What you need to know about SHIF under the Kenya’s Social Health Insurance Act of 2023

The Social Health Insurance Act of 2023 created the Social Health Insurance Fund (SHIF), an extensive public health insurance program managed by the government in Kenya.

On October 19, 2023, the Social Health Insurance Act of 2023 was approved by the president. It brings about a number of important changes to the way health and care services are provided in Kenya.

The primary goal of the Act, also known as “SHIA,” is to create a legislative framework for Universal Health Coverage (UHC), which will enhance the equity, affordability, and quality of public health insurance coverage. It also aims to make primary and preventive health care services accessible to a wide range of patients, regardless of their age, financial status, family structure, or living arrangement.

The National Health Insurance Fund (NHIF), the state parastatal in charge of Kenya’s public healthcare system since its founding in 1966, will finally and permanently be replaced by SHIA, which is at the core of the improvements it has brought about.

Low- and middle-class individuals and families are the primary objective of SHIF, in contrast to NHIF. When SHIF is completely implemented, Kenyan citizens and those in the country legally will be expected to have health insurance coverage.

NHIF provided healthcare benefits to working people, particularly civil servants, who were automatically enrolled in the program and made active contributions. SHIF is unique in that, through the application of its three special funds—the Primary Healthcare Fund, the Emergency, Chronic and Critical Illness Fund, and the Social Health Insurance Fund—the government will be strategically investing in public health through the expansion and, consequently, citizens’ access to clinical preventive care.

Differences between SHIF and NHIF

• While all Kenyan nationals over the age of eighteen are entitled to register for NHIF membership, SHIF registration is required for all citizens. Enrolment will start at birth for all children born after SHIF becomes operational later in October.

• When it comes to beneficiaries in both SHIF and NHIF the contributors, their spouses, individuals under 21 years old who live with their contributor and have no source of income, individuals under 25 years old who are enrolled full-time in college or university, and individuals with disabilities who live with their contributor and are completely dependent on them are the beneficiaries.

• Under a memo that went into effect in January 2020 stated that you can have up to six dependents on your NHIF card, which includes your spouse and five kids.  On the other hand, the government has clarified that Kenyans can register an infinite number of dependents per household under SHIF, provided that they are members of the major member’s nuclear family, which includes children and legally declared spouses.

• Employees of the National Health Insurance Fund (NHIF) who are salaried used to contribute to the fund according to an earned salary scale, with a minimum of Ksh150 and a maximum of Ksh1,700. However, SHIF has a standard rate that is capped at 2.75% of their salary plus additional deductions that their employers will make to the Primary Healthcare Fund, which is used to pay for primary healthcare services from primary healthcare facilities. Below is a comparison of deductions or contributions between SHIF and NHIF.

By the ninth day of every month, an employer is required to take out a salaried contributor’s contribution and submit it to the Authority on the employee’s behalf at the specified rate.
If a household does not receive its income from a salaried job, a monthly payment equal to a percentage of the household’s income will be made each year by the Authority.

A person’s eligibility for SHIF healthcare benefits is contingent upon their current and active contributions to the Social Health Insurance Fund.