Concerns raised over low benefits for Kenyans as gov't rolls out SHIF

Concerns have emerged regarding the effectiveness of the upcoming social health medical insurance program, with benefits for Kenyans perceived as significantly lower compared to private medical insurance schemes.

For instance, an employee with a monthly take-home pay of Ksh.100,000 will face a deduction of 2.75%, resulting in a payment of Ksh.2,750 to the medical scheme each month, totalling Ksh.33,000 annually.

For those seeking maternity care under the new model, the reimbursement is Ksh.10,000 for a normal delivery and Ksh.30,000 for a caesarean section. In contrast, other insurers with similar salary contribution scales offer Ksh.20,000 more for a normal delivery and an additional Ksh.20,000 for a caesarean section.

Regarding inpatient services, the new scheme provides Ksh.2,240 per day for a maximum of 180 days per household each year. Other insurers, however, typically cover up to half a million shillings annually, far exceeding the current model’s offerings.

The limits for dental care are also notably lower, with Ksh.2,000 per household per year under the new program, compared to Ksh.10,000 offered by other providers.

Similarly, for optical care, beneficiaries receive Ksh.950 for eyeglasses and a limit of Ksh. 1,000 per household annually. Other providers, however, offer between Ksh.7,000 and Ksh. 10,000 for similar coverage.

Significant inconsistencies exist in the new model regarding emergency, chronic, and critical illness coverage. Emergency services are covered for a maximum of 24 hours, while the SHIF package kicks in after 24 hours. Critical illnesses are covered for a maximum of 180 days under the SHIF.

Additionally, some exclusions include assisted fertility treatments such as IVF, vaccines, cosmetic procedures, and weight management treatment drugs. The plan also excludes nutritional supplements, coverage for epidemics and pandemics, professional fees above prescribed rates, and costs for diagnostic equipment.