Photo: Maria Immaculata Hospital, Wikimedia Commons, CC BY-SA 4.0What does SHA cover?
The SHA benefits package and what SHA pays, fund by fund
On this page · 8 sections
- The three SHA funds and who can use them
- Primary Healthcare Fund: what SHA pays at your local clinic
- Social Health Insurance Fund: hospital care at Levels 4 to 6
- Cancer care after the May 2026 update
- Emergency, Chronic and Critical Illness Fund
- What the SHA package leaves to you — and when private cover helps
- FAQ
- Sources
The three SHA funds and who can use them
SHA's benefit tariffs page (seen 28 October 2026) describes three funds, each with its own facilities and rules:
| Fund | Where | What it is for | Who can use it |
|---|---|---|---|
| Primary Healthcare Fund (PHF) | Level 2, Level 3 and selected Level 4 facilities | Everyday care: consultations, tests, prescriptions, immunisation, antenatal care, screening, deliveries | Every registered member and dependant |
| Social Health Insurance Fund (SHIF) | Levels 4 to 6 (referral hospitals) | Specialist and hospital care: admissions, surgery, maternity, dialysis, cancer, imaging, mental health | Registered members whose payments are up to date |
| Emergency, Chronic & Critical Illness Fund (ECCIF) | Levels 2 to 6 by service | Ambulance, accident and emergency, ICU/HDU, palliative care, chronic illness beyond the SHIF limit | Ambulance and accident & emergency care: every Kenyan resident, registered or not; other packages: registered members and dependants; the chronic package requires a paid-up SHIF member |
The access rules come from SHA's FAQ on receiving services the same day: no waiting period, PHF and ECCIF for any registered member or dependant, and SHIF "provided payments are up-to-date". To see whether you are active, use our guide on how to check your SHA status.
Primary Healthcare Fund: what SHA pays at your local clinic
SHA's Primary Healthcare Fund page lists outpatient care, maternity and child health, cancer screening, optical care, end-of-life services and medical inpatient services. The tariffs page adds the amounts:
| Benefit | SHA tariff or limit | Rule on SHA's page |
|---|---|---|
| Outpatient care (consultation, tests, X-ray and ultrasound, drugs, immunisation, antenatal and postnatal care) | KES 900 per person per year, paid to the facilities of your Primary Care Network | You are mapped to a Primary Care Network at registration and can use any facility in it |
| Normal delivery and essential newborn care | KES 10,000 | Free delivery for all registered beneficiaries at Level 2 and 3 |
| Caesarean section and essential newborn care | KES 30,000 | Same |
| Cancer screening | HPV test KES 3,600; PSA KES 1,500; stool for occult blood KES 400; cryotherapy or thermal ablation KES 3,000; LEEP KES 2,800 | Cancer-specific screening "rolled out subject to budgetary allocation" |
| Eyeglasses | KES 950 for dispensing; limit KES 1,000 per household per year | Refractive errors treated for under-18s in year one |
| Mortuary | Embalming KES 3,000; storage KES 500 a day for 5 days | Rolled out subject to budgetary allocation |
The KES 900 is not a cash benefit: it is a capitation SHA pays to the network of clinics, so outpatient visits there carry no SHA bill for you. Maternity in detail is in our article on Linda Mama under SHA.
Social Health Insurance Fund: hospital care at Levels 4 to 6
The SHIF page covers admissions, maternity, renal care, mental health, surgery, cancer treatment, imaging, a pharmacy package for chronic illness and specialised tests. SHA's tariffs (seen 28 October 2026):
| Benefit | SHA tariff | Limit |
|---|---|---|
| Medical admission (bed, meals, nursing, reviews, tests, drugs) | Per day: Level 3 KES 2,240; Level 4 KES 3,360; Level 5 KES 3,920; Level 6 KES 4,480 | Up to 180 days per household per year |
| Normal delivery / caesarean section | KES 10,000 / KES 30,000 | Anti-D serum KES 6,000 |
| Haemodialysis and haemodiafiltration | KES 10,650 per session | — |
| Peritoneal dialysis | KES 85,200 per month | — |
| Kidney transplant | Recipient surgery KES 700,000; donor nephrectomy KES 168,000 | Pre-transplant evaluation KES 150,000 and post-transplant care KES 200,000 per household per year |
| Imaging | MRI KES 11,000; CT KES 6,900; CT angiogram KES 8,000; fluoroscopy KES 4,000; mammogram KES 3,000; Doppler KES 5,000; ECHO KES 3,500; EEG KES 5,000 (adult) or KES 8,000 (child) | Up to 2 of each per household per year |
| Yearly tests for chronic disease | Diabetes KES 4,300; cardiovascular KES 2,850; sickle cell KES 6,800; COPD/asthma KES 700 | Once a year per person |
| Drug and substance abuse rehabilitation | KES 67,200 | — |
| Dental (extractions, fillings, scaling and others) | From KES 300 (screening) to KES 1,200 (scaling and polishing) | KES 2,000 per household per year |
| Treatment abroad (not available locally) | Overseas contracted providers | KES 500,000 per person per year |
Surgery is paid case by case from a list of several hundred procedures, each with its own tariff, published in Annex 3 of the same page. For each package, SHA's wording is that SHIF "will cover expenses up to the specified tariff": ask the hospital in writing, before admission, whether it will bill you anything above SHA's tariff.
