The Social Health Authority (SHA) has outlined the requirements that healthcare providers and facilities must meet as it prepares to start a new contracting cycle on October 1, 2026.
The new contracts will run until June 30, 2029 and will guide SHA’s engagement with hospitals and other healthcare providers offering services under the health insurance system.
SHA said providers will have to submit their details and regulatory documents for review before they can be contracted.
The onboarding process will be done through the Centralised Digital Platform, where facilities will submit the required information and documents for assessment.
“Providers will be onboarded through the Centralised Digital Platform, supported by the submission of the required documents and information for assessment. The process will also involve regulatory validation, know-your-customer verification, technical assessment and financial due diligence,” SHA stated.
Four SHA Funds Covered
The new contracts will cover four funds — the Primary Health Care Fund (PHCF), Social Health Insurance Fund (SHIF), Emergency, Chronic and Critical Illness Fund (ECCIF), and Public Officers Medical Scheme Fund (POMSF).
For primary healthcare providers, the PHCF contract will outline the services covered as well as the obligations of the facilities offering them.
SHA will also assess the digital capacity of healthcare providers before they are contracted.
Facilities will be required to have a functional electronic medical records system or another approved claims system to support digital contracting and claims processing.
They must also be able to submit claims electronically and have internet-enabled devices at points where patients receive services.
Each facility will further be required to appoint an administrator responsible for managing its activities on the SHA digital platform.
Documents Required by SHA
Healthcare providers seeking contracts have been asked to prepare several documents, including a valid facility licence, valid professional registrations, a beneficial ownership declaration and a valid tax compliance certificate.
Facilities must also provide a bank account registered in the official name of the healthcare facility or institution.
A bank confirmation letter will also be required as part of the contracting process.
SHA said providers will additionally be required to sign an undertaking covering anti-fraud, anti-bribery and conflict of interest requirements.
The authority said the requirements are part of the process of validating providers before they are formally contracted to offer services under the four funds during the new contracting period.