Kenyans brace for higher premiums as SHIF set to launch next week

In four days the government will roll out a new public medical insurance scheme, in the form of the Social Health Insurance Fund (SHIF), geared towards making Kenya's  Universal Health Coverage (UHC) programme a reality.

But as the government accelerates towards the launch date of October 1, 2024, there are weighty questions as to just how prepared the Ministry of Health is ahead of the rollout.

Citizen TV is highlighting some of the challenges faced by the Social Health Authority (SHA), particularly concerning insurance premiums that will significantly reduce the salaries of salaried Kenyans, offering benefits that do not meet the political promises made over a year ago.

These are some of the packages that you should expect starting Tuesday next week.

When the National Hospital Insurance Fund (NHIF) ceases to exist and the new entity takes over on October 1st, contributors currently paying between Ksh.500 and Ksh.1,700 per month will face new pinching realities.

With the introduction of SHIF, Kenyans will be required to pay 2.75 percent of their income. Employed individuals will pay this monthly, while those in the informal sector will make an annual payment in one instalment.

For example, a person earning Ksh.20,000 per month will now pay Ksh.6,600 annually. For someone earning Ksh.100,000 per month, the contribution rises from Ksh.1,700 to Ksh.2,700 monthly.

There is no cap on contributions; for instance, a person earning Ksh.500,000 monthly will pay Ksh.13,750 each month, totalling Ksh.165,000 annually. Top corporate executives earning up to Ksh.10 million per month will face deductions of Ksh.275,000  monthly, or Ksh.3.3 million per year.

In terms of services, every SHA member, regardless of income, will be entitled to a primary healthcare package of up to Ksh.900 per year. This amount will cover primary care consultations, laboratory tests, and prescriptions.

For optical care, each family will receive a limit of Ksh.1,000 shillings per year, regardless of the contribution, while dental coverage will offer a maximum of Ksh.2,000, though this will only be available once there is a budgetary allocation.

For cancer screening, although there are scheduled rates, cancer-specific screening will not be available immediately.

For individuals needing to monitor their blood sugar, an HbA1c test will be financed at Ksh.1,000, but only once a year.

For kidney patients who need to monitor their creatinine levels, the SHA package will cover Ksh.300, also once a year.

Cholesterol monitoring for patients at risk of cardiovascular diseases will be financed at Ksh.300, but only once annually.

Patients requiring hospital admissions in level 4, 5, and 6 hospitals will receive a payment of between Ksh.3,360 and Ksh.4,480 per day—a reduction from the packages proposed during public participation earlier this year, which had a maximum rate of Ksh.5,000  per day.

Each family will be entitled to a maximum of 180 days of hospitalization each year, meaning the highest inpatient coverage provided by SHIF would be just over Ksh.806,000 per family, regardless of the contributions made.

Patients needing overseas care will benefit from a limit of Ksh.500,000 per person per year, provided they seek services at SHA-empaneled healthcare providers abroad.