Patients seeking overseas treatment will now need to wait an additional 30 days to receive clearance from the Social Health Authority (SHA). Health Cabinet Secretary Aden Duale announced the changes on August 17, 2025, to align the package with the law and allow for system upgrade.
CS Duale has urged Kenyans to pursue available treatment locally, as the overseas package of Ksh500,000 will only cover treatments not accessible within the country.
The SHA Overseas Treatment Benefit Package under the Social Health Insurance Act, allows for treatment outside Kenya at a set annual rate of Ksh500,000 for services not available locally.
The new system aims to connect all stakeholders, including members, referring specialists, local hospitals, the Kenya Medical Practitioners and Dentists Council (KMPDC), the Ministry of Health, overseas facilities, and the SHA.
The SHA notes that several services previously sought abroad, such as PET scans, advanced imaging, kidney transplants, open-heart surgeries, and treatments for joint or spinal injuries, are now available in Kenya.
Duale urged Kenyans to use contracted local hospitals with the capacity to provide these services.
He said the Benefits Package and Tariffs Advisory Panel is finalizing the official list of treatments eligible for overseas referral.
Additionally, Duale said SHA will publish the list on its website and other channels as soon as it is ready.
SHA Requirements from Overseas Hospitals
Overseas hospitals must be formally contracted by the SHA.
The hospitals must hold accreditation in their home country and be recognised in Kenya.
They must also demonstrate links to a local, empanelled, and contracted health facility through a memorandum of understanding (MoU).
The process requires overseas hospitals to request pre-authorisation before the patient travels.
Also Read: Govt Changes SHA Medical Approval System for Patients and Hospitals
Hospitals must notify the SHA upon patient admission and discharge. Subsequently, they submit claims online for adjudication and payment.
Patients will then be able to access follow-up care through the linked local facility upon their return.
The system is expected to be fully operational within the next 30 days.
SHA is aligning with the law, has started contracting, and is implementing a new system to improve coordination among all stakeholders.
Also Read: EXPLAINED: Circumstances When SHA Cannot Cover Your Treatment Abroad
Overseas Treatment Process
- Preauthorization
Overseas hospitals will request preauthorization before the patient travels.
- Notification
Hospitals must notify SHA on the admission and discharge of patients.
- Claim
Submit claims online for adjudication and payment.
- Follow-up Care
Upon return, patients will access follow-up care in Kenya through the linked local facility.
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