SHA Benefits 2026: Exactly What’s Covered and How Much
SHA benefits in 2026 cover everything from a routine clinic visit to surgery, maternity, dialysis, ICU and cancer treatment, organised across three funds, and here is exactly what is covered and how much. The Social Health Authority (SHA) replaced NHIF in October 2024, and the package is now built around standardised tariffs rather than the old fixed bands. The key thing to understand is that your level of cover depends on which of the three funds applies, and whether your contributions are up to date.
The quick answer: how SHA cover is structured
SHA benefits sit in three funds, each covering a different layer of care:
- Primary Healthcare Fund (PHCF) pays for everyday outpatient and preventive care at Levels 1 to 3, funded by the government at about KES 900 per person per year.
- Social Health Insurance Fund (SHIF) pays for hospital admissions, surgery, maternity, dialysis and oncology at Levels 4 to 6, funded by your 2.75% contribution.
- Emergency, Chronic and Critical Illness Fund (ECCIF) tops up SHIF for ICU, accidents and catastrophic illness once SHIF limits are reached.
PHCF works even if you have not been contributing. SHIF and ECCIF only work fully if you are a paid-up member, so lapsed contributions stop your cover at primary care.
What each fund covers and how much
The table below sets out the main benefits and the published tariffs. Amounts are drawn from SHA’s benefit package and are reviewed periodically by gazette notice, so confirm the current figure before treatment.
| Service | Fund | Tariff / limit (KES) |
|---|---|---|
| Outpatient consultation at Level 1 to 3 | PHCF | ~900 per person per year (capitation) |
| Normal delivery and newborn care | SHIF | 10,000 |
| Caesarean section | SHIF | 30,000 |
| Hospital admission (bed) | SHIF | 2,240 to 4,480 per day, up to 180 days a year |
| Renal dialysis (haemodialysis) | SHIF | 10,650 per session |
| Peritoneal dialysis | SHIF | 85,200 per month |
| Kidney transplant (recipient surgery) | SHIF | up to 700,000 |
| ICU / HDU admission | ECCIF | 28,000 per day, up to 12 days |
| Oncology (cancer treatment) | SHIF | up to 400,000 per member per year |
| Oncology top-up | ECCIF | additional 150,000 |
| Accident and emergency | ECCIF | up to 107,633 |
| Overseas treatment | SHIF | up to 500,000 per person per year |
| Drug and substance abuse rehabilitation | SHIF | up to 67,200 |
| Ambulance (within 25 km) | ECCIF | 4,500, plus ~75 per km beyond 25 km |
Maternity: the most-used benefit
Maternity has been the most visible change under SHA. A normal delivery with essential newborn care is covered at KES 10,000, and a caesarean section at KES 30,000, with complications and postpartum emergencies also covered under the SHIF maternity package.
The scale is real. Across the scheme’s operation since October 2024, more than 1.08 million deliveries have been supported, worth roughly KES 18.5 billion. The government has also moved to fund free deliveries at Level 2 and Level 3 facilities so that women whose contributions have lapsed are not turned away. For a country where maternal mortality remains a serious concern, this is the benefit Kenyans have felt most directly.
Cancer, dialysis and critical illness
For serious illness, the cover spans both SHIF and the ECCIF top-up. Cancer treatment is covered up to KES 400,000 per member per year under SHIF, with an additional KES 150,000 available through ECCIF. There is active pressure to raise the annual oncology limit to KES 800,000, a change reported to be in the final stages of the regulatory process and awaiting gazettement, so this figure may rise.
Kidney patients are covered for dialysis at KES 10,650 per session, with transplant-related surgery and post-transplant care also included up to set limits. ICU and high-dependency care fall under ECCIF at KES 28,000 per day for up to 12 days. These are the catastrophic costs that pushed families into poverty under the old system, and they sit at the heart of what SHA is meant to fix.
What SHA does not cover
Some services are explicitly excluded from the benefit package:
- Cosmetic procedures, unless medically necessary
- Assisted fertility treatment such as IVF
- Private ward admissions, luxury services and personal comfort items
Knowing the exclusions matters as much as the limits, because they are where members most often end up paying out of pocket.
The honest caveats
Two things are worth being straight about. First, several tariffs sit below private market rates, which is why some private hospitals have been reluctant participants and why members are sometimes asked to top up. Second, the limits are annual caps, so a serious illness can exhaust the SHIF oncology or transplant allocation before the year ends, at which point ECCIF and out-of-pocket costs come into play.
The bottom line: SHA in 2026 offers genuinely broad cover, from a KES 900 clinic year to a KES 700,000 transplant, but the protection only holds if you are registered and paid up, and the caps mean you should know your limits before you need them. Check your status on the Afya Yangu platform or by dialling *147# before any planned treatment.
For the official, current benefit schedule and tariffs, see the Ministry of Health and the Social Health Authority, which publish the gazetted package and updates. For how your monthly deduction is worked out, read our guide on how the 2.75% SHIF contribution is calculated, and for more news and analysis across Kenya and Africa, visit the K-One Media homepage.
This article is general information, not medical or financial advice. Tariffs are reviewed periodically; confirm current figures with the SHA before relying on them.