Kenya Act or statute

Parliament of Kenya

Social Health Insurance Act, 2023

Jurisdiction: Kenya
Structure: 55 provisions
Citation: Act No. 16 of 2023
Dates: As at 24 Nov 2023

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Dates: As at 24 Nov 2023

Source attribution: Source: Kenya Law

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“This Act may be cited as the Social Health Insurance Act, 2023.”

This Act may be cited as the Social Health Insurance Act, 2023. Section 2 provides definitions for terms used in the Act, including "Authority", "beneficiary", "Board", "chronic illness", "contributor", and "primary health care". States that the objects of the Act are to provide a framework for improved health outcomes and financial protection in line with the right to health and universal health coverage. The Board must follow the Second Schedule for its business and affairs, but may regulate its own procedure. The Board may, by resolution, delegate its powers, functions or duties to a committee or to any member, officer, employee or agent of the Board.

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PRELIMINARY - 1. Short title

This Act may be cited as the Social Health Insurance Act, 2023.

Section 1

ESTABLISHMENT OF THE SOCIAL HEALTH AUTHORITY - 5. Functions of theAuthority

The Authority registers the beneficiaries in accordance with this Act.

Section 5

MISCELLANEOUS PROVISIONS - 46. Stakeholder engagement

The Authority must facilitate public participation and stakeholder engagement in carrying out its functions; the Cabinet Secretary must make regulations on how stakeholders are engaged nationally and in counties.

Section 46

BENEFITS, TARRIFS, EMPANELMENT, CONTRACTING AND CLAIMS - 32. Tariffs

The Cabinet Secretary must, in consultation with the Board, prescribe the tariffs for the benefits package under this Act.

Section 32

DISPUTE RESOLUTION TRIBUNAL - 45. Vacancy in theDispute Resolution Tribunal

Vacancy in theDispute Resolution Tribunal Section dies;

Section 45

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Showing 55 of 55 provisions

Provision 42Offence 7Interpretation 2Commencement 2

Part I

PRELIMINARY

§ 1PRELIMINARY - 1. Short titleShort title

This Act may be cited as the Social Health Insurance Act, 2023.

Section 1. Short title Section This Act may be cited as the Social Health Insurance Act, 2023.

Section 1Verify source

§ 2PRELIMINARY - 2. InterpretationInterpretation

Section 2 provides definitions for terms used in the Act, including "Authority", "beneficiary", "Board", "chronic illness", "contributor", and "primary health care".

Section 2. Interpretation Section "Authority" means the Social Health Authority established under section 4 ; “beneficiary” means a person who— (a) is a contributor ; (b) has not attained the age of twenty-one years, has no income of his own and is living with the contributor ; (c) has not attained the age of twenty-five years, is undergoing a full-time course of education at a university, college, school or other educational establishment or serving under articles or an indenture with a view to qualifying in a trade or profession and is not in receipt of any income other than a scholarship, bursary or other similar grant or award; (d) is a person with disability and is wholly dependent on and living with the contributor ; or (e) is a spouse of the contributor ; “Board” means the Board of the Social Health Authority ("the Social Health Authority established under;") constituted under section 7 ; “Cabinet Secretary” means the Cabinet Secretary for the time being responsible for matters relating to health; "chronic illness” means a condition that lasts one year or more and require ongoing medical attention or limit activities of daily living or both; "Claims Office” means the Claims Management Office established under section 35 ; "critical illness” means a serious and potentially life-threatening condition that demands urgent medical intervention and can have a substantial impact on a person’s health, well-being and quality of life; "contracting” means the entering into a formal agreement with an empaneled health care provider or healthcare facility for purposes of provision of services; "contributor” means a person liable to contribute to the Fund as provided under section 27 ; "Dispute Resolution Tribunal” means the Tribunal established under section 44 ; "Emergency, Chronic and Critical Illness Fund" means the fund established under section 28 ; "emergency treatment" means the necessary immediate health care that must be administered to prevent death or worsening of a medical situation; "empanelment" means enrolment of a health care provider into the list of health care service facilities approved by the Board ; "employer” has the meaning assigned under the Employment Act, ( No. 11 of 2007 ); "Funds" means the Primary Healthcare Fund established under section 20 , the Social Health Insurance Fund established under section 25 and the Emergency, Chronic and Critical Illness Fund established under section 28 ; "health care provider” has the meaning assigned to it under the Health Act, ( No. 21 of 2017 ); "healthcare services” has the meaning assigned to it under the Health Act, ( No. 21 of 2017 ); "household” means a social unit comprising of an eligible contributor , whether contributing by self or paid for, and their beneficiaries, or who share the same social-economic needs associated with consumption and production; “indigent” means a person who is poor and needy to the extent that the person cannot meet their basic necessities of life; “means testing” means a method that uses the Means Testing Instrument to determine whether an individual or a household has the ability to pay for their social health insurance premium; “Means Testing Instrument” means a set of indicators that capture various socio-economic aspects of an individual or a household for purposes of conducting a means testing ; “medical insurance provider” has the meaning assigned to it under the Insurance Act, ( Cap. 487 ); “Primary Healthcare Fund" means the fund established under section 20 ; “primary health care” means essential health care based on practical, scientifically sound and socially acceptable methods and technology that is made universally accessible to Individuals and families in the community at levels 1, 2 and 3 of health services, to meet their health needs at every stage of the life cycle, with their full participation and at an affordable cost to the community and the county; “spouse” means the wife or husband of a contributor ; “tariff” means the rates or fees that are paid to healthcare facilities or healthcare providers for services covered under this Act; “Universal Health Coverage" means that all individuals and communities receive the health services they need including the full spectrum of essential, quality health services from health promotion to prevention, treatment, rehabilitation, and palliative care without suffering financial hardship; and “vulnerable person” means a person who needs special care, support or protection, including the orphaned and vulnerable children, widows or widowers, person with disability, elderly persons or indigent due to a risk of abuse or neglect and who has been identified as such by the relevant government body.

