The Social Health Authority (SHA) has officially rolled out the final Public Officers Medical Scheme Fund (POMSF) tariffs, benefit package, and access rules for all contracted healthcare providers across Kenya.
The move, announced on April 1, 2026, ensures that services rendered to eligible POMSF beneficiaries are administered in line with the approved tariffs and guidelines, which are now fully integrated into the SHA claims system.
In accordance with the POMSF Addendum, Clause 10.2(c), the SHA conducted a nationwide market analysis during the first three months of the scheme’s commencement and engaged in negotiations with healthcare facilities to finalize tariffs.
These tariffs, now approved by the SHA Board, supersede any interim arrangements previously in place and will guide claims submission, reimbursement, and service access.
“All services rendered to eligible POMSF beneficiaries shall be administered strictly in line with the approved tariffs, benefit package, and access rules configured in the system,” the SHA statement read.
Providers are required to verify beneficiary eligibility through the SHA system prior to service provision and ensure that services follow approved referral pathways and authorization requirements.
The authority emphasized strict compliance, instructing healthcare providers to submit claims in accordance with the approved POMSF tariff structure and refrain from levying any charges outside the approved rates.
Providers must also ensure that their contracts with SHA are up to date and active.
Healthcare facilities are advised to align their internal billing, claims management, and patient access processes to comply fully with the new rules.
SHA highlighted that adherence to the guidelines is crucial to maintaining uninterrupted service delivery to beneficiaries, particularly as the system transitions from the interim arrangements to the final tariffs.
For clarification or support, providers can reach out to their respective SHA County Offices or the SHA Contact Centre at 0800 720 601.
The implementation of the final tariffs marks a critical step in streamlining healthcare payments and enhancing accountability under the POMSF scheme, ensuring that all contracted providers deliver services fairly, efficiently, and in accordance with the approved standards.
