The Social Health Insurance Act, no. 16 of 2023

This Act, divided into nine Parts and consisting of 55 articles, implementing provisions of Article 43 (1) (a) of the Constitution, establishes a framework for the management of social health insurance and the creation of the related Social Health Authority, for improving health outcomes and financial protection in line with the right to health and universal health coverage, for realigning healthcare systems, for providing access to health care services to all, for promoting strategic purchasing of healthcare services. The Act defines the following relevant terms: beneficiary; illness; contracting; contributor; dispute resolution Tribunal; primary healthcare fund; emergency treatment; household; indigent; tariff and fees; vulnerable persons, including: orphaned and vulnerable children, widows or widowers, person with disability, elderly persons or indigent. Part II of the Act provides for the establishment of the Social Health Authority, the specification of its functions and powers, including: managing the funds; registering the beneficiaries; receiving payments and other contribution; contracting health care providers and healthcare facilities; developing guidelines for the operations and implementation of the funds; monitoring and evaluating programmes and activities; implementing all government Policies on social health insurance and related functions.
Part III concerns the establishment of the primary healthcare fund, aiming at purchasing primary health care services from health facilities. This Part specifies sources of fund, its expenditure, and its implementation. Part IV concerns the establishment of the social health insurance fund; the sources of this fund; the compulsory registration of every Kenyan as a member of this fund; liability to contributions to the fund. Part V concerns the establishment of the emergency, chronic and critical illness fund, its sources and its implementation. Part VI concerns benefits, payable tariffs, contracting and claims management. Part VII concerns financial provisions. Part VIII focuses on the establishment of the dispute resolution tribunal, its competencies, its members. Part IX concerns miscellaneous provisions, including penalties and offences, power to issue Regulations.