Travelling To Kenya? You'll Need Insurance Cover Under New SHIF Fund

Those travelling to Kenya will be required to have a travel health insurance cover under the Social Health Insurance Fund (SHIF) regulations, 2023.

In a series of regulations published by Health Cabinet Secretary (CS) Susan Nakhumicha on Tuesday, November 29, a person travelling into Kenya shall possess a travel health insurance cover pursuant to section 26(6) of the Social Health Insurance Act.

The travel health insurance shall cover the person's entire period of stay in Kenya and provide the following benefits;

"Personal accident that may lead to death or permanent total disability, emergency medical expenses, emergency medical evacuation, repatriation of mortal remains.

"Hospital benefits, prescription medicines; and any other benefit as may be prescribed by the Cabinet Secretary," the regulations read in part.

Furthermore, a non-Kenyan may obtain the travel health insurance cover at the point of entry in Kenya.

Notwithstanding the provisions of the aforementioned, the Social Health Insurance Authority shall not provide travel health insurance covers for Kenyans or non-Kenyans.

In terms of Kenyans seeking treatment outside the country, they will be allowed to seek medical treatment abroad under SHIF but only after meeting the necessary requirements.

A beneficiary may access treatment outside Kenya where their contributions in favour of the beneficiary are up to date and provide proof that the treatment sought abroad is not available in Kenya.

"The treatment sought is being provided by a healthcare provider or health facility contracted by the Authority," added the regulations.

Furthermore, anyone who requires treatment outside Kenya shall request the Social Health Authority to authorize the treatment by providing a referral for overseas treatment from the treating doctor or consultant submitted online as prescribed in the regulations.

The referral should contain the name of the receiving healthcare provider or health facility, the diagnosis of the beneficiary including all results from the tests done by the treating doctor or consultant and the medical history of the beneficiary including any relevant medical conditions including allergies and recent or related diseases;

It should also contain clear and concise medical reasons for the referral and the signature of the treating doctor or consultant.

The patient should also fill in a duly filled form prescribed under the Medical Practitioners and Dentists Act.

"The Claims Management Office shall review the request and shall confirm that the healthcare service for which the beneficiary is being referred is not available in Kenya, the referral is to a health service provider or health facility that is contracted by the Authority based on peer review undertaken by the Claims Management Office, the referral is medically necessary and the financial implication of the healthcare service sought outside Kenya is within the limits of the essential benefits package," added the regulations.

Where the Authority approves the request, the Authority shall undertake to pay for the treatment sought at the health facility outside Kenya.

Kenyans usually travel abroad to seek specialized treatment for illnesses such as cancer and heart-related diseases, with countries such as India, the United Kingdom (UK) and the United States (US) being particularly popular destinations.

Medanta Hospital in India. /FILE