The Social Health Insurance Fund

The Social Health Insurance Fund (SHIF)in Kenya provides comprehensive health insurance to all citizens. It pools contributions from the formal and informal sectors, ensuring access to essential medical services for everyone. The fund covers a wide range of healthcare needs, including outpatient treatments and hospitalizations. This helps reduce the financial burden on individuals and households. Through this program, the government ensures equitable and affordable healthcare access across the country.

Initial Registration of The Social Health Insurance Fund

1. Within ninety days of these Regulations coming into force, every resident of Kenya must apply to the Authority for registration as a member of the Social Health Insurance Fund, following section 26(1) of the Act.
2. Applicants must submit Form 1, outlined in the First Schedule of these Regulations, along with:
   • A copy of their national identification document, or
   • If they lack a national ID, any other document approved by the Authority.
3. For a child without identification, the application must include documentation provided by the state department responsible for social protection to register the child.
4. After examining the application and verifying the information, the Authority will register the applicant as a member of the SHIF and assign a social health insurance number to each beneficiary.
5. Upon successful registration, the Authority will notify the applicant within fourteen days of the registration date.
6. Each beneficiary must provide their biometric data at a designated service point.
7. The Authority will make special arrangements, such as mobile registration services, for registering persons with disabilities, older persons, those in lawful custody, marginalized communities, and individuals incapacitated by illness.
8. The Authority will process personal data in compliance with the Data Protection Act, 2019, and the Digital Health Act, 2023.

Registration of Beneficiaries

Contributor’s Responsibility

1. A contributor lists beneficiaries in Form 1, provided in the First Schedule, at the time of registration, allowing them to access benefits under the contributor’s cover.

Beneficiary Details

2. To include a beneficiary, the contributor provides the following details:
   • Full name
   • Date of birth
   • Place of birth
   • Sex
   • Passport photograph
   • Nationality, if necessary
   • Contact information
   • Relationship with the contributor
   • Disability status, if applicable
   • Any additional information required by the Authority.

Identification Documents

3. The contributor submits the following identification documents for the beneficiary:
   • For a spouse: A copy of the spouse’s national identification and a marriage document recognized under the Marriage Act.
   • For a child: A copy of the child’s birth certificate, or a birth notification if the child is under six months old.
   • For an adopted child: A copy of the adoption order.
   • For a child under the contributor’s guardianship: A will, deed, or court order.
   • For a person with a disability dependent on the contributor: A national ID and a registration certificate from the National Council for Persons with Disabilities.
   • For a non-Kenyan resident: A work permit or alien identification card.
   • For a person in lawful custody: The prison admission number, remand identification number, or national ID.
   • For a child in conflict with the law: The admission number from a remand home, rehabilitation institution, borstal institution, or a birth certificate.
   • For a refugee: An asylum-seeker’s pass, movement pass, recognition letter, refugee identification card, or a conventional travel document.

Amendment of Beneficiaries of the Social Health Insurance Fund

Requesting an Amendment

1. A contributor can amend the list of beneficiaries under their cover by submitting a duly filled Form 1 to the Authority, as outlined in the First Schedule of these Regulations.

Required Documentation

2. When requesting an amendment of beneficiaries, the contributor must provide:
   • For a new spouse: A copy of the spouse’s national identification and a marriage document recognized under the Marriage Act.
   • For a child: A copy of the child’s birth certificate or birth notification document.
   • For an adopted child under the contributor’s guardianship: A will, deed, or court order.
   • In the case of divorce: A copy of the divorce decree.
   • In the case of death: A copy of the death certificate or a decree declaring the presumption of death of the beneficiary.
   • In the case of annulment of a marriage: A decree of annulment.
   • In the case of divorce or annulment in another country: A decree of divorce or annulment recognized in Kenya under the Marriage Act.

Accessing Benefits

3. A beneficiary can:
   • For a spouse: Access benefits under the contributor’s cover within fourteen days from the date of the amendment if the contributor’s contributions comply with section 27(1) and (2) of the Act and these Regulations.
   • For a child: Access benefits from the date of the amendment if the contributor’s contributions comply with section 27(1) and (2) of the Act and these Regulations.
   • In the case of divorce, annulment, or death of a beneficiary: Cease to access benefits within fourteen days from the date of the amendment.