Full list of SHA packages including in-patient, maternity, ICU, cancer & more

Established under the Social Health Insurance Act of 2023, the SHA will manage three key funds

Primary Healthcare Fund (PHF): This fund is designed to provide essential health services at local facilities like dispensaries and health centers.

Notably, services accessed through this fund will be free of charge for patients, funded by government allocations and external grants, ensuring that no individual contributions are necessary.

Social Health Insurance Fund (SHIF): The SHIF will cover inpatient services at higher-level healthcare facilities (Level 4 to 6) following referrals. All registered Kenyans will contribute 2.75% of their income to this fund, which encompasses comprehensive inpatient services including hospital accommodation and nursing care

Emergency, Chronic, and Critical Illness Fund: This fund is tailored for serious health conditions requiring immediate care, further enhancing the safety net for vulnerable populations.

Full list of benefit packages Kenyans will access under the SHA

Below is a comprehensive list of all the benefits Kenyans will access, however experts have raised concerns that the packages are below market rates and may be inadequate to cover Kenyans.

1. Primary Healthcare Fund

This fund is designed to provide essential health services at local facilities like dispensaries and health centers.

Outpatient Care Services

1. Health education, consultation, diagnosis, and treatment
2. Prescribed lab tests and basic radiology (X-rays, ultrasounds)
3. Prescription and drug dispensing
4. Management of acute and chronic conditions
5. Minor surgeries and immunization as per schedule

Tariff: Sh900 per person annually

Maternity, Newborn and Child Health Services

1. Antenatal care, normal delivery, caesarean sections
2. Postnatal care for mother and newborn
3. Nursing care, ward charges, diagnostic lab tests

Tariff: Normal delivery – Sh11,200; Caesarean section – Sh32,600

Screening & Management of Pre-Cancerous Lesions

1. Screening for cancers (breast, cervix, prostate, colon)
2. Cryotherapy, thermal ablation, and LEEP

Tariff:

1. HPV screening – Sh3,600
2. PSA test – Sh1,500
3. Stool occult blood test – Sh 400
4. Cryotherapy & Thermal Ablation – Sh 3,000
5. LEEP – Sh 2,800

Optical Health Services

1. Consultation and diagnosis for eye health
2. Provision of eyeglasses for refractive errors

Tariff: Sh 935 for consultation and eyeglasses. Limit: Sh 1,000 per household

End of Life Services

1. Preparation, preservation, and storage of body in mortuary

Tariff: Sh 500 per day (limit up to 5 days)

Medical Inpatient Services

1. Disease management, admission charges, nursing care
2. Laboratory tests, imaging, medication, and therapeutic support

Tariff: Sh 2,400 per day (limit up to 50 days)

2. Social Health Insurance Fund

The SHIF will cover inpatient services at higher-level healthcare facilities (Level 4 to 6) following referrals.

Outpatient Care Services

1. Similar to primary health care services, including consultations, diagnosis, treatments
2. Screening for common health conditions

Tariff: Sh 2,000 per visit (limit of 4 visits per person annually)

Medical Inpatient Services

Similar to PHC inpatient services, including hospital accommodation, specialist reviews

Tariff:

• Level 4 – Sh 3,500 per day
• Level 5 – Sh 4,000 per day
• Level 6 – Sh 5,000 per day

Limit: Up to 50 days per household

Maternity, Neonatal and Child Health Services

1. Normal deliveries, assisted deliveries, caesarean sections
2. Newborn care, midwifery, diagnostics, and family planning

Tariff:

• Normal delivery – Sh 11,200
• Caesarean Section – Sh 32,600

Renal Care Package

1. Dialysis management for chronic and acute kidney failure
2. Specialist consultations, lab tests, medication

Tariff:

• Hemodialysis & Hemodiafiltration – Sh 10,650 per session
• Peritoneal dialysis – Sh 180,000 per month

Limits:

• 3 sessions per week for haemodialysis
• 2 sessions per week for haemodiafiltration
• 12 sessions annually for peritoneal dialysis

Mental Wellness Benefit Package

1. Mental health education, screening, management of disorders
2. Rehabilitation for substance use disorders

Tariff:

• Outpatient – Sh 1,200 per visit (limit of 7 visits)
• Inpatient (per diem):
• Level 4 – Sh 3,500
• Level 5 – Sh 4,000
• Level 6 – Sh 5,000
• Detoxification – Sh 14,000
• Rehabilitation – Sh 125,000

Surgical Services Package

1. Pre-operative care, minor, major, and specialized surgeries
2. Post-operative care, including follow-ups and pain management
3. Organ transplants and implants

Access Point: Level 3-6 facilities with appropriate equipment

Tariff: Based on a schedule of surgical procedures

Oncology Services

1. Cancer screening and treatment (breast, prostate, cervical, childhood cancers)
2. Administration of chemotherapy, radiotherapy, brachytherapy

Tariff:

• Chemo administration – Sh 5,000
• PET Scan – Sh 53,500
• PSMA PET Scan – Sh 64,200
• CT Scan – Sh 9,600
• MRI – Sh 11,000

Medical Imaging and Other Investigations Package

Specialized imaging: MRI, CT scans, mammography, ultrasounds

Tariff:

• MRI – Sh 11,000
• CT Scan – Sh 9,600
• CT Angio – Sh 8,000
• Mammography – Sh 3,000

Pharmacy Package

Medicines for chronic conditions like diabetes, hypertension, asthma, renal disease, oncology, mental health, epilepsy

Tariff: Quarterly limit of Sh 5,000 per person

Specialized Laboratory Services

Laboratory tests for chronic conditions and select diseases

Tariff: Quarterly limit of Sh 5,000 per person

End of Life Services

Preparation, preservation, and storage of the body

Tariff: Sh 500 per day (limit up to 5 days)

3. Emergency, Chronic, and Critical Illness Fund

This fund is tailored for serious health conditions requiring immediate care, further enhancing the safety net for vulnerable populations.

Ambulance Evacuation Services

Ground evacuation from incident location to the nearest facility

Tariff:

• Up to 25 km radius – Sh 4,500
• Beyond 25 km – Sh 75 per km

Accident & Emergency Services

Resuscitation and stabilization for trauma, shock, respiratory distress

Tariff: Varies based on the emergency condition

Critical Illness Package

Critical care admissions (ICU, HDU, NICU, PICU)

Tariff:

• ICU – Sh 35,000 per day
• HDU – Sh 10,000 per day

Palliative Care Services

Enhancing the quality of life for chronic or life-threatening conditions

Tariff: Sh 5,000 per day (up to 60 days)

Chronic Illnesses

Management of chronic conditions exceeding SHIF limit (diabetes, hypertension, mental health)

Tariff: Follows the SHIF tariff and rules

Assistive Devices

Provision of devices for permanent physical or sensory disabilities

Tariff: Varies based on the device (e.g., Hearing aids – Sh 55,000)