SHA Explains How Children Over 18 Can Remain on Parents’ Health Cover

The Social Health Authority (SHA) has issued fresh clarification on eligibility for dependents, stating that children above 18 years can remain covered under their parents’ health insurance if they are still in school and below the age of 25.

In this public advisory campaign, the Authority stressed the need for these beneficiaries to satisfy certain criteria prior to accessing these health services through the national health program.

The notice highlights ongoing efforts to streamline access to healthcare following the transition from the defunct National Hospital Insurance Fund (NHIF).

“Are they above 18 and still in school and under 25? They remain eligible,” the Authority stated in the advisory, underscoring the policy shift aimed at protecting young adults still in education.

Registration and Compliance Requirements

SHA further outlined that eligibility is conditional upon prior enrolment into the system.

“The child must first be registered as a SHA member,” the notice reads, adding that guardians are required to formally link dependents to their accounts.

According to the Authority, “A parent/guardian can then add them as a dependant in their SHA account,” SHA stated.

Additionally, proof of academic status remains mandatory.

“Attach a document proving the child is in school/college,” the advisory directs.

Also Read:SHA Announces Gradual Rollout of Tariffs in Claims System

SHA’s Year One in Operation: Milestones and Highlights

After SHA was established in October 2024, it has made an important contribution to Kenya’s quest for Universal Health Coverage as described by the Social Health Insurance Act of 2023.

Noteworthy progress within the first year of operations includes the enrollment of millions of Kenyan nationals through the program.

It is estimated that more than 20 million people have been covered within the first year of SHA operations.

Among others, structural changes at SHA include the establishment of the following funds: Primary Healthcare, Social Health Insurance, and Emergency, Chronic, and Critical Illness.

Another key development in the evolution of the organization concerns the concept of digitization.

In this case, electronic platforms were used in registering members, handling claims, and preventing fraud.

Persisting Operational and Financial Challenges

While the organization has had some successes, SHA has also had persistent operational and financial challenges in its first year of operation.

For instance, there have been numerous complaints about delayed payment for services rendered by healthcare service providers, which have resulted in tensions with healthcare facilities, as well as in some cases, withdrawal of services from the program.

In many instances, the healthcare facilities have recorded huge losses in the form of billions of unpaid claims.

Initial audits and performance evaluation of the program indicate issues in claims management and system stability with many contributors failing to contribute regularly to the program.

Some of the contributors who were registered failed to make any contributions towards the program.

Also Read: How to Easily Add Your Spouse to SHA Health Coverage Online

Dissatisfaction and Technical Issues

Public dissatisfaction with the program has been fueled by issues such as a lack of clear guidelines on the benefits provided by the system, technical errors in processing claims as well as additional payments made by some patients despite having enrolled in the system.

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