Kenyans will now be entitled to medical treatment abroad of up to Sh500,000 per year for procedures that are not available locally, Health Cabinet Secretary Aden Duale has confirmed.
The benefit is provided under the Overseas Treatment Package of the Social Health Authority (SHA), anchored in the Social Health Insurance Act 2023 and the Social Health Insurance Regulations 2024. Duale said the system will be fully operational within 30 days.
“The new system will connect all stakeholders, including members, local hospitals, overseas facilities, specialists, and regulators, ensuring seamless coordination,” the CS said in a statement.
Strict rules for overseas hospitals
According to SHA, overseas hospitals must be formally contracted, accredited in their home countries, recognized in Kenya, and directly linked to a local health facility through a Memorandum of Understanding (MoU).
Hospitals abroad will also be required to seek pre-authorization before a patient travels, notify SHA on admission and discharge, and submit all claims online for review and payment. Patients will then be required to access follow-up care locally through the partnered Kenyan facility.
Focus on building local capacity
Duale stressed that several advanced treatments once sought abroad are now available in Kenya, including PET scans, kidney transplants, open-heart surgeries, joint replacements, and spinal procedures. He encouraged members to utilize accredited local hospitals whenever possible.
Meanwhile, the Benefits Package and Tariffs Advisory Panel (BPTAP) is finalizing the official list of procedures eligible for overseas referral. Duale said the list will be published “as soon as possible” through the SHA website and other official channels.
“The system is expected to be fully operational in the next 30 days,” the CS reiterated.
