Medical Cover and SHIF in Kenya: What Employees Should Know

If you are checking a payslip, a contract or a hospital bill, start by identifying which type of cover you mean. This employee-focused guide explains the difference between medical attention under the Employment Act, Social Health Insurance Fund (SHIF), private employer-promised cover and work injury benefits. It also sets out what records to keep if cover is unavailable or a claim is disputed.

Does my employer have to provide private medical insurance?

The Employment Act sets out medical-attention duties; it does not describe those duties as a private insurance policy. A contract, collective bargaining agreement (CBA) or workplace policy may separately provide private medical cover or reimbursement. If your documents promise a benefit, read the wording carefully: eligibility, dependants, exclusions, annual limits, waiting periods and the claim process can all affect what is covered.

Do not assume that having SHIF means a private benefit promised to you no longer applies. Nor should a private policy be assumed to replace statutory obligations. Keep a copy of the exact document that sets out your benefit.

What does section 34 of the Employment Act say?

Section 34 is the Employment Act provision most directly concerned with medical attention. It is not a blanket promise to reimburse every medical expense, and it should not be confused with a private insurance policy. The facts, the circumstances of the illness and the relevant employment documents matter when assessing a particular dispute.

If you become ill, notify your employer or supervisor promptly using a channel you can later show, especially if you need help at work. Keep the message, any reply and relevant medical documents. In an emergency, seek appropriate care first and keep records of what happened and when.

How is SHIF different from private medical cover?

SHIF operates under the Social Health Insurance Act, 2023. It is distinct from a private policy offered through work. Your payslip may show a statutory health contribution, but a payslip entry alone does not tell you every detail of the cover available or prove that a particular treatment is covered.

Because contribution rules and administrative directions can change, confirm the current amount, payment timetable and how to check your status through the Social Health Authority before relying on a figure. If a deduction appears on your payslip and you are unsure whether it was remitted, ask for written clarification and retain the response.

What if my contract promises medical cover?

Find the clause or policy schedule that describes your cover. Check who is insured, when cover starts, the benefits and exclusions, and the steps for pre-authorisation or reimbursement. If the insurer or employer says a service is excluded, request the specific policy term and the reason in writing.

A CBA or contract can provide terms that are more favourable than a statutory minimum, but the result depends on the exact wording and how the terms apply. If the documents conflict or the benefit has been withdrawn, preserve the versions you received and get advice before assuming what you can recover.

What if I become ill or injured because of work?

The Work Injury Benefits Act, 2007 covers work injury benefits. If an incident or illness may be work-related, report it promptly, ask for the incident to be recorded and keep copies of medical records and communications. Reporting and assessment requirements can depend on the kind of injury or disease, so do not rely on a general medical policy as a substitute for following the WIBA process.

Keep details such as the date, location, witnesses, task being performed, symptoms and any notice given. Seek individual advice promptly about the correct reporting route and applicable time requirements.

Is sick leave the same as medical insurance?

Section 30 of the Employment Act addresses sick leave. Its requirements are separate from section 34 medical attention, SHIF and a private insurance benefit. Follow your workplace notification process, obtain the medical evidence required by law or your employment terms, and retain a copy.

If you need more detail about leave, see our guide to leave rights in Kenya. For general workplace topics, browse the employment-law guides.

What can I do if cover is missing or a claim is refused?

1. Identify the issue. Is this about section 34 medical attention, SHIF, a promised private benefit, sick leave or a work-related injury?
2. Notify and ask clearly. Send a dated message to the appropriate employer contact or insurer. State what happened and what information or action you are requesting.
3. Keep evidence. Save contracts, policy documents, payslips, medical notes, invoices, receipts, forms and all responses.
4. Ask for the basis of a refusal. Request the relevant policy term or written reason. Do not send original documents unless required and keep copies of anything submitted.
5. Get advice early. Applicable deadlines depend on the legal basis and facts. Do not assume that every medical expense has the same time limit.