SHA Benefits Package: Complete Guide to What’s Covered
SHA (the Social Health Authority) covers Kenyans through three separate funds: the Primary Healthcare Fund (PHF), which covers everyday outpatient care at a flat KES 900 per person per year; the Social Health Insurance Fund (SHIF), which covers inpatient care, surgery, dialysis (KES 10,650 per session), and maternity at Level 4–6 hospitals; and the Emergency, Chronic and Critical Illness Fund (ECCIF), which tops up cover for ICU admission, ambulance evacuation, and cancer treatment beyond SHIF’s annual limit. Below is the full breakdown of what each fund pays for, current tariffs, and what SHA does not cover.
What Is SHA, and How Is It Different From SHIF?
SHA (Social Health Authority) is the government body that replaced NHIF in 2024 and administers Kenya’s health cover under the Social Health Insurance Act No. 16 of 2023. SHIF (Social Health Insurance Fund) is not a separate scheme — it’s one of the three funds SHA manages, specifically the one covering inpatient admission, specialist care, and surgery at Level 4 to 6 hospitals. The confusion is understandable: SHA is the institution, SHIF is one part of what it pays for.
The Three SHA Funds Explained
1. Primary Healthcare Fund (PHF) — everyday care
Covers consultation, diagnosis and treatment, prescribed lab tests, basic X-rays and ultrasounds, medication, chronic disease management, screening, KEPI immunization, and maternal/child health services at Level 2 and 3 facilities (and select Level 4 primary care referral facilities).
| Service | Tariff |
|---|---|
| Outpatient care (annual capitation) | KES 900 per person per year |
| Eyeglasses dispensing | KES 950 (limit KES 1,000/household/year, under-18s in year one) |
| Normal delivery + newborn care | KES 10,000 |
| Caesarean section + newborn care | KES 30,000 |
| Mortuary: embalming | KES 3,000 |
| Mortuary: storage | KES 500/day, up to 5 days |
2. Social Health Insurance Fund (SHIF) — specialist and hospital care
Covers inpatient admission, surgery, dialysis, oncology, mental health treatment, and specialist diagnostics at Level 3–6 hospitals, accessed via referral from a primary care facility.
| Service | Tariff |
|---|---|
| Inpatient (Level 3) | KES 2,240/day |
| Inpatient (Level 4) | KES 3,360/day |
| Inpatient (Level 5) | KES 3,920/day |
| Inpatient (Level 6) | KES 4,480/day |
| Haemodialysis / haemodiafiltration | KES 10,650 per session (max 2/week) |
| Peritoneal dialysis | KES 85,200/month |
| Kidney transplant surgery | KES 700,000 |
| Oncology (diagnosis, staging, treatment) | Up to KES 400,000/person/year |
| Overseas treatment (unavailable locally) | Up to KES 500,000/person/year |
| MRI / CT scan | KES 11,000 / KES 6,900 (up to 2/household/year) |
3. Emergency, Chronic and Critical Illness Fund (ECCIF) — the safety net
Steps in for life-threatening emergencies, critical care, and chronic conditions that exceed SHIF’s limits — and it’s accessible to every Kenyan regardless of registration or payment status in a genuine emergency.
| Service | Tariff |
|---|---|
| Ambulance (within 25km) | KES 4,500 flat |
| Ambulance (beyond 25km) | KES 75 per km |
| Accident & Emergency stabilization | Fee-for-service, first 24 hours, all Kenyans |
| Critical care (ICU/HDU) | KES 28,000/day, up to 12 days |
| Cancer treatment top-up (once SHIF’s KES 400,000 is exhausted) | Additional KES 400,000/year (KES 800,000 total) |
| Hearing aids | KES 55,000 (under-18s, once per lifetime) |
| Wheelchair | KES 15,000 |
How Much You Pay: SHA Contribution Rates
SHA contributions are set at a flat 2.75% of gross salary (for employees, deducted by your employer) or 2.75% of declared income (for self-employed and informal-sector workers), with a minimum contribution of KES 300 per month and no upper cap.
| Monthly gross income | SHA contribution (2.75%) |
|---|---|
| KES 20,000 | KES 550 |
| KES 30,000 | KES 825 |
| KES 50,000 | KES 1,375 |
| KES 80,000 | KES 2,200 |
| KES 150,000 | KES 4,125 |
| No income / unemployed | KES 300 minimum |
SHA Outpatient Cover: What You Actually Get
General outpatient care — consultation, basic labs, common medication — is covered under the Primary Healthcare Fund at Level 2–3 facilities for a flat KES 900 per person per year, with no visit limit. SHIF’s outpatient cover at Level 4–6 hospitals is narrower and targeted: it pays for specific diagnostic panels for four chronic conditions — diabetes (KES 4,300), cardiovascular disease (KES 2,850), sickle cell anaemia (KES 6,800), and COPD/asthma (KES 700) — each reimbursed once per year per person.
SHIF services at Level 4–6 hospitals generally require a referral from a primary care facility. Walking directly into a referral hospital for a non-emergency issue may not be covered.
How Much Does SHA Pay for Surgery?
Surgical procedures are reimbursed according to a fixed tariff schedule covering 13 specialties — from general surgery and orthopaedics to cardiothoracic and neurosurgery — with tariffs ranging from a few thousand shillings for minor procedures to over KES 1 million for the most complex cardiac interventions. Households are limited to 3 minor, 2 major, and 1 specialized procedure per year under SHIF.
What SHA Does Not Cover
Cosmetic procedures not medically necessary · IVF and other assisted fertility treatment · private ward or luxury room upgrades · treatment abroad (except the KES 500,000/year overseas package for genuinely unavailable procedures) · medicines outside the Kenya Essential Medicines List · weight management drugs · nutritional supplements · stop-smoking aids.
FAQ: SHA Benefits Package
How much is SHA payment per month?
2.75% of gross salary for employees (deducted automatically) or 2.75% of declared income for self-employed members, with a minimum of KES 300/month and no upper cap.
How do I check my SHA benefits or contribution status?
Through the SHA self-service portal at sha.go.ke, the SHA mobile app, or by dialling *147# on your phone.
How much does SHA cover for surgery?
SHA pays a fixed tariff per procedure across 13 surgical specialties. Households are limited to 3 minor, 2 major, and 1 specialized procedure per year under SHIF.
What is the SHA rate for Kenya in 2026?
2.75% of gross salary or declared household income, with a KES 300/month minimum and no maximum.
What is the difference between SHA and SHIF?
SHA is the government authority that runs Kenya’s health cover. SHIF is one of the three funds under SHA, specifically the one covering inpatient and specialist care at Level 4–6 hospitals.
Does SHA cover pre-existing conditions?
Yes, from the point of registration, including chronic conditions like diabetes, hypertension, and sickle cell disease.
What does SHA not cover?
Cosmetic procedures, IVF, private ward upgrades, treatment abroad outside the overseas package, non-formulary medication, and weight management drugs, among other exclusions listed above.
Need Help With Your SHA Registration or Contributions?
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WhatsApp Us NowTariffs reflect the Social Health Insurance (Benefit Package) Tariffs as amended under Legal Notice No. 78 of 2026. Verified July 2026.
