The Ministry of Health has defended the premium structure of the Social Health Insurance Fund (SHIF) following concerns raised by the Rural Private Hospitals Association of Kenya (RUPHA).
In a statement issued on Wednesday, February 26, 2025, the Ministry clarified the basis for the Ksh880 minimum premium, stressing that the new contribution rates are designed to ensure universal access to quality healthcare under the Taifa Care program.
According to the Ministry, the minimum premium of Ksh880 is calculated as 2.75% of the national minimum wage of Ksh13,520, in line with the provisions of the Social Health Insurance (General) Regulations, 2024.
“This structure ensures equity, enabling all Kenyans to contribute according to their earnings while guaranteeing access to comprehensive healthcare services,” the Ministry said.
RUPHA had earlier expressed concerns that the premium rates were unaffordable for many Kenyans, particularly those in rural areas.
In response, the Ministry emphasized that the SHIF model is income-based, meaning individuals earning less than the minimum wage will contribute less than Ksh880 per month.
“The base premium of KES 880 applies to those earning the minimum wage, but contributions adjust proportionally for lower-income earners,” the statement read.
Ksh880 base premium Vs minimum Ksh300 contribution
Addressing the confusion over the minimum contribution, the Ministry explained that the Ksh880 figure represents the lowest premium for individuals earning the national minimum wage.
For those earning below this threshold, contributions are calculated at 2.75% of their actual earnings, potentially reducing the monthly payment to as low as Ksh300.
“The aim is to ensure that no Kenyan is excluded from essential health coverage due to financial constraints,” the Ministry noted.
The government also reassured Kenyans that measures are in place to support vulnerable populations through subsidies.
Households unable to afford the minimum contributions will be identified and assisted through targeted social protection programs, ensuring inclusivity in the pursuit of Universal Health Coverage (UHC).
SHIF payments
The Health Ministry underscored its commitment to transparency and accountability in managing SHIF payments.
From the launch of Taifa Care on October 1, 2024, to January 31, 2025, the Ministry reported collecting Ksh20.9 billion in SHIF contributions.
Out of this amount, Ksh18.2 billion has been disbursed to healthcare providers, with Ksh16.97 billion allocated to SHIF claims and Ksh1.33 billion to Primary Health Care capitation.
“These disbursements highlight the government’s dedication to ensuring timely reimbursements for services rendered, safeguarding uninterrupted access to healthcare for all Kenyans,” the Ministry stated.
According to the Ministry, despite legal provisions allowing a 90-day window for claim settlements, it has consistently processed payments in under 30 days.
This expedited turnaround is part of the government’s strategy to strengthen healthcare financing, reduce financial strain on facilities, and enhance the overall responsiveness of the health system.
The Ministry says some claims remain pending due to issues such as incomplete documentation, ongoing verification processes, or preauthorization challenges.
The Ministry urged hospitals facing delays to engage directly with its teams to resolve submission errors and improve claim accuracy.
To ensure proper use of funds, the Health Ministry says all claims undergo clinical audits to verify that preauthorized procedures were approved and carried out before payment is processed.
This verification process aims to prevent fraud and strengthen financial integrity within the sector.
Additionally, certain claims have been rejected due to documentation errors, duplicate submissions, or missing authorizations.
To address this, the Ministry is rolling out training programs for hospital administrators on correct claim submission procedures, with the goal of reducing rejections and improving efficiency.
The Ministry reiterated its commitment to working with all stakeholders to refine payment processes and maintain uninterrupted service delivery under Taifa Care.
“We encourage healthcare providers to adhere to submission guidelines and engage with us to address any issues promptly,” the Ministry added.
Martin Oduor
The alchemist of literary works – a master wordsmith with a proven record of transforming the raw materials of language into a rich tapestry of emotion, thought, and imagination.
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