Social Health Authority (SHA) Kenya

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Social Health Authority (SHA) Kenya

Overseas Treatment in India for SHA Members - Coordinated by Satyug Healthcare

The Social Health Authority (SHA) is Kenya's universal public health insurance scheme that replaced the National Health Insurance Fund (NHIF) in October 2024. Under SHA's Overseas Treatment Benefit Package, eligible members can access advanced medical care abroad for 36 specialised procedures not currently available in Kenya, with cover capped at KSh 500,000 per patient per year. Satyug Healthcare is a medical travel facilitator in India that helps SHA members navigate the overseas referral process, reach SHA-empanelled hospitals, and manage every logistical detail of the journey - free of charge.

About SHA Kenya & the Overseas Treatment Package

The Social Health Authority was established under the Social Health Insurance Act, 2023 and became operational on 1 October 2024, replacing NHIF as Kenya's primary mechanism for Universal Health Coverage. Coverage applies to all Kenyan residents on registration, with no exclusions based on age, income or pre-existing conditions. Contributions are 2.75% of salary for formal-sector employees (matched by employers), and a flat KSh 300 per month for the informal sector.

The SHA Overseas Treatment Benefit took effect on 14 April 2026, following the empanelment of overseas providers. It is governed by the SHA Claims Management Office, the Benefits Package and Tariffs Advisory Panel (BPTAP) chaired by Prof. Walter Jaoko, and the Kenya Medical Practitioners and Dentists Council (KMPDC).

Key Features of the SHA Overseas Package

Feature	Details
KSh 500,000 Cover	Maximum overseas treatment cover per patient per year - covers medical costs only.
36 Specialised Procedures	Only treatments unavailable in Kenya - including paediatric transplants, bone marrow transplant, proton therapy, complex cardiac & neurosurgery.
Empanelled Hospitals Only	9 SHA-approved hospitals globally (India, Turkey, Saudi Arabia) - 2 in India: KIMS Hospitals and Apollo Proton Cancer Center, Chennai.
Strict Referral Process	Formal referral from a Kenyan empanelled facility plus SHA pre-authorization is mandatory. Self-referrals are not accepted.

Important: SHA covers medical costs only, up to KSh 500,000. Travel, visa, accommodation, food and attendant costs are the patient's responsibility. If treatment cost exceeds KSh 500,000, the balance must be paid by the patient. Satyug Healthcare helps you plan and manage these additional costs transparently.

SHA-Approved Procedures (36 Conditions)

SHA covers only procedures that are not currently available locally in Kenya. The list, reviewed by the Benefits Package and Tariffs Advisory Panel, is grouped into four broad categories:

Category	Examples
Joint & bone surgery	Complex wrist, hand, ankle, hip and knee joint replacements; major bone reconstruction, grafting and advanced limb salvage surgery
Transplants & major complex surgery	Paediatric liver transplant, paediatric kidney transplant, bone marrow / stem cell transplant, complex congenital heart surgery requiring ECMO, voice box (larynx) transplant
Cancer & advanced oncology	Proton beam therapy, intrathecal chemotherapy for retinoblastoma, modern targeted cancer therapies
Other complex & congenital procedures	Foetal blood transfusion and therapy, complex neurosurgical procedures, Transjugular Intrahepatic Portosystemic Shunt (TIPS), and other rare interventions

Adult kidney transplants and standard joint replacements are excluded from the overseas list, as these are now available within Kenya. The full 36-procedure list is maintained by SHA/BPTAP and may be updated periodically.

SHA Overseas Referral & Approval Process - Step by Step

SHA has established a strict, controlled referral pathway to prevent fraud and ensure appropriate use of the overseas benefit. Patients cannot self-refer or seek reimbursement after travelling independently.

Step	What Happens
1. Assessment in Kenya	You are assessed at a recognised SHA-empanelled facility in Kenya (KUTRRH, KNH, Aga Khan, MP Shah or other approved Level 5/6 hospital). A specialist determines whether your condition requires treatment abroad.
2. Formal referral	The Kenyan doctor issues a formal referral to an SHA-approved overseas hospital (KIMS Hospitals or Apollo Proton Cancer Center, Chennai). The referral note is submitted to SHA via the Kenyan facility.
3. Overseas hospital logs request	The Indian hospital electronically logs the admission request into the SHA system. Satyug Healthcare liaises with the hospital's international patient desk to share your reports and ensure prompt registration.
4. SHA verification & pre-authorization	SHA verifies active, paid-up membership and confirms your condition is on the 36-procedure list. The Claims Management Office and KMPDC review the request; once approved, a Pre-Authorization Letter is issued confirming the KSh 500,000 cover.
5. Travel & treatment	With approval secured, you travel to India. Satyug Healthcare coordinates the hospital's Medical Visa Invitation Letter, airport pickup, accommodation, hospital admission and all logistics.
6. Discharge & follow-up	The Indian hospital submits the discharge summary and claim to SHA for settlement within the KSh 500,000 cap. Back in Kenya, you report to a designated local facility for follow-up; Satyug coordinates tele-follow-up with your Indian specialist.

