Govt Explains SHA's Benefits & Tariffs Including For ICU Patients
The Ministry underlined that with regard to the extent of SHA's coverage, it is in line with gazetted tariffs as stipulated by the law.
Viral Tea Ke Writer 
The government through the Ministry of Health on Sunday, December 15 clarified the framework governing the Social Health Authority (SHA) benefits and tariffs, published in November 2024.
In a statement, the Ministry underlined that with regard to the extent of SHA's coverage, it is in line with gazetted tariffs as stipulated by the law. "In light of recent concerns regarding the extent of SHA coverage, we wish to clarify the framework governing SHA's benefits and tariffs," the statement read in part.
"The Ministry of Health confirms that SHA's coverage is based on gazetted Tariffs to the Benefits, published in November on the SHA Website These tariffs (available at https://sha.go.ke/resources/categories/7) ensure sustainable healthcare coverage and equitable access while maintaining a shared responsibility model."
However, the Ministry noted that in cases where hospital charges exceed specified limits, beneficiaries may be required to make co-payments.
Health Cabinet Secretary (CS) Deborah Barasa during a media breakfast meeting held at Sarova Panafric in Nairobi on September 18, 2024. /MINISTRY OF HEALTH
"Regarding ICU and HDU services, SHA provides for admissions in critical care units and high dependency units (ICU and HDU). The provider payment mechanism (PPM) is a per diem rate, and the rate depends on the type of facility visited as follows," added the statement.
For level 4, patients will have to pay Ksh3,360 per day while those visiting level 5 will have to part with Ksh3,920 per day as co-payments for HDUs. Patients visiting level 6 will be required to shoulder an extra Ksh4.480 per day.
Each household has a limit of 180 days per year for access rules. The Ministry however noted that registered users can get services from empanelled and contracted level 4 - 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," added the Ministry.
The government also revealed that SHA is proactively addressing emerging challenges to ensure seamless access to all services like cancer management, renal care, maternity, and outpatient care, further expressing commitment to removing any barriers that may hinder access, ensuring beneficiaries face no hurdles in obtaining the care they need.
"As such, 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 Committee report will address both short- and long-term interventions to ensure SHA sustainability and responsiveness to the needs of Kenyans," added the statement.
In the meantime, the government encouraged all Kenyans to enrol in SHA, and for informal sector members to undertake means testing and remit their premiums to ensure the continuity of service delivery.
Employers were encouraged to ensure all their employees were onboarded on SHA and promptly remit their monthly premiums.
Additionally, the Government announced that it is evaluating avenues to bolster the overall healthcare delivery system, including the potential recapitalization of the Kenya Medical Supplies Authority (KEMSA) to improve the flow of essential commodities to healthcare facilities. This measure will complement SHA's efforts to ensure uninterrupted access to critical healthcare services.
"We urge all beneficiaries and stakeholders to refer to official SHA channels for accurate information about benefits, tariffs, and access rules. For further inquiries or clarification, please contact 147 or email customerservice@sha.go.ke," added the Ministry.
The SHI Act repealed the NHIF Act of 1998 and established the Social Health Authority (SHA) to pool resources and undertake strategic purchasing of health services from health providers through the management of three Funds: The Social Health Insurance Fund (SHIF), the Primary Healthcare Fund (PHCF), and the Emergency, Chronic, and Critical Illness Fund (ECCIF).
The SHA rollout began on October 1, 2024, and implementation is ongoing through the registration of members, contracting of healthcare service providers, and digitization of health systems to facilitate access to healthcare services.