Cancer care after the May 2026 update
SHA's public notice of 11 May 2026, issued under Legal Notice No. 78 of 2026, raised the cancer benefit. In SHA's words, the annual cancer benefits package went "from KES 550,000 up to KES 800,000", supported by an increase in the ECCIF allocation for chronic illnesses "from KES 150,000 to KES 400,000". The tariffs page shows how the two add up: KES 400,000 per person per year for diagnosis, staging and treatment under SHIF, and an additional KES 400,000 under ECCIF for patients who exhaust it.
- Oncology consultations: up to KES 2,500 per visit.
- Chemotherapy administration KES 5,500; radiotherapy KES 3,600 per session, for 30 sessions.
- CT KES 6,900, MRI KES 11,000, PET scan KES 53,500, PSMA PET KES 64,200.
- Brachytherapy KES 40,000 for three sessions; SBRT/SBRS up to KES 70,000 for 5 sessions.
- Supportive care medicines up to KES 10,000.
The same notice added sickle cell services: apheresis platelets at KES 20,000 and red cell exchange at KES 70,000, each "covered up to three times per policy period".
Emergency, Chronic and Critical Illness Fund
The ECCIF page covers ambulance evacuation, accident and emergency care, critical care, palliative care and chronic illness. The tariffs:
- Ambulance: KES 4,500 within a 25 km radius; KES 75 per km beyond.
- Accident and emergency (burns, head injuries, fractures, seizures, snake bites, rabies and others): care for up to 24 hours, after which SHIF benefits apply "for paid-up members".
- Critical care (ICU, HDU, NICU, PICU, burns unit) at Levels 4 to 6: KES 28,000 a day, limit 12 days of admission; longer stays need SHA's authorisation.
- Palliative care: at the inpatient daily rates, within the 180 days per household per year.
- Assistive devices (rolled out subject to budget): hearing aids KES 55,000 (18 and under, once per lifetime), wheelchair KES 15,000, crutches KES 900, clubfoot brace KES 1,000, walking frame KES 500, therapeutic footwear KES 1,000; one device per household per year.
- Chronic illness beyond the SHIF limit: admissions, dialysis, transplant care, cancer and inpatient mental health; the member "must be a paid-up SHIF member".
What the SHA package leaves to you — and when private cover helps
- Limits per household, not per person: 180 inpatient days, KES 2,000 of dental care and two of each scan are shared by the whole family for the year.
- Ward bed tariffs: the daily admission rates are for a ward bed; a private room costs what the hospital charges above it.
- Anything outside the package: SHA's tariffs page excludes any investigation, injury or illness "not specified in the benefits package" for the facility level.
- Budget-dependent benefits: several packages (mortuary, assistive devices, some screening) are marked as rolled out "subject to budgetary allocation".
Private medical cover can sit on top of SHA. Our guide on SHA vs private medical insurance compares the two; insurers' own packages are in our articles on Jubilee, AAR and CIC. What SHA costs you each month is 2.75% of income, at least KES 300 (SHA premium rates) — see the SHA contribution calculator.
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Frequently asked questions
What does SHA cover in Kenya?
Outpatient and primary care, deliveries, admissions, surgery, dialysis and transplants, cancer treatment, imaging, mental health, dental care, emergencies, ambulance and intensive care, through three funds: PHF, SHIF and ECCIF. Each benefit has a tariff and a limit set by SHA.
How much does SHA pay per day for admission?
SHA's tariffs: KES 2,240 a day at Level 3, KES 3,360 at Level 4, KES 3,920 at Level 5 and KES 4,480 at Level 6, for up to 180 days per household per year.
Does SHA cover cancer treatment?
Yes. KES 400,000 per person per year under SHIF, plus KES 400,000 under ECCIF once that is exhausted. SHA's notice of 11 May 2026 describes the package as raised from KES 550,000 up to KES 800,000.
Does SHA cover dialysis?
Yes: haemodialysis at KES 10,650 per session and peritoneal dialysis at KES 85,200 per month, at Level 3 to 6 facilities able to offer it.
Does SHA cover dental and eye care?
Basic dental care up to KES 2,000 per household per year, and eyeglasses at KES 950, within KES 1,000 per household per year (for under-18s in year one).
Can I use SHA if my contributions are not up to date?
Primary care (PHF) and emergency care (ECCIF) remain open to registered members — ambulance and accident & emergency care even to unregistered residents. Hospital care under SHIF requires payments to be up to date.
Sources
- Social Health Authority — Benefit Tariffs: Primary Healthcare Fund, Social Health Insurance Fund and Emergency, Chronic & Critical Illness Fund (seen 28 October 2026)
- Social Health Authority — Public notice "Enhancement of the Benefit Packages", 11 May 2026 (Legal Notice No. 78 of 2026)
- Social Health Authority — Primary Healthcare Fund (seen 28 October 2026)
- Social Health Authority — Social Health Insurance Fund (seen 28 October 2026)
- Social Health Authority — Emergency, Chronic & Critical Illness Fund (seen 28 October 2026)
- Social Health Authority — FAQ: Can I register and receive services on the same day? (seen 28 October 2026)
- Social Health Authority — Premium rates (seen 21 October 2026)