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The Social Health Authority (SHA) is set to replace the National Health Insurance Fund (NHIF) effective October 1, 2024.
SHA will be in charge of administration and oversight of the three funds introduced by the Social Health Insurance Act of 2023;
- Primary Healthcare Fund
- Social Health Insurance Fund (SHIF)
- Emergency, Chronic, and Critical Illness Fund
Kenyans who register for the SHA shall automatically be registered in the three funds and will not require a card like NHIF.
Primary Healthcare Fund
The PHF focuses on procuring primary healthcare services from various facilities, including dispensaries and health centers.
It serves as the first point of entry for individuals seeking health services at Level 2 and 3 facilities, or upon referral by community health promoters, where patients will be treated for free.
All persons shall be eligible for free treatment and there is no individual contributions required to access the benefits of the Primary Healthcare Fund. The main source of funding will be allocation from the government and grants.
Social Health Insurance Fund (SHIF)
The Social Health Insurance Fund (SHIF) is what has received a lot of publicity but its only a component of the SHA.
Kenyans can use the Social Health Insurance Fund when referred to a level 4, 5 or 6 facility or an empaneled healthcare provider. The cost is 2.75% of one’s monthly or yearly income depending on whether they are salaries or in the informal sector.
SHIF covers inpatient services including pre-admission evaluation, hospital accommodation, meals, nursing care and ward bed charges.
It also covers costs associated with management of diseases or illness while admitted. The limit is 180 days per household.
Other services include maternity, neonatal and child health services, renal care services, mental wellness, surgical services, haematology, oncology medical imaging and other tests, oral health as well as overseas treatment.
Emergency, Chronic and Critical Illness Fund
This is a fund established to provide money to pay the costs of management of chronic illnesses after depletion of the SHI over and to cover the costs of emergency treatment.
Kenyans suffering from a chronic illness shall, upon exhaustion of his or her benefits under the Social Health Insurance Fund, access treatment for the chronic illness from an empanelled and contracted healthcare provider or health facility.
Emergency services shall include the management of;
- Cardiac or pulmonary arrest
- Major trauma including burns and any serious injuries that are life-changing and could result in death or serious disability including head injuries, severe wounds and multiple fractures
- Shock states including trauma, hemorrhagic, septic shock, dehydration, hypotension and significant tachycardia or bradycardia
- Unconscious or altered level of consciousness or confusion.
- Severe respiratory distress.
- Seizures or status epilepticus.
- Acute coronary syndrome or chest pain.
- Acute cardiovascular accidents or stroke.
- Pregnancy related complications.
- Ambulance and evacuation services
Frequently asked questions
Who can contribute to the Social Health Authority?
Contributors include every Kenyan household, non-Kenyan residents who have been living in Kenya for over 12 months, the national government, county governments, and any other employers or donors.
How will I contribute to the SHA?
For households with income from salaried employment, contributions will be made through a monthly statutory deduction from wages or salary by the employer.
For households with income from informal employment, an annual advance contribution will be made to the SHA.
If both spouses are employed, are both required to make monthly contributions?
Yes, both spouses are required to make contributions based on their individual incomes.
What happens if the heads of a household have separate incomes concerning the 2.75% contribution?
The combined income of all members in a household will be subjected to the 2.75% contribution based on that total income.
How much will I contribute to the SHA?
The contribution rate is 2.75% of both individual and household income.
Who is required to pay the minimum contribution of Sh300 per month?
Those whom the means testing tool determines to fall in or below the contributions threshold of Sh300 will contribute the base premium of Sh300. The government will contribute for those who apply for a subsidy if they fall below this threshold.
Is there an option for capping the deductions?
No, deductions are not capped.
How will the determination of income for the informal sector be done?
Means testing will be used to determine proxy income based on expenditure patterns.
Should members wait until means testing is conducted to make contributions?
For salaried employees, contributions will be based on their salaried income. However, for non-salaried income earners, contributions will only be determined using the means testing tool. Hence, payments will be made after means testing.
If someone transitions or there is a change of income, who is responsible for determining the contribution? What is the reporting mechanism?
The contributor is required to notify the Social Health Authority of any changes in income, and they will be informed of the new contribution rates by the authority.
Are Kenyans contributing to all three funds, and how do these contributions work?
No. The Primary Healthcare Fund and the Emergency Chronic and Critical Illness Fund will be publicly funded through government budget allocations and will be available to registered SHA members. Direct contributions will only be made to the Social Health Insurance Fund.
How many times will I contribute to SHI?
For salaried or payroll employment households, contributions are made monthly. For non-payroll households whose income is not derived from salary, contributions are made annually as determined by the means testing instrument.
Will services be accessible if I lose employment (formal vs informal)?
Yes, as long as the authority is notified and new contribution arrangements are agreed upon and honoured by the contributor.
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