The Social Health Authority has warned contracted healthcare providers that failure to agree on new tariffs under the Public Officers Medical Scheme Fund will result in immediate contract termination, as nationwide negotiations kick off on Monday.
SHA issued the notice on Thursday, 24 April 2026, directing all contracted providers to engage in countrywide talks on tariffs, service delivery arrangements and claims management processes under Clause 10.2(c) of the POMSF Addendum.
The negotiations involve stakeholders including the State Department for Public Service, the Teachers Service Commission, the National Police Service, the Kenya Prisons Service, the Kenya National Union of Teachers (KNUT), the Kenya Union of Post Primary Education Teachers (KUPPET) and the Union of Kenya Civil Servants.
During the negotiation period, providers must not charge POMSF beneficiaries any out-of-pocket fees or co-payments — a directive that follows mounting complaints from teachers and civil servants who have been forced to pay cash at hospitals despite holding active cover under the scheme.
"Providers with whom tariffs are not successfully agreed will be notified of termination of the POMSF contract immediately," the notice, signed by SHA Chief Executive Officer Mercy Mwangangi, reads.
The talks, set to conclude within four weeks, form part of a broader SHA effort to standardise reimbursement rates across Level 3 to Level 6 facilities. SHA had earlier completed negotiations with Level 5 and Level 6 hospitals and is now turning to lower-tier facilities.
The negotiations aim to deliver a harmonised, evidence-based reimbursement framework, with the "walk-in, walk-out" principle to apply strictly once talks conclude, barring any co-payments.
Ahead of the negotiations, SHA will hold a virtual information session for providers on Sunday, 27 April 2026, from 3 p.m. to 4 p.m. Providers can register via the SHA website or contact SHA on 0800 720 601.
The rollout of POMSF has been marred by confusion, with teachers encountering new tariffs at hospital reception desks and facing system downtimes that have left many paying out of pocket despite holding active cover.