How Satyug Healthcare Helps SHA Members

Satyug Healthcare is not an SHA-empanelled facility ourselves - we are a medical travel facilitator in India who works with SHA-approved hospitals (KIMS and Apollo Proton) to coordinate every non-clinical aspect of your journey. Our services are free of charge to SHA members.

Pre-travel medical coordination - sharing reports with KIMS/Apollo Proton, obtaining treatment plans and cost estimates
SHA documentation support - coordinating with the hospital's international desk to log requests and follow up approvals
Medical Visa Invitation Letter - issued for the patient and up to two attendants
Airport pickup & accommodation - transfer to verified guesthouses/serviced apartments near the hospital

Hospital admission & coordination - doctor scheduling, ward management, daily updates to family in Kenya
Language & cultural support - English and Swahili-speaking team; halal and dietary requirements arranged
Transparent cost planning - clear breakdown of what SHA covers vs. what you pay, no hidden charges
Post-treatment tele-follow-up - scheduled remote consultations with your Indian doctor after you return home

What If Your Condition Isn't Covered by SHA Overseas?

If your condition is not on SHA's 36-procedure list, or if treatment costs exceed the KSh 500,000 cap, Satyug Healthcare can still help. We have empanelled relationships with India's top JCI/NABH hospitals - BLK-Max, Apollo, Medanta, Fortis Memorial, Max Saket, Manipal, Artemis, Amrita and more - offering:

60-80% lower cost than treatment in the US, UK or Europe
No waiting list - surgery/treatment scheduled within 1-2 weeks of arrival
Free medical opinions from leading Indian specialists within 24-48 hours
Self-pay packages with full transparency
Coordination with private insurance providers (Britam, Jubilee, AAR, Heritage, etc.) if you hold supplementary cover

Documents Required to Begin

National ID / SHA member number - proof of active SHA membership
Patient's passport - bio-data page copy
Attendant's passport - accompanying family member(s)
Doctor's referral letter - from a Kenyan empanelled hospital (required for SHA approval)
Medical reports - diagnostic tests, scans, biopsies, treatment history
Hospital records - admission/discharge summaries if previously treated

Why Choose Satyug Healthcare?

12+ years of experience supporting East African patients in India
1000+ Kenyan patients served - from oncology and cardiac surgery to transplants and paediatric care
Established working relationships with international patient desks at KIMS and Apollo Proton Cancer Center
Swahili and English-speaking case managers - direct communication with patients and families in Kenya
Empanelled with BLK-Max, Apollo, Medanta, Fortis, Max, Manipal, Artemis, Amrita for non-SHA-listed procedures
24/7 patient helpline - single point of contact throughout your journey
Transparent billing - no fee from patient, no hidden charges, no commission

Frequently Asked Questions

1. Can I travel to India for treatment using my SHA card directly?

Not directly. You must first be referred by a Kenyan empanelled hospital and your condition must be on SHA's 36-procedure list. The referral goes to SHA, and only after SHA pre-authorization can you travel for treatment at an SHA-approved overseas hospital. Self-referrals are not allowed and SHA does not reimburse patients who travel independently.

2. How much does SHA cover for overseas treatment?

SHA covers up to KSh 500,000 per patient per year for the listed 36 procedures. This covers medical costs only (hospital, surgery, drugs, diagnostics). Travel, visa, accommodation, food and attendant costs are NOT covered - these are your responsibility.

3. What if the treatment costs more than KSh 500,000?

You pay the balance directly to the hospital. Many complex procedures (BMT, transplants, proton therapy) cost more than KSh 500,000. Satyug Healthcare helps you obtain a clear estimate before you travel so you can plan the additional out-of-pocket cost or arrange supplementary insurance, fundraising, or family contribution.

4. Which Indian hospitals are SHA-empanelled?

As of April 2026, two Indian hospitals are SHA-empanelled: KIMS Hospitals (multi-speciality, multiple cities) and Apollo Proton Cancer Center, Chennai (cancer and proton therapy). Additional hospitals are being onboarded and the list is updated periodically by SHA. If your condition isn't on the 36-procedure list, Satyug can help you access top JCI/NABH hospitals on a self-pay or private insurance basis.

5. How long does the SHA approval process take?

Once the Kenyan referral and complete medical documents are submitted, SHA approval typically takes 7-14 working days. Urgent cases (paediatric cancer, transplants) may be expedited. Satyug Healthcare works in parallel with the Indian hospital's international desk to keep things moving and follow up daily.

6. Does Satyug Healthcare charge any fee for SHA patients?

No. Our coordination, airport pickup, hospital assistance and case management services are completely free for SHA patients. We are paid a coordination fee directly by our partner hospitals - there are no charges, no commissions and no hidden fees from patients.

Start Your SHA Overseas Treatment Journey

SHA member from Kenya? Get a free medical opinion and a clear cost breakdown (SHA cover + out-of-pocket) from leading Indian hospitals within 24-48 hours.

International Patient Helpdesk: +91-8860606766 | +91-9910655125 | query@satyughealthcare.com

SHA replaced the National Health Insurance Fund (NHIF) on 1 October 2024 under the Social Health Insurance Act, 2023. This page is for general guidance only; SHA's procedure list, cover limits and empanelled hospitals are subject to change and should be verified with SHA directly.