The Ministry of Health has clarified the provisions of the Overseas Treatment Benefit Package under the Social Health Insurance Act, 2023.
Health CS Aden Duale said the package allows Kenyans to access treatment abroad at a rate of Sh500,000 per person per year, but only for services that are not available locally.
"SHA is currently aligning with the provisions of the law and has commenced the contracting process. The new system will connect all stakeholders, including members, referring specialists, local hospitals, the Kenya Medical Practitioners and Dentists Council, the Ministry of Health, overseas facilities, and SHA, ensuring seamless coordination," Dual said in a statement on Sunday.
He said the services covered will be reviewed annually by the Benefits Package and Tariffs Advisory Panel (BPTAP).
Duale said the Authority has already begun aligning with the new law and has started the contracting process.
The system will involve members, specialists, local hospitals, the Kenya Medical Practitioners and Dentists Council, the Ministry of Health, and overseas facilities.
According to the CS, overseas hospitals must meet strict requirements before they can offer services under the package.
They must be formally contracted by SHA, hold accreditation in their home country with recognition in Kenya, and demonstrate linkages to a local health facility through a Memorandum of Understanding.
Duale said hospitals abroad must request preauthorization before patients travel.
They will be required to notify SHA upon admission and discharge, submit claims online, and ensure that patients receive follow-up care in Kenya through the linked local facility.
The CS noted that several medical procedures that once required patients to travel abroad can now be done locally.
These include PET scans, kidney transplants, open-heart surgeries, and joint or spinal surgeries.
The CS encouraged 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 that will qualify for overseas referral.
The CS said SHA will publish the list of treatments as soon as possible on its website and other channels.
The system is expected to be fully operational in the next 30 days.
