The Social Health Insurance Fund (SHIF) replaces the 57-year-old National Health Insurance Fund (NHIF). NHIF underwent numerous reforms to enhance its effectiveness and accommodate Kenyans’ changing healthcare needs.
In 2021, the agency introduced new contribution rates, ranging from a minimum of Sh150 to a maximum of Sh1,700 for employees
SHIF seeks to ensure equity and access to health services by the poor and those in the informal sector, who were left out for the years NHIF has existed.
The SHIF 2.75% Contribution
All workers are expected to contribute 2.75 percent of their salaries towards the new health fund.
Under NHIF, Kenyans were deducted between Sh150 to Sh1,700 for salaried workers and Sh500 for self-employed.
Kenyans earning Sh20,000 were deducted Sh750, while those getting Sh50,000 paid 1,200.
Those earning Sh100,000 and above were deducted Sh1,700.
The maximum cap of Sh1,700 for those earning Sh100,000 or more will be eliminated.
Under SHIF those earning Sh20,000 will be deducted Sh550 with Kenyans getting Sh50,000 paying Sh1,375.
Kenyans earning Sh100,000 will be deducted Sh2,750 and those getting Sh200,000 will pay Sh5,500.
Those earning Sh500,000 will pay Sh13,750 while Kenyans getting Sh1 million and above will pay Sh27,500.
12 key advantages of the SHIF – new Medical scheme:
1. Expanded Coverage: SHIF offers broader coverage, including outpatient services, which NHIF previously limited.
2. Increased Benefit Limits: The new scheme provides higher benefit limits for various medical services, ensuring better financial protection.
3. Access to More Facilities: SHIF will partner with a wider range of healthcare facilities, allowing members more choices for medical treatment.
4. Comprehensive Preventive Care: The scheme emphasizes preventive health services, aiming to reduce long-term healthcare costs.
5. Maternity Benefits: Enhanced maternity coverage is a notable feature, providing more comprehensive support for expectant mothers.
6. Chronic Disease Management: SHIF includes better management programs for chronic diseases, ensuring continuous care for members.
7. Telehealth Services: The introduction of telehealth services under SHIF allows members to consult healthcare professionals remotely.
8. Mental Health Support: Recognizing the importance of mental health, SHIF offers dedicated services for mental health issues.
9. Flexible Payment Plans: The new scheme includes more flexible payment options to accommodate varying income levels.
10. Family Coverage: SHIF allows for family coverage, making it easier for households to enroll their members under one plan.
11. Enhanced Customer Service: Members can expect improved customer service and support for inquiries and claims processing.
12. Transparency and Accountability: The new scheme aims to promote transparency in fund management and service delivery, fostering trust among members.
The unemployed
Contributors not employed or categorized as vulnerable individuals will pay a monthly contribution of Sh1,000, as opposed to the Sh500 initially proposed in the draft regulations of 2022.
The national and county governments will pay contributions to needy Kenyans.
The national government will contribute Sh13,300 on behalf of individuals listed as vulnerable by the State Department of Social Protection.
The mandatory
Contribution to the fund will be mandatory for all adults seeking government services.
The laws also make it compulsory for all foreigners visiting the country for more than 12 months to enlist and contribute to the social health insurance scheme.
Visitors coming into the country for less than a year will need to buy travel health insurance, which must be recognized under Kenyan insurance laws and regulations.
The government is also required to build at least one health facility for every 5,000 of its citizens under the ambitious UHC program.
The Primary Health Care Act, 2023 provides for the construction of community health units nationwide to facilitate delivery and access to primary health care services at the grassroots.
With these benefits, SHIF is positioned to significantly improve healthcare access and quality for its members, marking a transformative step in Kenya’s health insurance landscape.
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