The Ministry of Health on Sunday announced a 30-day suspension of the Social Health Authority (SHA) overseas treatment package to allow key policy changes to take effect.
During this period, patients seeking SHA assistance for treatment abroad will have to wait as the ministry upgrades the system, which aims to encourage more Kenyans to seek specialised care locally.
Health Cabinet Secretary Aden Duale explained that SHA will only cover treatment abroad if the procedure is unavailable in Kenya. He noted that services such as PET scans, advanced imaging, kidney transplants, open-heart surgeries, and treatment for joint and spinal injuries are now accessible within the country.
In addition, overseas hospitals must meet new requirements, including being formally contracted by SHA, accredited in their home country, and recognised in Kenya. They will also be required to sign a Memorandum of Understanding (MoU) with a Kenyan health facility already empanelled and contracted under SHA.
The ministry maintained that the annual cap for overseas treatment coverage will remain at Ksh500,000.
“The Social Health Authority Overseas Treatment Benefit Package under the Social Health Insurance Act allows for treatment outside Kenya at a set annual rate of Ksh500,000 for services not available locally,” Duale stated.
He added that SHA has begun the process of contracting hospitals and implementing a new system to enhance coordination among stakeholders.
New Process for Overseas Treatment
Under the revised guidelines, foreign hospitals will be required to:
- Seek pre-authorisation from SHA before the patient travels.
- Notify SHA upon admission and discharge of the patient.
- Submit claims online for verification and payment.
- Ensure patients receive follow-up care in Kenya through their linked local facility after returning.
The announcement follows a January 23 directive by the ministry to fast-track the review of the overseas benefits package after numerous complaints from Kenyans.
“The indication initially was that we are supposed to review the tariff and benefits after two years, but because of the call from Kenyans regarding their experience with SHA, that will be done much sooner,” said Ministry of Health Director General Patrick Amoth.
He further explained that the changes are meant to align the scheme with its core objective of ensuring every Kenyan has access to affordable and comprehensive healthcare.
