With the rollout of the Social Health Insurance Fund (SHIF) around the corner, a large number of Kenyans are still not well versed on the facts regarding the new era of healthcare in Kenya.
From October 1, you will no longer have access to the National Health Insurance Fund (NHIF), which will transition to the Social Health Authority (SHA). Kenyan citizens including dependents will, by law, be required to register as members of SHA.
Ahead of the October 1 deadline, Kenyans.co.ke highlights some of the key issues regarding the transition as Kenyans brace themselves to embrace a new system altogether.
Key dates: As Kenyans continue to register for the SHA, the NHIF continues to be in effect, with the last date for admission being on September 30, 2024. SHA benefits will begin on October 1. As far as contributions are concerned, payments made before October 9 will be credited to NHIF, while those received from November 9 will go to SHIF.
The differences between the new SHIF and NHIF are like night and day, with the government adopting the new model in a bid to ease the burden of healthcare on Kenyans.
SHA funds will be split into three categories; the Primary Healthcare Fund, whose primary source of contributions will be through government funding, the Social Health Insurance Fund (SHIF), which will be facilitated by household contributions and the Emergency Chronic and Critical Illness Fund (ECCIF), which will also run through government funding.
SHA Benefits: One of the biggest pros of the SHA is that primary health services and emergency services will be available to all Kenyans. With NHIF, one had to be registered for the fund and membership needed to be fully paid to access treatment, which was mostly rehabilitation-oriented. and curative. The government has attempted to solve this problem by providing screening for chronic diseases and provision of palliative health care services.
Outpatient care under SHA will also see patients access a broader range of services compared to NHIF, which was mostly limited, especially for patients with chronic conditions. There is also a standardised reimbursement rate for Inpatient care compared to the previous NHIF, where the reimbursement rate varied between public and private institutions.
Under the SHA, patients who need specialised treatment will also enjoy the advantage of having better access to foreign healthcare providers, who will be contracted for services not offered in Kenya. Previously there was no empaneling or contracting of foreign health workers. Also, while the NHIF never covered emergency treatment including resuscitation and stabilisation for various critical conditions, this is set to be covered under SHA.
Patients with permanent disabilities can also access assistive devices, with the new coverage also extending to progressive chronic health conditions. This was previously never covered under NHIF. Another new service added to the SHA is dental care, which was previously not covered under NHIF.
What SHIF means for employers: After a court ruling on September 20, the Social Health Insurance Act, Primary Health Care Act and Digital Health Act all remained in operation, meaning employers would have to comply with the requirements to register for the Social Health Authority (SHA) and make contributions to the SHIF.
Salaried employees will make a contribution of 2.75% of the gross salary, with a minimum contribution of Ksh 300 per month and no maximum limit. This contribution needs to be made by the ninth of the subsequent month. Non-salaried people will contribute 2.75% of the household income with a minimum contribution of Ksh 300.
Households that fail to make their contributions on time will be subjected to a penalty equivalent to 2% of the unpaid contribution for the period in question. Employees' SHI contributions will be primarily managed through the SHA employer portal.
