The Ministry of Health, through the Social Health Authority (SHA), has unveiled a new framework for Kenyans seeking specialized medical care abroad, introducing strict rules and financial limits under the Social Health Insurance (SHI) scheme.

In a press statement issued on Saturday, September 20, 2025, Health Cabinet Secretary Aden Duale said the move, anchored in the Social Health Insurance Act, 2023, and its regulations, is aimed at ensuring transparency, accountability, and value for money in overseas referrals.

Qualifications for SHA treatment abroad

Under the new system, Kenyans will only qualify for treatment outside the country if the service is unavailable locally and their SHA contributions are up-to-date.

The treatment must be offered by an overseas provider accredited in its home country, recognized by Kenyan regulators, and linked to a contracted health facility in Kenya for follow-up care.

“The Ministry of Health, through the Social Health Authority (SHA), is proud to announce a new era for specialized medical care for all Kenyans under the Social Health Insurance (SHI) scheme. This milestone is a testament to the government’s commitment to ensuring that no Kenyan is denied access to life-saving, specialized medical and surgical procedures not yet available locally, while simultaneously strengthening our national health system,” Duale’s statement read in part.

A preliminary list of 36 specialized services not available in Kenya has already been gazetted by the Benefits Package and Tariffs Advisory Panel (BPTAP). This list will be updated continuously based on health technology assessments.

SHA referrals abroad

Referrals will be subject to peer review by the SHA’s Claims Management Office to ensure medical necessity. However, experimental or unconventional treatments will not be covered.

The government has also set a financial cap of KSh500,000 for overseas treatment per beneficiary, subject to review after contracting and negotiations with accredited providers abroad.

“This announcement follows a rigorous, systematic, and evidence-based assessment by the Benefits Package and Tariffs Advisory Panel (BPTAP) to identify services eligible for overseas referral. This new process, unlike the previous framework under the defunct National Health Insurance Fund (NHIF), is guided by a robust legal framework, including the Social Health Insurance Act, 2023, and its attendant regulations and the Public Procurement and Asset Disposal Act,” Duale stated.

The Social Health Authority (SHA) Board of Directors has now been directed to begin empaneling and contracting overseas facilities, after which the public will be notified of approved providers.

“The Ministry of Health has directed the SHA Board of Directors to proceed with the empanelment and contracting of overseas facilities and to notify the public of the list of contracted facilities to facilitate approval of overseas treatment requests in line with the regulations and the MOH guidelines. This new framework guarantees a transparent, evidence-based, and accountable system for Kenyans seeking treatment abroad, ensuring value for money and quality care,” the statement read.