Employers directed to register employees with Social Health Authority by October 1

All employers have been directed to register their employees with the Social Health Authority (SHA) before October 1, 2024.

In a notice issued by SHA Acting Chief Executive Officer Elijah Wachira, the transition from the National Health Insurance Fund (NHIF) to SHA will take effect on this date.

He said the final day for NHIF admissions will be on September 30, 2024, with SHA benefits commencing the following day.

“Effective October 1, 2024, the National Health Insurance Fund (NHIF) will be transitioned to the Social Health Authority (SHA). As such, every Kenyan citizen, including dependents, is mandated by law to register as a member of the SHA,” Wachira said.

He said employers must ensure all employee registrations are completed by the deadline to avoid disruptions in healthcare coverage.

According to Wachira, payments made on or before October 9, 2024, will be credited to NHIF, while those made from November 9, 2024, will be allocated to SHA.

Employers are required to use the SHA Employer Portal (https://sha.go.ke/) for managing employee SHI contributions, including registration, contribution remittance, and report generation.

To register their employees and their dependents with SHA, employers have been instructed to visit the SHA website and create an employer account.

After setting up the account, employers must verify it according to the provided instructions, then enter their employees' details to complete the registration process.

Wachira noted that it is also essential to use the portal to remit Social Health Insurance (SHI) contributions on time to ensure compliance with the new regulations.

For any queries or assistance, individuals have been urged to contact the SHA’s support team available via email at [email protected] or through the Toll-Free Number: 0800 720 601.

A view of the NHIF headquarters in Upper Hill, Nairobi. (Photo: File)

New proposals

Under the new proposals, the Social Health Insurance Fund (SHIF) will provide coverage for various medical services. Expectant mothers undergoing a normal delivery will receive a standard delivery fee of Sh10,000.

For those requiring a caesarean section, SHIF will cover up to Sh34,200 for a maximum hospital stay of three days. Kidney patients needing dialysis will benefit from full coverage of their procedures.

Specifically, patients with acute kidney injury will be eligible for up to five dialysis sessions, with SHIF covering three sessions and the Emergency, Chronic, and Critical Illness Fund (ECCIF) covering the remaining two.

Oncology services will see SHIF covering up to Sh400,000 for surgeries, chemotherapy, radiotherapy, hormone therapy, and immunotherapy. Additionally, ECCIF will contribute up to Sh250,000 for these services. Coverage includes screening and treatment for cancers such as breast, prostate, colorectal, cervical, and childhood cancers.

Mental health care will also be improved under SHIF, offering support for chronic substance use disorders, including addiction to alcohol, tobacco, cannabis, heroin, mandrax and cocaine.

The insurance will cover a three-stage treatment programme, including rehabilitation, with a total of up to Sh139,000 available for rehabilitation and addiction disorders.

Mental health services will be accessible at level 4, 5, and 6 facilities, though some services will remain uncovered, requiring patients to pay out of pocket.

Excluded from coverage are fertility treatments, weight management drugs, nutritional supplements, vaccines not part of the Kenya Expanded Programme on Immunisation (KEPI), products not listed in the Kenya Essential Medicine List (EML) and the Kenya Essential Diagnostics List (EDL), medical costs associated with research and clinical trials, smoking cessation aids, and care related to epidemics and pandemics. Additionally, admissions to private wards, sanatoriums, or old people’s homes will not be covered.

Healthcare providers will be compensated at a rate of Sh900 per person per year under a capitation model, where they receive a fixed amount to deliver services. Providers must cover any costs exceeding this budget themselves.