The Social Health Insurance Act 2023 regulations establishes the Social Health Authority (SHA) to replace the National Health Insurance Fund (NHIF)
Health Cabinet Secretary (CS) Susan Nakhumicha on January 25 appointed a 10-member transition committee to lead the enactment of SHA.
“”With all the staff of our Ministry of Health and members of SAGAs from the Ministry of Health, we have engaged on the Social Health Act and regulations.
The staff have asked questions, and they have been answered. Now, every member of staff of the Ministry of Health is an ambassador to disseminate this information,” said the CS after unveiling the SHA transition committee.
This comes after the court lifted orders against the implementation of the Social Health Insurance Act 2023.
This article provides answers to five common questions Kenyans are asking about the new health fund.
What are the funds included under the New Fund
SHA establishes Funds namely, Primary Health Care Fund, Social Health Insurance Fund (SHIF) and the Emergency Chronic and Critical Illness Fund.
The purpose of the Primary Healthcare Fund shall be to purchase primary healthcare services from health facilities. The capital of this fund will include appropriation from the National Assembly.
All citizens will be registered as members of SHIF including children born after the commencement of the Act who will be registered at birth.
It will consist of funds from, contribution under the act, appropriation by the National Assembly for indigent and vulnerable persons, National and County governments employees and any other employer.
Additionally, the Emergency Chronic and Critical Illness Fund shall be used for financing the costs and management of chronic illnesses after the depletion of the SHIF and to cover emergency treatment costs.
Who benefits from the commitments made by SHA?
According to the MOH, all Kenyans benefit from the commitments made by the new fund, including the elimination of fundraising for medical expenses and the provision of free healthcare access at level 1, 2, and 3 facilities through SHA registration.
This marks a significant step towards comprehensive healthcare coverage for the entire population.
What are the Changes in Contributions?
SHA introduces a 2.75% contribution of the gross salary for the salaried Kenyans remitted on the ninth day of each month.
Those in the informal sector will also contribute 2.75% of their income.
“We have developed a means testing tool to be able to be able to analyze the income to determine estimates of income and that is what we are going to rely on.
Like the Ministry of Education has used a means testing to be able to determine the bursaries that they are going to give students so it’s going to be unique to us,” said Nakhumicha in a past interview.
The contributions will be compulsory for all adults and shall not be less than Ksh.300.
Under SHA, it will be compulsory for all foreigners visiting the country for more than 12 months to enlist and contribute to the social health insurance scheme.
This is a shift from NHIF where salaried people were compelled to contribute between Ksh.150 and Ksh.1700 depending on their income.
Kenyans earning Ksh20,000 were deducted Ksh750, while those getting Ksh50,000 paid 1,200.
Those earning Ksh100,000 and above were deducted Ksh1,700.
Those in the informal sector contributed Ksh.500 per month, this was, however, not compulsory.
What happens if one cannot afford to contribute?
The national or government will not pay for Kenyans who cannot afford the scheme.
“Remember we have hustler fund; they have people have onboarded the fund and for your credit limit to be determined it is based on your income.
In SHA, we want to leverage on that. Should you not be able to pay your contributions you can borrow money from hustler fund and pay for your premium, “Nakhumicha explained in a past interview.
Do NHIF members automatically become members?
No. Social Health Authority management will conduct a new registration exercise. This includes hospitals under NHIF who will apply afresh to be SHA accredited.
Every person resident in Kenya will have to apply for SHA membership within 90 days upon its implementation and get a social health insurance number.
Contributors will provide a l list of beneficiaries just like in NHIF.