NHIF SHA Coverage Treatment Abroad Kenya: Strict Limits, Real Options

NHIF SHA coverage treatment abroad Kenya is a common search, but the NHIF name is out of date. The National Hospital Insurance Fund is now defunct, and the Social Health Authority (SHA) took over when it launched in October 2024.

SHA does pay for some treatment abroad, but the benefit is narrow, capped and tightly controlled. This guide explains who qualifies, what is covered and how approval works.

NHIF SHA Coverage Treatment Abroad Kenya: The Short Answer

Yes, but only in limited cases. SHA’s overseas treatment package opened on 14 April 2026. To qualify, all of the following must apply:

• Your procedure is one of 36 services the government has listed as unavailable in Kenya.
• You are treated at a hospital abroad that has a contract with SHA.
• Your SHA contributions are up to date.

SHA pays up to Ksh 500,000 per patient per year. The patient covers any cost above that. See The Star’s report on the package and K24’s coverage of the original notice.

What Changed From NHIF to SHA

SHA’s chief executive has said the new package is meant to fix problems under NHIF, where patients were often referred abroad without proper checks on hospitals, costs or medical necessity.

Overseas approvals were also paused while the framework was finalised. In February 2026, SHA told the National Assembly it would not finance treatment already sought abroad until its overseas process was ready, as The Standard reported.

Which Procedures SHA Covers Abroad

The government gazetted 36 procedures in September 2025. They fall into a few groups:

• Bone and joint surgery: wrist, metacarpal and ankle joint replacement, and femoral and proximal tibial replacement.
• Transplants: liver, bone marrow, paediatric kidney and laryngeal transplants.
• Cancer treatment: CAR T-cell therapy, bispecific T-cell engagers, Lutetium-177 therapy and proton therapy.
• Foetal and pregnancy procedures: including intrauterine blood transfusion and fetoscopy.
• Complex paediatric heart surgery that requires ECMO.

Many common reasons for travelling abroad are not on the list. Health Cabinet Secretary Aden Duale has said hip replacement does not qualify. Adult kidney transplants and knee replacements are also excluded. The full list is on The Star. The government has said it may expand the list over time, so check the current version before you plan.

The Ksh 500,000 Coverage Cap

For general SHA members, overseas cover is capped at Ksh 500,000 per patient per year. Anything above the cap is the patient’s responsibility, according to Nation Africa.

The government has said the figure may be adjusted as contracts with overseas providers are finalised. Public officers covered under the Public Officers Medical Scheme Fund have a higher cap of Ksh 2.5 million.

Several listed procedures, such as transplants and complex heart surgery, are major operations. Treat the cap as a contribution toward the bill, not full cover.

How Approval Works, Step by Step

You need SHA’s written approval before you travel. Mr Duale has said that without a formal commitment letter, SHA cannot pay the hospital bills. The process runs as follows:

1. A doctor at a recognised Kenyan facility decides you need treatment abroad and issues a formal referral to an SHA-approved hospital.
2. The referring hospital emails SHA five documents: the official overseas referral form, the Kenya Medical Practitioners and Dentists Council referral form, a specialist report on a contracted Level 6 facility’s letterhead, the overseas hospital’s treatment plan, and its pro forma invoice.
3. SHA reviews the file and confirms you are an active, paid-up member.
4. If satisfied, SHA asks you for a second set of documents. These include certified ID copies, passport pages and visas.
5. SHA issues commitment forms and arranges return tickets.
6. The overseas hospital notifies SHA on your arrival and sends weekly progress and cost updates.
7. After discharge, the hospital sends SHA its claim documents, including a fit-to-fly certificate.
8. Back in Kenya, a contracted local hospital linked to the overseas one manages your follow-up care.

Sources: Nation Africa and Kenyans.co.ke.

SHA-Approved Hospitals, Including Three in India

SHA has contracted nine hospitals in India, Turkey and Saudi Arabia. In India, Nation Africa names Wockhardt Hospital, Apollo Cancer Centre (Apollo Hospitals Enterprise Limited) and KIMS Hospital Enterprises Private Limited.

The other six are four Acibadem hospitals in Turkey, and Dr Soliman Fakeeh Hospital and King Faisal Specialist Hospital in Saudi Arabia. SHA says contracting is ongoing, so more facilities may be added.

Being in India does not make a hospital eligible. SHA funds only contracted hospitals.

What SHA Does Not Cover

• Procedures outside the 36-item list, including treatments available in Kenya.
• Costs above the Ksh 500,000 cap.
• Treatment at hospitals that do not have an SHA contract.
• Treatment started without SHA’s written commitment letter.

Checklist Before You Travel

1. Check that your diagnosis and procedure appear on the current list of 36.
2. Ask your Kenyan specialist to start the SHA referral.
3. Confirm your contributions are up to date.
4. Confirm the overseas hospital is on SHA’s current contracted list.
5. Get the commitment letter in writing before you book travel.
6. Plan how you will pay for any cost above the cap.

If your procedure is not on the list, you can still plan private treatment in India. Contact MedicHorizon to discuss hospital options, or browse our hospitals in India guide. For the broader picture, start from the MedicHorizon treatments.

Rules, caps and hospital lists can change. Confirm current details with SHA or your referring hospital before making plans. This article is general information, not medical or legal advice.