Kenyans will still have access to medical treatment abroad under the newly introduced Social Health Insurance Fund but only after fulfilling a number of requirements
In a set of regulations released on Tuesday by Health CS Susan Nakhumicha, the Fund will contract several health facilities abroad to cater to Kenyans with health emergencies.
All those seeking treatment abroad through the Insurance Fund will, however, first have to ensure that their contributions are up to date.
Furthermore, they should prove that the treatment sought in foreign countries is not available in Kenya.
"A beneficiary may access treatment outside Kenya where the treatment sought is being provided by a healthcare provider or health facility contracted by the Authority," reads part of the regulations.
The beneficiary will also be required to request authorisation from the Social Health Authority, on which Francis Atwoli and Dr Patrick Amoth are members.
While seeking approval, they should provide a duly filled form prescribed under the Medical Practitioners and Dentists Act.
The patient should also provide a referral for overseas treatment from the treating doctor or consultant submitted online as prescribed.
The referral should contain the name of the receiving healthcare provider, the diagnosis of the beneficiary, the medical history, clear reasons for the referral, and the signature of the treating doctor or consultant.
Once submitted, the Claims Management Office will access the information provided to verify whether the service sought is not available in Kenya.
The office will also check whether the healthcare provider is registered with the Authority and whether the money required is within the limits of the patient's package.
"Where the Authority approves the request, the Authority shall undertake to pay for the treatment sought at the health facility outside Kenya based on the tariffs prescribed," the regulations indicated.
Kenyans usually fly out for specialised treatment for illnesses such as cancer and heart-related diseases. Countries Kenyans frequent for treatment are India and the UK.
The new insurance fund comes in place to replace the National Health Insurance Fund (NHIF) and is aimed at offering medical services to Kenyans.
