The Social Health Authority (SHA) is a vital initiative for ensuring access to healthcare. Below are answers to frequently asked questions about SHA and how you can benefit from it.
1. What is the Social Health Authority?
The Social Health Authority pools contributions made under the Act to purchase healthcare services from empaneled and contracted providers. It ensures quality healthcare for beneficiaries and also receives contributions for indigents, vulnerable individuals, and those in lawful custody.The Social Health Authority provides healthcare coverage for all citizens. It aims to make healthcare affordable and accessible, focusing on universal health coverage.
2. How can I register for the Social Health Authority?
All residents of Kenya must register as members of the Social Health Authority within 90 days of the regulations coming into effect. To apply, complete Form 1 from the First Schedule and include a copy of your national ID or another document approved by the Authority.You can register online through the SHA website. Complete the form and submit your identification documents. In some cases, online registration is allowed, while others may need in-person verification.
3. Who is eligible to register for the Social Health Authority?
Every resident of Kenya must register with the Social Health Authority. There are special provisions in place for children who do not have identification documents everyone, including citizens, permanent residents, and documented expatriates, can register.
4. What identification documents are required for registration?
As an adult, you need a National ID Number. For children, a birth certificate is necessary. Additionally, foreign residents can provide their Foreign Resident Certificate (Alien ID) or if they are refugees they will need government-issued ID. Sometimes, proof of residence or employment might be needed.
5. Can children be registered for the Social Health Authority?
Yes, parents or guardians can register their children as dependents.However, if a child does not have a form of identification, the application must include documentation from the state department in charge of social protection during your registration process.
6. What benefits are covered under the Social Health Authority?
SHA covers general medical consultations, inpatient and outpatient care, maternity services, and preventive healthcare. It also includes integrated promotive, curative, rehabilitative, and palliative care. These services are available at level 4, 5, and 6 health facilities. Some Immunizations and other essential health services.
7. How are contributions to the Social Health Authority made?
Contributions to the Social Health Authority will occur through payroll deductions for employed individuals. Self-employed individuals can make direct contributions. Additionally, government subsidies will support indigent and vulnerable populations. Digital payment options, such as mobile apps, are also available.
8. Are employers required to contribute to the Social Health Authority for their employees?
Yes, employers must contribute on behalf of their employees. Employers will allocate 2.75% of their employees’ salaries to the health insurance fund.
9. What healthcare services are provided by the Social Health Authority?
The fund acquires healthcare services from empaneled and contracted providers. This includes primary healthcare, referrals to secondary and tertiary care, as well as tailored packages for chronic and critical illnesses.The SHA covers emergency care, surgeries, routine check-ups, and treatment for chronic illnesses. It also provides preventive services like health screenings and vaccinations.
10. How can beneficiaries access healthcare services under the fund?
Beneficiaries obtain healthcare services from empaneled providers, who deliver the necessary services funded by the program. To access these services, bio metric verification will be required. You will receive a membership card that allows access to these services.
11. Who qualifies as a dependent under the Social Health Authority?
Dependents usually consist of the spouse, children, and occasionally other elderly parents who rely on the primary insured for financial assistance. These individuals are covered under their insurance policy.Dependents can include your spouse, children, and sometimes . Each program has specific guidelines for dependents.
12. Can indigent and vulnerable persons receive coverage under the Social Health Authority?
Indeed, the fund actively accepts contributions aimed at supporting indigent individuals, vulnerable populations, and those under legal custody, which demonstrates its commitment to ensuring their coverage. Government subsidies or exemptions may apply to help these individuals.
13. What is the role of empaneled and contracted healthcare providers?
They are healthcare providers and facilities engaged by the fund to deliver a variety of healthcare services to beneficiaries. They guarantee access to quality care. Providers are authorized to offer care to SHA beneficiaries. They ensure quality care and submit claims for reimbursement.
14. How does the Social Health Authority ensure the quality of healthcare services?
The Quality assurance mechanisms often encompass the accreditation of providers, routine audits, and strict adherence to clinical guidelines. By implementing these strategies, healthcare organizations can ensure that beneficiaries receive care that meets high-quality standards. SHA conducts regular audits, inspections, and collects feedback. Providers must follow set standards, or they face penalties or removal.
15. Are there specific benefits for chronic and critical illnesses?
Yes, the fund covers the treatment and management of chronic illnesses, along with critical care services that extend beyond the basic healthcare benefits package. The SHA offers coverage for chronic and critical illnesses like cancer or diabetes. Coverage may vary based on the specific plan.
16. How can I list beneficiaries under my Social Health Authority coverage?
You can add beneficiaries during registration or when updating membership details, contributors have the opportunity to include their dependents for coverage under their health insurance. Each beneficiary needs to provide identification, and in some cases, proof of relationship.
17. What happens if a member fails to make contributions to the fund?
If you miss contributions, you may have your benefits suspended until you resume your contributions. You risk losing coverage or having benefits suspended. It’s important to stay current on payments to ensure access to healthcare.
These answers to Frequently asked questions about SHA should help you better understand the Social Health Authority and how to access its benefits.