The government is set to roll out the Social Health Authority (SHA) on October 1, 2024, automatically phasing out the National Health Insurance Fund (NHIF).
SHA will deliver its mandate through three funds including the Primary Healthcare Fund (PHC), the Social Health Insurance Fund (SHIF) and the Emęrgency, Chronic, & Critical Illness Fund (ECCIF).
Through SHA, Kenyans who register will be eligible for a number of benefits, which will be delivered through the SHA Primary Healthcare Fund.
SHA PHC benefits
The SHA Primary Healthcare Fund will ensure service for all regardless of payment status.
Services under this Fund are freely available in level 2 and 3 facilities for registered individuals, except for complex conditions that will require one to be paid up.
Outpatient benefits will include consultation, lab tests, medicine, counselling and mental support, Kenya Expanded Programme on Immunization (KEPI) vaccines, and services for expectant mothers including delivery.
Patients registered for SHA PHC will get screening for common conditions and targeted screening for cancęr, eye tests and treatment, and eyeglasses for children under 18 years.
For inpatients, Kenyans will enjoy the management of diseasę while admitted to a Level 3 hospital. This will include admission costs, x-rays and ultrasound, medicine, physiotherapy, oxygen, bloòd products, and follow-up after discharge.
In case one dięs, the fund will cater for mortuary services and storage costs.
SHA ECCIF Benefits
The SHA ECCIF cover is aimed to ensure families do not go bankrupt because of a loved one contracting a condition like cancėr, kidney disėase requiring dialysis, and other similar situations.
These benefits under this cover include transportation to the nearest hospital, cover for heart attàcks, breathing difficulties, major traumà, shock, seizures, snake bites, dog attàcks, and critical care admission in ICU or HDU in level 4 to level 6 hospitals.
The cover will also provide palliative care which entails enhancing the quality of life of patients with chronic or life-threatening illnesses and also provision of hearing aids for children under 18 years, wheelchairs, crutches, clubfoot brace, walking frames, and therapeutic footwear.
For chronic illnesses, the scheme will cover costs for admission, dialysis, therapy after kidney transplant, management of càncer, and inpatient mental health support.
SHIF benefits
SHIF will function similarly to the NHIF, by pooling resources to cover all Kenyans under the SHA essential benefit package in line with the Universal Health coverage objectives.
The SHIF benefits include enhanced outpatient services inclusive of lab diagnostics for diabetes, heart disėase, sickle cell anaemia, and asthma in level 4 to level 6 hospitals.
For inpatients, the scheme will cover the management of disėases while admitted to Level 4 to Level 6 hospitals. This will include admission costs, x-rays and ultrasound, medicine, physiotherapy, oxygen, bloòd products, and follow-up after discharge.
The scheme also covers Level 2 to Level 6 hospitals for normal, assisted and Ceaserian deliveries, aftercare for mother and newborn; operation, treatment and maternity ward costs; lab tests, bloòd products and oxygen; managing infėctions, birth traumas, childbirth-related conditions and family planning.
For renal services, SHIF covers enhanced management in Level 3 to Level 6 hospitals for dialysis, routine lab tests, catheter insertion and removal, medicine, consultation and review, and kidney transplant including pre and post-operation services.
SHIF also provides medical imaging coverage including MRI, CT scans, mammography, echo, EEGs, specialised ultrasounds and reviewing and reporting of the imaging findings.
For surgeries, SHIF provides coverage in Level 3 to Level 6 hospitals for pre-operation admission and care; all levels of surgeries including specialized procedures such as organ transplants and implants; required services related to the procedure; required tests, and post-surgery services.
For cancėr management, SHIF provides coverage in Level 3 to Level 6 hospitals for radiotherapy, chemotherapy and other treatments, consumables for treatments, lab investigations, blood products, surgical procedures, and more.
The scheme also covers costs for overseas treatment for medical and surgical procedures that are not available in Kenya.
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