The Ministry of Health has suspended the Social Health Authority (SHA) overseas treatment package for a month to allow new policy changes to take effect.
During the pause, Kenyans seeking SHA support for treatment abroad will have to wait as the government retools the scheme, which is being realigned to encourage more people to seek care locally.
Health Cabinet Secretary Aden Duale said only cases where treatment is not available in Kenya will qualify for coverage once the package resumes.
He noted that procedures often sought abroad such as PET scans, advanced imaging, kidney transplants, open-heart surgery, and treatment for joint or spinal injuries are now being carried out in local facilities.
“To qualify, overseas hospitals must be formally contracted by SHA, accredited in their home countries, recognised in Kenya, and have a memorandum of understanding with an empanelled Kenyan hospital,” Duale said.
The annual cap of Ksh500,000 per patient will remain unchanged.
Under the new rules, overseas hospitals will be required to seek pre-authorisation before a patient travels, notify SHA on admission and discharge, file claims online, and link returning patients to follow-up care in Kenya.
The shake-up follows months of complaints from Kenyans who felt the package was poorly structured.
In January, the Ministry of Health announced it would fast-track a review of SHA benefits instead of waiting two years, citing pressure from patients who had struggled to access care.
Director General Patrick Amoth said the review aims to protect the scheme’s central promise ensuring all Kenyans are covered fairly under the Social Health Insurance Act.
