The Ministry of Health has revealed that private insurance will provide complementary health coverage to expand the services available under the Social Health Authority (SHA).
In a statement on Monday, the ministry stated that private insurers will, from today, complement the services offered by the government scheme with additional plans, including overseas care, elective procedures, and premium add-ons.
Furthermore, the two parties have agreed to co-finance treatment of chronic illnesses under SHA's Emergency, Chronic, and Critical Illness Fund (ECCIF).
The decision was made after Health Cabinet Secretary Aden Duale held a meeting with the Chief Executive Officers of Medical Insurance Companies in Nairobi on Monday, August 18, to deliberate on areas of partnership in the health sector, especially through SHA.
According to the ministry, the partnership will also see the insurers linked to SHA's centralised claims platform to allow real-time verification of claims, faster processing, and prevention of double-billing.
The ministry and the insurers have further assured that they will harmonise the accreditation criteria to ensure that all Kenyans receive quality healthcare regardless of whether they are under the SHA or private schemes.
"The Health Cabinet Secretary today held a bilateral meeting with the CEO of Medical Insurance Companies at Afya House, Nairobi, to explore areas of partnership, particularly with the SHA, aimed at expanding access to quality and affordable healthcare for all Kenyans, regardless of age or economic status," the ministry stated.
In an effort to eliminate fraud in the medical scheme, the ministry and the insurers will also establish anti-fraud measures, including biometric verification, joint audits, and a shared database to weed out fraudulent health providers.
"In his remarks, CS Duale acknowledged structural challenges facing the health system, noting that the Ministry is addressing them through laws and data-backed reforms to restore public trust. He called for a Public–Private Collaborative framework between MoH, SHA, the Association of Private Insurers, and IRA — starting with tariff alignment, data sharing, and fraud elimination," the ministry stated.
The announcement comes hours after the ministry announced a temporary pause of the SHA overseas package for the next 30 days to pave the way for key policy changes in the package.
In a statement on Sunday, August 17, Duale claimed that the changes are aimed at encouraging more Kenyans to seek treatment locally.
Under the new rules, SHA will only cover overseas treatments that are not available in Kenya. According to Duale, several services, which were once sought abroad, are now available in Kenya, including PET scans, advanced imaging, kidney transplants, open-heart surgeries, and joint/spinal surgeries.
Furthermore, according to Duale, overseas hospitals must be formally contracted by SHA, hold accreditation in their home country, and be recognised in Kenya for patients to qualify for coverage, and they will also be required to have a Memorandum of Understanding (MOU) with a Kenyan Empanelled and contracted facility.
"The law provides for treatment outside Kenya at a rate of KES 500,000 per person per annum, strictly for services not available locally. These services are determined annually by the Benefits Package and Tariffs Advisory Panel (BPTAP)," Duale stated.
