended to improve service quality, strengthen planning and prevent interruptions in care. The system was piloted in health centres in the Eastern Province in January 2026 and will be rolled out nationwide.
Instalment payments
Under the new rules, Mutuelle beneficiaries will be allowed to pay their annual premiums in instalments while still accessing healthcare services.
Once a member has paid at least 75 per cent of their annual contribution, they will be eligible for treatment between July 1 and December 31, with the remaining balance payable later.
Concerns over implementation
Despite broad support for the reforms, lawmakers and citizens have raised concerns about communication and implementation.
Christine Mukabunani, the Deputy Chairperson of Parliament’s Committee on Social Affairs, said the reforms were necessary but criticised the lack of advanced public sensitisation.
She said some vulnerable families were mistakenly removed from support programmes and warned that challenges persist, particularly for patients who need specialised medicines only available at private pharmacies. She called for arrangements similar to those used by other insurance schemes that partner with private providers.
Civil society groups have welcomed the expanded coverage but stressed that higher premiums must translate into better services, especially consistent availability of medicines.
Citizens feel the impact
For some households, the reforms have already had a direct financial impact. Alphonse Uhagaze, a 58-year-old resident of Kimihurura Sector in Gasabo District, said his contribution increased from Rwf3,000 to Rwf5,000 per person.
For his family of five, annual payments rose from Rwf15,000 to Rwf25,000.
"Money isn’t the main issue; the real problem is the service,” he said. "If these reforms solve medicine shortages and improve access to treatment, they will be truly helpful.”