Government issues an update on the SHA benefits and tariffs after concerns
The Ministry of Health on Sunday issued an update on the benefits and tariffs under the Social Health Authority (SHA)
The Ministry of Health on Sunday issued an update on the benefits and tariffs under the Social Health Authority (SHA).
In a statement, the Ministry emphasised that the coverage of SHA is in line with gazetted tariffs as stipulated by the law.
“The Ministry of Health confirms that SHA’s coverage is based on gazetted tariffs to the benefits, published in November 2004. These tariffs ensure sustainable healthcare coverage and equitable access while maintaining a shared responsibility model,” the Ministry stated.
However, the Ministry noted that in cases where hospital charges exceed specified limits, beneficiaries may be required to make out-of-pocket expenditures.
“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,” the Ministry elaborated.
For level 4, patients will have to pay Ksh3,360 per day while those visiting level 5 will have to part with Ksh3.900 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 in level 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 has committed to removing barriers that may hinder access, ensuring beneficiaries face no hurdles in obtaining the care they need.
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“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 encouraged Kenyans to enrol in SHA. Informal sector members were equally urged to undertake means testing and remit their premiums to ensure the continuity of service delivery.
Additionally, the Government 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.
“We urge all beneficiaries and stakeholders to refer to official SHA channels for accurate information about benefits, tariffs, and access rules.”
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