Government rolls out SHA overseas benefits criteria

Government rolls out SHA overseas benefits criteria. [File, Standard] The government has unveiled a framework to facilitate access to Social Health Authority (SHA) benefits for Kenyans seeking medical services abroad. In a statement issued on Saturday, September 20, Health Cabinet Secretary Aden Duale said the Ministry has identified 36 healthcare services not available locally, which Kenyans will now be allowed to access overseas under the SHA. The list, which Duale said has been gazetted, is based on recommendations by the Benefits Package and Tariffs Advisory Panel (BPTAP). "This is a preliminary list, as the process of identifying additional interventions is continuous and will be guided by a comprehensive Health Technology Assessment (HTA)," he said. Duale noted that referrals for overseas treatment will be subject to a peer review mechanism by the claims management office to ensure medical necessity. Currently, the Ministry of Health has capped Sh500,000 as the amount payable by the social health scheme for beneficiaries seeking services abroad. This figure, Duale added, is subject to review upon completion of contracting and rate negotiations with accredited providers outside the country. "A beneficiary can only access treatment outside Kenya if the healthcare service is not available locally. The beneficiary's contributions must also be up-to-date," he said. The treatment must also be offered by an SHA-contracted health facility. Additionally, Duale stressed that it must fall within the financial limits of the benefits package and must not be an "unproven, experimental, or unconventional therapy." He further urged the public to ensure that overseas facilities from which they seek services are accredited in their home countries and officially recognised by the relevant regulatory body in Kenya. "These overseas providers must be linked to a contracted health facility in Kenya to ensure continuous follow-up care upon the beneficiary's return," he said. The CS added that the SHA Board has been directed to fast-track the empanelment and contracting of foreign hospitals and publish the official list for public access. This move is aimed at addressing challenges that have left some Kenyans stranded abroad after SHA failed to settle their medical bills. "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, while simultaneously strengthening our national health system," said Duale.

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