The Ministry of Health has clarified the framework for the Social Health Authority (SHA) benefits and tariffs, addressing public concerns about the extent of its coverage.
In a statement on Sunday, December 15, the Ministry affirmed that SHA’s benefits align with gazetted tariffs published in November 2024, ensuring sustainable healthcare access under a shared responsibility model.
Key Features of SHA Coverage
The SHA framework provides for critical healthcare services, including ICU and HDU admissions, based on a per diem co-payment rate. The specific charges are as follows:
- Level 4 facilities: Ksh 3,360 per day
- Level 5 facilities: Ksh 3,920 per day
- Level 6 facilities: Ksh 4,480 per day
Each household is limited to 180 covered days annually. Patients may need to make co-payments if hospital charges exceed the set limits. Coverage applies to public, faith-based, and private healthcare facilities contracted under SHA.
The Ministry emphasized its commitment to seamless access to services such as cancer treatment, renal care, maternity, and outpatient care. Efforts to address emerging challenges include the formation of a committee to review tariffs and benefits under Regulation 41 of the Social Health Insurance Regulations.
Enhancing Healthcare Delivery
To bolster healthcare services, the government is considering measures such as recapitalizing the Kenya Medical Supplies Authority (KEMSA) to ensure a consistent supply of essential commodities. This complements SHA’s mission to guarantee uninterrupted access to critical services.
Encouraging Enrollment
The Ministry urged all Kenyans to enrol in SHA, with informal sector members undergoing means testing to determine their premium contributions. Employers were also encouraged to ensure their staff are onboarded and premiums are promptly remitted.
SHA, established under the Social Health Insurance (SHI) Act, replaced the NHIF Act of 1998. Its rollout began on October 1, 2024, focusing on member registration, contracting service providers, and digitizing health systems for improved access to care.
Contact and Information
For accurate details about SHA benefits, tariffs, and rules, the Ministry advised beneficiaries and stakeholders to rely on official SHA channels. Queries can be directed to 147 or customerservice@sha.go.ke.
The government reaffirmed its dedication to ensuring equitable and affordable healthcare for all Kenyans through the SHA framework.
