Kenyans seeking specialised medical care abroad now have eight hospitals cleared for treatment under the Social Health Authority’s overseas referral scheme, which is set to start next week.
The move comes months after the benefit was suspended, with the Ministry of Health confirming that only procedures not available in Kenya will qualify for the Sh 500,000 cover.
Social Health Authority CEO Mercy Mwangangi told the Senate that the first batch of foreign hospitals has now been approved for patient referrals.
The approved hospitals include Manipal Hospitals, Yatharth Hospital, Sitecare Hospital, KIMS Hospital, and Sarvodaya Hospital in India; Acibadem Group of Hospitals and Medical Point Izmir Hospital in Turkey; and SAGE Group in Saudi Arabia.
“So far we have eight groups of hospitals that are now going to be accessible overseas to Kenyans next week. The process of enrolling hospitals for overseas treatment is continuous. We will be using an SPP procedure and this list will be changing as more and more providers apply," Mwangangi said, noting that additional facilities are still undergoing training on the SHA claims system.
She explained that the referral process starts with an assessment at a recognised health facility in Kenya. If a doctor confirms that the treatment required is not available locally, a formal referral letter must be issued and submitted to SHA.
The chosen foreign hospital, once logged into SHA’s system, will electronically request admission. SHA will then verify that the patient is an active member and has paid premiums before authorising treatment.
After approval, the patient will travel for care, and upon discharge, the hospital abroad will submit a discharge summary and a claim for payment within the Sh 500,000 limit. Patients are also required to report to a designated local facility for follow-up care upon returning to Kenya.
Health Cabinet Secretary Aden Duale said the overseas treatment package is strictly for cases not treatable locally. “SHA will only pay for overseas treatment if the procedure is not available locally. We have capped the maximum payable amount for these overseas treatments at Sh 500,000,” he said.
Duale added that all foreign hospitals must maintain formal links with local facilities to ensure continuity of care once patients return.
Speaking at a Senate retreat in Naivasha, he also addressed claims of financial losses at SHA, saying, “I wish to categorically state that there has been no loss of Sh 11 billion from the Social Health Authority. This figure, which currently stands at Sh 12.7 billion as of today, represents claims that were flagged, rejected, and unpaid by our new digital gatekeeper. Therefore, this represents money saved, not lost.”
Meanwhile, in Nairobi, a suspect linked to SHA fraud was arraigned in court facing multiple charges.
Harun Liluma is accused of conspiracy to defraud and operating an unlicensed health facility.
Court records indicate that he and others allegedly accessed regulatory systems and altered records to unlawfully register several health facilities, enabling them to fraudulently claim over Sh 12 million from SHA. Liluma was released on Sh 4 million cash bail as investigations continue.
