The Social Health Authority (SHA) has issued guidance to contracted healthcare providers on the required documents for submitting healthcare claims for children under alternative care arrangements.
In a notice dated July 16, SHA said it had observed inconsistencies in the documentation submitted in support of claims for children in alternative care.
The authority said the guidance is intended to promote consistency in claims processing and ensure uninterrupted access to healthcare services for eligible beneficiaries.
According to SHA, healthcare providers must submit specific legal documents depending on the type of alternative care arrangement under which the child is living.
SHA Required Documents For Children Living with Guardians
SHA has since outlined the minimum documentation required for different categories of alternative care as shown below:
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- Adopted children: A certified adoption order.
- Children under legal guardianship: A deed or will appointing the guardian, or a certified guardianship order.
- Children in kinship care: A custody order or a letter from a Children’s Officer confirming the kinship care arrangement.
- Children in foster care: A letter from the Children’s Services confirming approval of the foster care placement or a relevant court order.
- Children living in charitable children’s institutions (children’s homes): A court committal or care order together with the child’s admission record.
- Children placed under court orders: A certified court order.
- Children under parental responsibility arrangements: Legal documents such as a guardianship order, residence order or a fit person order.
- Children under Kafaalah arrangements: A Certificate of Registration (Form CK10) or a Placement Certificate (Form CK9).
In the notice, SHA said the guidance provides the minimum documentary requirements applicable to the various categories of alternative care and is expected to help streamline the processing of healthcare claims.
Children living under alternative care arrangements, including adoption, guardianship, foster care, kinship care and children’s homes, can access healthcare under the Social Health Authority once their legal relationship with a registered caregiver has been verified.
The authority said the required documents help healthcare providers confirm a child’s eligibility before submitting claims, reducing delays caused by incomplete or inconsistent documentation.
Healthcare providers requiring further clarification have been advised to contact the authority through its toll-free number, 147.
SHA Benefit Package
Children in alternative care who are successfully enrolled and verified with SHA are eligible to access healthcare services covered by the national health scheme.
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The documentation required by the authority helps healthcare providers confirm a child’s legal care arrangement before submitting reimbursement claims.
Under SHA’s “Bima Bora, Afya Nyumbani” benefit package, members have access to a wide range of healthcare services.
Outpatient services are available without a limit on the number of visits, while inpatient care is covered for up to 180 days, subject to the applicable daily rebate.
The package also covers emergency treatment during the first 24 hours, diagnostic and imaging services such as CT, MRI, PET, angiography, and ultrasound, as well as maternity care, mental health services, and rehabilitation.
The package also covers treatment for chronic and serious illnesses. Cancer care is covered up to KSh800,000, while eligible members can access up to KSh1.12 million for high-cost treatments.
Patients requiring renal dialysis are entitled to up to two sessions per week, while intensive care unit (ICU) services are covered at KSh28,000 per day for up to 12 days.
SHA also provides limited support for overseas treatment where necessary, subject to eligibility requirements.
The authority says the benefit package has no exclusions based on pre-existing medical conditions or age.
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