SHA vs private medical insurance in Kenya — comparison

Short answerChecked 23 September 2026

SHA is the public scheme everyone contributes to (2.75% of income, minimum KES 300 a month, no waiting period once up to date). Private medical insurance is optional: the price depends on the plan, age and family size, and it usually adds a wider hospital network, higher limits and outpatient cover, often with waiting periods and exclusions. Most families use private cover on top of SHA, not instead of it.

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Answers come from the law, the regulator and the insurers' own documents, with the source under each answer. General information, not advice.

Does the cover include outpatient care?How do waiting periods work?What should I check before I buy?

Side by side

	SHA	Private medical insurance
Compulsory?	Yes — contributions required by the Social Health Insurance Act	No
Price	2.75% of income, min. KES 300/month, no ceiling	Set by the insurer: plan, age, family size, limits
Who sells it	The Social Health Authority	Insurers and medical insurance providers licensed by IRA
Waiting period	None once contributions are up to date (SHA FAQ)	Usually, for some benefits — read the policy
Pre-existing conditions	—	Often excluded or covered after a waiting period
Where you are treated	SHA-contracted facilities	The insurer's panel of hospitals
If you stop paying	No services until arrears + 2% monthly penalty are paid	The policy lapses

When a private plan is worth adding

You want a specific private hospital that is not in SHA's network.
You need outpatient cover (consultations, medicines) beyond what SHA gives you.
Your employer pays for a group plan — then compare it with what SHA already covers.

Compare plans with our health insurance checklist and check the provider on the IRA registry.

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Next step

1. Find the cover that fits 2. Get free quotes

Frequently asked questions

Do I still need SHA if I have private medical insurance?

Yes. SHA contributions are required by law; a private plan is an addition, not a replacement.

Is private medical insurance better than SHA?

Neither is better in general: SHA is the base everyone pays; a private plan can add hospitals, limits and outpatient cover for a price. Compare what you actually need.