Gov’t Announces New SHA Benefits, Tariffs As Public Outcry Continues
On Sunday, the Ministry of Health provided an update on Social Health Authority (SHA) benefits and rates.
In a statement, the Ministry highlighted that SHA coverage is consistent with gazetted prices as required by law.
“The Ministry of Health confirms that SHA’s coverage is based on gazetted tariffs to the benefits, published in November 2024,” the Ministry stated.
“These tariffs ensure sustainable healthcare coverage and equitable access while maintaining a shared responsibility model.”
However, the Ministry stated that in circumstances when hospital charges exceed defined limits, beneficiaries may be asked to pay out-of-pocket expenses.
UPDATE ON THE SOCIAL HEALTH AUTHORITY TARIFFS TO THE BENEFITS pic.twitter.com/g5AAukR50f
— Ministry of Health (@MOH_Kenya) December 15, 2024
“Regarding ICU and HDU services, SHA provides for admissions in critical care units and high dependency units (ICU and HDU),” the Ministry elaborated.
“The provider payment mechanism (PPM) is a per diem rate, and the rate depends on the type of facility visited.”
Patients at level 4 must pay Ksh3,360 per day, while those at level 5 must pay Ksh3,900 per day as HDU co-payments.
Patients visiting level 6 will have to pay an additional Ksh4.480 each day. Each home has a maximum of 180 days per year for access rules.
However, the Ministry stated that registered users can access services at levels 4–6 facilities.
“Members can access service from empanelled and contracted Level 4 to 6 facilities. The members will top up any amount that exceeds the above cover limit (co-pay). The cover limit is the same for public, faith-based, and private facilities,” SHA clarified.
The Ministry is committed to eradicating barriers to access, ensuring that beneficiaries face no obstacles in receiving the care they require.
“The Ministry is in the process of constituting a committee pursuant to Regulation 41 of the Social Health Insurance Regulations to review tariffs and benefits Based on feedback from stakeholders gathered over time, the committee will be expected to review and provide practical solutions and make informed recommendations,” the Social Authority added.
Meanwhile, the government pushed Kenyans to enroll in the SHA.
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Members of the informal sector were also advised to conduct means testing and pay their premiums in order to ensure that service delivery continued.
Furthermore, the government is considering ways to improve the whole healthcare delivery system.
This would include a possible recapitalization of the Kenya Medical Supplies Authority (KEMSA) to increase the delivery of key commodities to healthcare facilities.
“We urge all beneficiaries and stakeholders to refer to official SHA channels for accurate information about benefits, tariffs, and access rules.”
Gov’t Announces New SHA Benefits, Tariffs As Public Outcry Continues
