Relief for civil servants as Gov’t bans co-payments in new SHA deal

In a joint communiqué on Thursday, the three parties said the agreement follows a consultative meeting convened to address disruptions that have recently affected civil servants seeking medical care, inc;luding reports of patients being detained in hospitals and the imposition of unauthorized co-payments.

The institutions reaffirmed their commitment to safeguarding the health and dignity of civil servants, assuring that the government has not reduced medical benefits under the scheme. 

They noted that outpatient limits, which exceed Ksh.70,000 depending on job groups, remain intact alongside comprehensive optical and dental coverage for more than 120,000 principal members and their dependents.

As part of immediate measures, the Social Health Authority prohibited all contracted health facilities from charging civil servants any out-of-pocket fees.

The directive, the parties said, aligns with existing contractual obligations between healthcare providers and the authority, with strict tariff applications under the scheme’s addendum remaining suspended.

Further, the authority will publish a comprehensive list of all contracted facilities on its official website to guide beneficiaries on where to access services.

To ensure the sustainability of the fund, the Social Health Authority will also enforce cost-containment measures, including regular claims audits to detect fraud, quarterly utilization reviews, and continuous monitoring of loss ratios.

"SHA will optimise the provider network, ensuring only facilities that adhere to clinical standards and negotiated pricing are contracted," the statement read in part.