The board of Social Health Authority (SHA) held a consultative meeting with all service providers in the healthcare industry with an aim to iron out issues derailing the transition from the National Health Insurance Fund (NHIF) to the Social Health Insurance Fund (SHIF).
SHA chairperson Abdi Mohamed noted that the Ministry of Health is committed to providing health services as enshrined in the constitution ensuring no registered SHA beneficiary is denied health care services.
In the meeting, the authority’s chairperson noted that the SHA e-claims are up and running with a total of 10,904 end users being trained and enrolled and their credentials sent. SHA also confirmed it would refund all patients who paid medical bills out of pocket when its systems failed. The chairperson, therefore, directed all affected patients who experienced the problem to contact the Authority.
Dr Abdi Mohamed confirmed that services are currently available on the SHA e-claim portal. He, however, urged Kenyans to add their dependents for them to access healthcare services as well.
A hospital ward in Kenya.
Photo
Kenyans.co.ke/Murang’a GH
“We have also noted that most beneficiaries are registering but not adding their dependants. We call upon all to add their dependents for them to access healthcare services as well,” he stated.
He clarified that registered SHA beneficiaries are entitled to free access to primary healthcare services under the primary healthcare fund at Levels 2 in dispensaries, Level 3 in health centers, and selected Level 4 facilities.
For healthcare providers who have not received credentials, SHA has circulated a provider service portal on-boarding form with healthcare providers encouraged to fill and submit the forms immediately.
“We have so far registered 12,704,548 members into the Social Health Authority. This number includes verified members who were under the defunct NHIF and who have been transitioned to the Social Health Authority as per Legal Notice No. 147 of 2024,” the SHA chair revealed.
Mohamed assured that the health insurance claims system is still in operation to facilitate member verification as well as for claims management.
“We have also made sure the health insurance claims system (HICS) is operating under the defunct NHIF and continues to be in operation for member verification, discharge of patients admitted before October 1, 2024, and for claims management of actively enhanced schemes whose contracts have not yet expired.”
On the issue of the pending bills and bills arising during the transfer during the transition, health providers agreed with SHA that a joint committee chaired by the Principal Secretary State Department for Medical Services shall be constituted to undertake verification of all pending bills incurred under the defunct NHIF.
While also addressing the press, Brian Lishenga, the chairperson of the Rural and Urban Private Hospitals Association (RUPHA), confirmed they had agreements with SHA that NHIF portal remains open for health facilities to return contracts so as to commence offering services to those who have registered on SHA.
A side-to-side image of President William Ruto and the National Health Insurance Fund (NHIF) building in Nairobi.
William Ruto
