SHA Benefits and Claims Assistance: Find Your Next Step
A hospital said SHA won’t cover your treatment, a claim was rejected, or you are not sure what you are entitled to. This page sends you to the right SHA benefits and claims guide, gives you the exact questions to ask the facility, and lists every official SHA contact channel we have verified.
Find your problem in the table below. For a question about your own cover or claim, call SHA toll-free on 0800 720 601 or dial 147, or email info@sha.go.ke. Decisions on benefits, claims and appeals are made by SHA.
How SHA benefits and claims assistance works
Problems with SHA usually fall into one of three groups. The first is what your cover includes, which is a benefits question. The second is what happens to a claim after treatment, which runs between the facility and SHA. The third is money you paid, which covers contributions and refunds.
Work out which group your problem is in, then go to the matching guide. Most people only need one.
Find your problem in SHA benefits and claims assistance
| Your problem | Read this first |
|---|---|
| The hospital said SHA won’t cover it | SHA benefits package, to check what your fund covers, then the facility steps below |
| I don’t know what I am entitled to | SHA benefits package, by fund and level of care |
| A claim was rejected, returned or is taking too long | SHA claims Kenya, for how claims are submitted, returned and rejected |
| I was charged a bill after a claim was rejected | SHA claims Kenya, then the facility steps below before you pay |
| I want a refund for a wrong M-Pesa payment | SHA claims Kenya, which covers the refund process |
| My monthly contribution is too high | SHA premium reduction assistance, the appeal guide |
Facility steps for SHA benefits and claims assistance
Use these at the hospital or clinic, in this order. Write down each answer with the date, the time and the name of the person you spoke to.
Ask for your SHA status and the services recorded
Ask the front desk to confirm that your SHA number is active and which services they have recorded against it. If they say it is not active, ask what status they can see and why.
Ask whether your treatment needs preauthorisation
Ask: “Does this procedure, scan or treatment need SHA preauthorisation, and has it been requested?” If it has, ask for the preauthorisation reference. If it has not, ask why not before the procedure starts.
Ask for the claim reference and submission date
After discharge, ask for the reference number of the claim the facility has submitted to SHA, and the date it was sent. Claims are sent by the facility, so this is the number you will quote if you follow up.
Ask for the reason in writing if SHA support is refused
If SHA support is declined, ask for the reason in writing on the facility’s letterhead or in a signed note. Ask for the name and designation of the person who made the decision.
Ask for an itemised bill before paying
If you are asked to pay, ask for an itemised bill that separates what SHA should cover from what is outside the package. Do not pay a lump sum without it, and keep every receipt.
Ask for your discharge summary and copies
Ask for a copy of your discharge summary and any lab or scan reports. You will need them to check a claim or to support an appeal.
Contact SHA about benefits and claims assistance
Use the channel that matches your problem. Have your National ID and SHA number ready for every contact.
| Channel | Details | Use it for |
|---|---|---|
| Toll-free line | 0800 720 601 | Benefits questions, claim status and reference numbers |
| Short code | 147 | Quick questions and account checks |
| info@sha.go.ke | Written questions you want on record | |
| Website | sha.go.ke | Official notices, forms and current rules |
Have these ready when you call or email
- Your National ID number and SHA number
- The facility name, the date of visit or discharge, and the service involved
- The claim reference or preauthorisation reference, if the facility gave you one
- What the facility told you, with the date and the name of the person you spoke to
- Copies of any written reason, itemised bill or discharge summary
What SHA benefits and claims assistance cannot do
We do not decide claims, change your cover, or act for SHA or a facility. We help you understand the process, prepare your questions and find the right official page or number. Benefits, claims and appeal decisions are made by SHA.
Frequently asked questions about SHA benefits and claims assistance
What does SHA cover?
Coverage depends on the fund and the service. The SHA benefits package page explains what each fund covers.
What is preauthorisation?
It is approval from SHA before certain procedures, scans or treatments go ahead. Ask the facility whether your treatment needs it, and ask for the reference if it does.
What if a facility says SHA won’t cover me?
Ask for the reason in writing, check your fund on the SHA benefits package page, then call 0800 720 601 or 147 with your details.
Who submits the claim to SHA?
In most cases the facility submits the claim, not you. Ask for the claim reference and submission date. The SHA claims Kenya page explains how claims are handled.
Can I email SHA instead of calling?
Yes. Email info@sha.go.ke with your details and the reference numbers, and keep a copy of what you sent.
Not sure which step applies to you?
Tell us what the facility or SHA said, and we will point you to the right guide and the next step. We do not act for SHA.
Chat with us on WhatsAppRelated SHA benefits and claims assistance guides
Sources for SHA benefits and claims assistance
- Social Health Authority, sha.go.ke, for current benefits, claims rules, notices and forms.
- SHA contacts listed above: toll-free 0800 720 601, short code 147 and email info@sha.go.ke. Confirm these on sha.go.ke before relying on them.
Disclaimer: MyCyber is an independent digital assistance service, not affiliated with SHA or any government body. This page explains the process and is not legal or medical advice. SHA makes all decisions on benefits, claims and appeals. Confirm current rules and contacts at sha.go.ke, since details can change.
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