Kenyans entitled to Sh500,000 for treatment abroad for services unavailable locally under SHA - Duale
The system will be operational within 30 days and will require overseas hospitals to be formally contracted and linked to local facilities.
The Social Health Authority (SHA) has clarified the rules governing the Overseas Treatment Benefit Package, saying Kenyans will be entitled to treatment abroad at an annual cap of Sh500,000 per person, but strictly for medical services that are unavailable locally.
According to Health Cabinet Secretary Aden Duale, the system will be operational within 30 days and will require overseas hospitals to be formally contracted and linked to local facilities.
The package is anchored in the Social Health Insurance Act No. 16 of 2023, the Social Health Insurance Regulations 2024, and the gazetted Benefits Tariffs (Legal Notice No. 56). Duale said the services eligible for overseas referral will be determined annually by the Benefits Package and Tariffs Advisory Panel (BPTAP).
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“SHA is currently aligning with the provisions of the law and has commenced the contracting process. The new system will connect all stakeholders including members, referring specialists, local hospitals, the Kenya Medical Practitioners and Dentists Council, the Ministry of Health, overseas facilities, and SHA ensuring seamless coordination,” he said in a statement.
Under the new rules, overseas hospitals must be formally contracted by SHA, hold accreditation in their home countries and recognition in Kenya, and demonstrate linkages with a local empanelled and contracted health facility through a Memorandum of Understanding (MoU).
The treatment process will follow a structured procedure where overseas hospitals must request pre-authorisation before the patient travels, notify SHA upon admission and discharge, and submit claims online for adjudication and payment. On returning home, patients will be required to access follow-up care in Kenya through the linked local facility.
SHA also pointed out that several procedures which Kenyans previously sought abroad are now available locally. These include PET scans, advanced imaging, kidney transplants, open-heart surgeries, and joint or spinal surgeries. Members have been encouraged to utilise contracted hospitals in Kenya that already have the capacity to offer these specialised services.
Meanwhile, Duale noted that the Benefits Package and Tariffs Advisory Panel (BPTAP) is finalising the official list of treatments that will qualify for overseas referral. He said the list will be published “as soon as possible” on its website and other channels.
“The system is expected to be fully operational in the next 30 days,” he said.
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