Principal Secretary for Medical Services Harry Kimtai has said the Ministry of Health is in the process of constituting a committee to review the Social Health Authority (SHA) tariffs and benefits.
In a statement, he said the committee will be expected to review and provide practical solutions, and make informed recommendations, based on feedback from stakeholders.
“The Committee report will address both short- and long-term interventions to ensure SHA sustainability and responsiveness to the needs of Kenyans,” he added.
As they await the committee’s report outcomes, Kimtai urged Kenyans to enrol in SHA and informal sector members to undertake means testing and remit their premiums to ensure the continuity of service delivery.
He encouraged employers to ensure all their employees are onboarded on SHA and promptly remit their monthly premiums.
Additionally, the government is evaluating avenues to bolster the overall healthcare delivery system, including the potential recapitalisation of the Kenya Medical Supplies Authority (KEMSA).
This is to improve the flow of essential commodities to healthcare facilities.
Kimtai said the measure will complement SHA's efforts to ensure uninterrupted access to critical healthcare services.
The PS urged 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 [email protected],” he added.
Kimtai noted that the SHA tariffs ensure sustainable healthcare coverage and equitable access while maintaining a shared responsibility model.
He added that in cases where hospital charges exceed specified limits, beneficiaries may be required to make co-payments.
He clarified that SHA provides admissions in cases of Intensive Care Units (ICU) and High Dependency Units (HDU).
Kimtai added that the provider payment mechanism (PPM) is a per diem rate, and the rate depends on the type of facility visited as follows: Level 4 - Sh3,360 per day, Level 5 - Sh3,920 per day and Level 6 -Sh4,480 per day.
The PS further noted that each household has a limit of 180 days per year for access rules, adding that members can access service 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,” Kimtai said.
