The Health Ministry and the insurance industry have reached agreement for insurers to offer medical plans beyond coverage provided by the Social Health Authority (SHA).
The medical insurance policies that insurers would cover include overseas care and elective procedures. Insurers could also co-finance chronic care, such as diabetes, cancer, and hypertension, alongside the SHA’s Emergency, Chronic, and Critical Illness Fund (ECCIF), reported Kenya News Agency.
The agreement was reached at a high-level meeting on 18 August between the Health Cabinet Secretary Mr Aden Duale and CEOs of medical insurance companies. The meeting discussed areas of partnership, particularly with the SHA), to expand access to quality and affordable healthcare for all Kenyans.
Apart from complementary coverage, the two sides also agreed on:
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Shared claims & data — Linking insurers to SHA’s centralised claims platform for real-time verification, faster processing, and prevention of double billing
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Aligned empanelment standards — Harmonised accreditation criteria to guarantee all Kenyans, whether insured by SHA or private schemes, receive quality care under the same standards
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Taking joint anti-fraud action to crack down on health insurance malpractice — Anti-fraud measures include biometric verification, joint audits, and a shared database of fraudulent providers.
The CEOs requested the Ministry’s support in strengthening the National Health Registry to provide a standardised and accessible platform for healthcare information and the establishment of a regulatory framework for drug pricing to enhance transparency, accountability, and integrity in the sector.
Mr Duale called for a public–private collaborative framework between the Association of Private Insurers, the Health Ministry, SHA and the Insurance Regulatory Authority, starting with tariff alignment, data sharing, and fraud elimination.