Explainer: The Social Health Authority (SHA)

On October 1, 2024, the Ministry of Health officially launched the Social Health Authority (SHA) to replace the National Health Insurance Fund (NHIF). The new entity aims to achieve universal health coverage by providing affordable, accessible, and quality healthcare services to all Kenyans. Established under the Social Health Authority Act, 2023, the scheme mandates all workers to contribute 2.75% of their gross salary to the fund.

SHA)was established to manage social health insurance in the country. The SHA has three funds: the Primary Healthcare Fund, the Social Health Insurance Fund, and the Emergency, Chronic and Critical Illness Fund. Healthcare providers in Kenya can contract with the SHA to provide healthcare services to beneficiaries. This blog post will provide an overview of the SHA and its contract with healthcare providers.

Why SHA?

Here are some of the benefits of SHA:

• Wider Coverage & Inclusivity – Unlike the NHIF, which primarily targeted the formal sector and employed individuals, SHA aims to provide health insurance for every citizen, including those in the informal sector and vulnerable groups who have been historically underserved.
• Revised Premiums & Contributions – SHA has a tiered contribution system that factors in the income levels of contributors. This system will replace the flat rate under the NHIF, making the insurance model more progressive and equitable.
• Comprehensive Benefits Package – SHA covers a broader spectrum of health services, including outpatient services, chronic disease management, and maternal and child health, which aligns with the Universal Health Coverage goals.

Under this new regime, the minimum monthly contribution has come down to Ksh. 300 from Ksh. 500 under the NHIF.

SHA is the overall manager that keeps track of the three separate accounts, namely:

• The Primary Health Care Fund

It is fully funded by the government. All Kenyans registered for SHA will be automatically registered for the Primary Healthcare Fund. It is used when visiting level 2 and level 3 facilities or upon referral by community health promoters, where patients are treated for free.One will be able to access promotive, preventive, curative, rehabilitation, palliative care and referral services from this fund.

• The Social Health Insurance Fund (SHIF)

This is funded by taxpayers using the 2.75% of gross salary contributions. It is primarily used in levels 4, 5 and 6 , and will only be accessed through a referral from a primary health facility.

• The Emergency Chronic and Critical Illness Care Fund (ECCIF)

It is a special fund that caters for emergencies and chronic illnesses, after exhausting limits under the Social Health Insurance Fund.

SHA Benefits Packages and Tariffs

The SHA offers a variety of benefits packages to its beneficiaries. These packages cover a wide range of healthcare services, including outpatient care, inpatient care, maternity care, renal care, mental healthcare, overseas treatment, surgical services, oral health services, ambulance evacuation services, accident and emergency services, critical illness care, palliative care services, and assistive devices.

The specific services covered under each package are listed in the SHA’s tariffs document, which is annexed to the contract between the SHA and healthcare providers. The tariffs document also specifies the rates that healthcare providers will be paid for providing these services. For example, the tariff for a normal delivery and essential newborn care is KES. 10,000.

SHA Registration

Who Needs to Register?

Registration for SHA is mandatory for every resident of Kenya. This includes:

• Children: Parents are encouraged to register their school-going children as dependents under their SHA membership.
• Employers: Businesses must register their employees and remit contributions on their behalf.

This initiative is part of the government’s broader agenda to achieve UHC in Kenya, ensuring that healthcare is accessible and affordable for all.

Registration Process for Individuals

How to Register via USSD

One of the simplest ways to register for SHA is through the USSD code *147#. Here’s how:

1. *Dial 147# on your mobile device.
2. Accept the SHA terms and conditions when prompted.
3. Enter your Kenyan ID card number and first name for verification.
4. Confirm your details and proceed with entering additional information as requested.
5. Await a confirmation message indicating successful registration.

This method is user-friendly and allows individuals without internet access to complete their registration quickly.

How to Register Online

If you prefer online registration, follow these steps:

1. Visit the Official SHA Website: Go to sha.go.ke.
2. Click on Registration: Find the option for individual registration on the homepage.
3. Fill Out the Registration Form: Provide necessary details such as:
   • Full name
   • Occupation
   • Date of birth
   • Marital status
   • KRA PIN (Kenya Revenue Authority Personal Identification Number)
   • Address and contact details

4. Review Your Information: Ensure all details are accurate before submitting.

5. Verify Your Account: Follow instructions sent to your email or phone to verify your account.

Online registration provides a convenient way for tech-savvy individuals to complete their registration at their own pace.

Registration Process for Employers

Creating an Employer Account

Employers play a crucial role in the SHA registration process by registering their employees. Here’s how employers can set up an account:

1. Access the SHA Employer Portal: Visit sha.go.ke and navigate to the employer section.
2. Create an Account: Fill out required details about your business, including:
   • Business Registration Certificate
   • KRA Certificate
3. Verify Your Account: Follow verification steps similar to those for individual accounts.

Registering Employees

Once registered as an employer, you can add employees:

1. Log into Your Employer Account: Access your dashboard.
2. Enter Employee Details: Provide information such as names, ID numbers, and dependents.
3. Submit Registration: Review all entries before submitting.

Managing Contributions

Employers are responsible for remitting contributions on behalf of their employees:

• Contributions are calculated at 2.75% of each employee’s gross salary.

• Use the employer portal to make monthly remittances easily.

Frequently Asked Questions (FAQs)

What happens if I miss the registration deadline?

If you miss the registration deadline, you may not be able to access healthcare benefits under SHA until you complete your registration during a subsequent enrollment period.

Can I register my family members?

Yes, you can register your dependents, including children, under your SHA membership.

What if I don’t have a KRA PIN?

While having a KRA PIN is recommended for online registration, alternative identification methods may be accepted during in-person registrations at designated centers.

How do I update my information after registration?

To update your information, log into your account on the SHA website or contact customer support through their official channels.

Benefits of Registering for SHA

Registering for SHA offers numerous advantages:

• Comprehensive Coverage: Access a wide range of healthcare services including preventive care, hospitalization, and specialized treatments.
• Universal Health Coverage: Contributes towards achieving UHC in Kenya by pooling resources for better healthcare delivery.
• Financial Protection: Reduces out-of-pocket expenses during medical emergencies or chronic illnesses.