In a significant shift from the previous NHIF model, the Social Health Authority (SHA) has officially capped overseas treatment coverage at Ksh 500,000 per patient. This new framework, announced by Health Cabinet Secretary Aden Duale, is designed to curb “medical tourism,” eliminate corruption between local and foreign doctors, and encourage the growth of local specialist care.

Here is everything you need to know about the new SHA overseas referral rules for 2026.

The SHA Overseas Tracker: 36 Procedures You Can (And Can’t) Seek Abroad

Under the new Social Health Insurance (SHI) scheme, SHA will only cover medical procedures that are strictly unavailable within Kenya’s borders. The Benefits Package and Tariffs Advisory Panel (BPTAP) has identified exactly 36 interventions that the country currently lacks the infrastructure or expertise to handle.

1. The 36 Eligible Procedures

The gazetted list categorizes these life-saving interventions into four main pillars. If your condition is not on this list, SHA will not authorize or pay for overseas treatment.

A. Transplants and Major Surgeries

• Liver Transplants

• Bone Marrow Transplants (for blood cancers)

• Pediatric Kidney Transplants

• Laryngeal (Voice Box) Transplants

• Complex Heart Surgeries (requiring life support machines)

B. Advanced Cancer Treatment

• Specialized Radiation Therapy (e.g., Proton Therapy)

• Immune Cell Treatments (CAR T-cell therapy)

• Advanced Diagnostic Scans (e.g., DOTA-TATE scans)

• Nerve Ablation and Neural Regenerative Therapy

C. Joint and Bone Surgery

• Wrist, Hand, and Ankle Joint Arthroplasty (Replacements)

• Bone Replacement and Mega-prostheses

D. Unborn Baby (Intrauterine) Procedures

• Fetal Blood Transfusions

• Shunt placement for bladder outlet obstruction

• Complex surgical interventions like Laser Ablation and Amnioreduction

2. The Ksh 500,000 Cap: A Strategic Ceiling

The most controversial aspect of the 2026 guidelines is the financial limit.

• The Limit: SHA will pay a maximum of Ksh 500,000 per beneficiary for overseas treatment.

• The Rationale: The Ministry argues this prevents the “drain” of public funds to foreign health systems and forces local facilities to upgrade their technology to treat these 36 items at home.

• The Reality: For complex procedures like liver transplants, which can cost over Ksh 3 million, the Ksh 500,000 cover will only act as a partial subsidy, leaving families to bridge the gap.

3. Vetting and “Empanelment” Rules

You cannot simply choose a hospital in India or the UK and expect SHA to pay.

• Contracted Facilities: SHA will only pay overseas hospitals that are empanelled (officially registered) with the authority.

• Local Linkage: Every foreign hospital must be linked to a contracted Kenyan facility to ensure follow-up care once the patient returns home.

• Up-to-Date Contributions: You must have a fully paid-up SHA account to qualify.