MoH rolls out new overseas treatment framework under SHI
The framework was developed following a thorough review by the Benefits Package and Tariffs Advisory Panel (BPTAP), which identified services eligible for overseas referral.
The Ministry of Health (MoH) has introduced a new system under the Social Health Insurance (SHI) scheme that allows Kenyans to access specialised medical care abroad when treatments are not available locally.
The initiative is aimed at ensuring no Kenyan is denied life-saving procedures, while also strengthening the country’s healthcare system.
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Health Cabinet Secretary Aden Duale on Saturday said the new framework represents a major step forward.
“This milestone is a testament to the government’s commitment to ensuring that no Kenyan is denied access to life-saving, specialised medical and surgical procedures not yet available locally,” he said in a statement.
The framework was developed following a thorough review by the Benefits Package and Tariffs Advisory Panel (BPTAP), which identified services eligible for overseas referral.
The system replaces the previous arrangement under the now-defunct National Health Insurance Fund and is guided by the Social Health Insurance Act, 2023, its regulations, and the Public Procurement and Asset Disposal Act.
Under the new rules, only beneficiaries with up-to-date contributions whose required medical services are unavailable in Kenya can access treatment abroad.
Furthermore, overseas healthcare facilities must be contracted by the Social Health Authority (SHA), accredited in their home country, and recognised by Kenyan regulatory authorities.
These facilities must also maintain links with local providers to ensure continuous follow-up care after the patient returns.
CS Duale pointed out that the BPTAP has initially gazetted 36 healthcare services for overseas treatment, with plans to expand the list through ongoing Health Technology Assessment.
Referrals will be carefully reviewed by the Claims Management Office to ensure treatments are medically necessary and within financial limits. Unproven or experimental therapies will not be covered.
Financial support for overseas treatment is capped at Sh500,000 per patient, a figure that may be revised after completing contracting and rate negotiations with accredited providers abroad.
Duale emphasised the system’s commitment to transparency and accountability, saying it ensures value for money while providing quality care.
“The Ministry of Health has directed the SHA Board of Directors to proceed with the Empanelment and Contracting of Overseas Facilities and to notify the Public of the List of Contracted Facilities,” Duale added.
The move is expected to streamline approvals for overseas treatment, providing timely and safe access to critical care for Kenyans.
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