Patients to Access Overseas Treatment Through Social Health Insurance

Kenyans can now access treatment abroad through the Social Health Insurance (SHI) scheme under the Social Health Authority (SHA), with the cost capped at Sh500,000.

Health Cabinet Secretary Aden Duale said the move is a major step in ensuring that patients who need life-saving care not available locally can get help.

“This milestone is a testament to the government’s commitment to ensuring that no Kenyan is denied access to life-saving, specialized medical and surgical procedures not yet available locally, while simultaneously strengthening our national health system,” Duale said in a statement.

The announcement follows a review by the Benefits Package and Tariffs Advisory Panel (BPTAP), which identified services that will be eligible for overseas referrals.

How Social Health Insurance Works

Patients will only be referred for treatment outside Kenya if the required service is not available in the country. The treatment must be carried out in an SHA-contracted facility abroad.

The Health Ministry said the overseas hospitals must be accredited in their home countries and recognized by Kenyan regulators. They must also be linked to contracted facilities in Kenya to ensure continuous follow-up care once patients return.

BPTAP has already drawn up an initial list of 36 healthcare services not currently available in Kenya. Referrals for such treatments will undergo peer review by the Claim Management Office to confirm necessity.

The maximum amount payable for overseas treatment is capped at Sh500,000. The Ministry noted that this limit could be reviewed after contracting and negotiations with accredited foreign providers are complete.