Section 2Verify source

§ 3PRELIMINARY - 3. Objects of the ActProvision

States that the objects of the Act are to provide a framework for improved health outcomes and financial protection in line with the right to health and universal health coverage.

Section 3. Objects of the Act Section provide a framework for improved health outcomes and financial protection in line with the right to health and universal health coverage;

Section 3Verify source

Part II

ESTABLISHMENT OF THE SOCIAL HEALTH AUTHORITY

§ 10ESTABLISHMENT OF THE SOCIAL HEALTH AUTHORITY - 10. Conduct of business and affairs of theBoardProvision

The Board must follow the Second Schedule for its business and affairs, but may regulate its own procedure.

Section 10. Conduct of business and affairs of theBoard Section The conduct and regulation of the business and affairs of the Board shall be as provided in the Second Schedule, but subject thereto, the Board may regulate its own procedure.

Section 10Verify source

§ 11ESTABLISHMENT OF THE SOCIAL HEALTH AUTHORITY - 11. Delegation by theBoardProvision

The Board may, by resolution, delegate its powers, functions or duties to a committee or to any member, officer, employee or agent of the Board.

Section 11. Delegation by theBoard Section The Board may, by resolution either generally or in any particular case, delegate to any committee of the Board or to any member, officer, employee or agent of the Board the exercise of any of the powers or the performance of any of the functions or duties of the Board under this Act.

Section 11Verify source

§ 12ESTABLISHMENT OF THE SOCIAL HEALTH AUTHORITY - 12. Remuneration of membersProvision

The chairperson and members of the Board must be paid remuneration, fees, allowances and other reimbursements approved by the Cabinet Secretary in consultation with the Salaries and Remuneration Commission.

Section 12. Remuneration of members Section The chairperson and members of the Board shall be paid such remuneration, fees, allowances and such other reimbursements as may be approved by the Cabinet Secretary in consultation with the Salaries and Remuneration Commission.

Section 12Verify source

§ 13ESTABLISHMENT OF THE SOCIAL HEALTH AUTHORITY - 13. Appointment of the Chief Executive OfficerProvision

Section 13 creates a Chief Executive Officer of the Authority who must be competitively recruited and appointed by the Board; the CEO shall hold office on terms determined by the Board on the advice of the Salaries and Remuneration Commission.

Section 13. Appointment of the Chief Executive Officer Section 13(1) There shall be a Chief Executive Officer of the Authority ("the Social Health Authority established under;") who shall be competitively recruited and appointed by the Board . Section 13(2) The Chief Executive Officer shall hold office on such terms as the Board may, on the advice of the Salaries and Remuneration Commission, determine.

Section 13Verify source

§ 14ESTABLISHMENT OF THE SOCIAL HEALTH AUTHORITY - 14. Qualification for appointment as Chief Executive OfficerOffence

Sets qualifications for appointment as Chief Executive Officer and assigns responsibilities for administration and management of specified health funds, including accounting, reporting, contracting (with approvals), and spending restrictions.

Section 14. Qualification for appointment as Chief Executive Officer Section 14(1)(a) has a minimum of a master’s degree from a university recognized in Kenya; Section 14(1)(b) has at least ten years' knowledge and experience in health insurance, health financing, health economics, healthcare administration or any other relevant field; Section 14(1)(c) has served in a management level for a period of at least five years; Section 14(1)(d) has not been convicted of an offence and is not serving a term of imprisonment; and Section 14(1)(e) meets the requirements of Chapter Six of the Constitution. Section 14(2) The Chief Executive Officer shall, subject to the directions of the Board , be responsible for the day to day management of the affairs and staff of the Board . Section 14(3) The Chief Executive Officer shall be administrator of the Funds ("the Primary Healthcare Fund established under, the Social Health Insurance Fund established underand the Emergency, Chronic and Critical Illness Fund established under;") established under this Act. Section 14(4)(a) open and operate such banks with the approval of the Board and the National Treasury; Section 14(4)(b) supervise and control the day-to-day administration of the Funds ("the Primary Healthcare Fund established under, the Social Health Insurance Fund established underand the Emergency, Chronic and Critical Illness Fund established under;") established under this Act; Section 14(4)(c) in consultation with the Board , develop such policies as may be necessary for the attainment of the objects of the Funds ("the Primary Healthcare Fund established under, the Social Health Insurance Fund established underand the Emergency, Chronic and Critical Illness Fund established under;") established under this Act; Section 14(4)(d) consult with the Board on matters relating to the administration of the Funds ("the Primary Healthcare Fund established under, the Social Health Insurance Fund established underand the Emergency, Chronic and Critical Illness Fund established under;") established under this Act; Section 14(4)(e) cause to be kept books of accounts and other books and records in relation to the Funds ("the Primary Healthcare Fund established under, the Social Health Insurance Fund established underand the Emergency, Chronic and Critical Illness Fund established under;") established under this Act of all activities and undertakings financed from the Funds ("the Primary Healthcare Fund established under, the Social Health Insurance Fund established underand the Emergency, Chronic and Critical Illness Fund established under;") ; Section 14(4)(f) with the approval of the Board , enter into and sign contracts or agreements in furtherance of the objects of the Funds ("the Primary Healthcare Fund established under, the Social Health Insurance Fund established underand the Emergency, Chronic and Critical Illness Fund established under;") established under this Act; Section 14(4)(g) prepare, sign and transmit to the Auditor-General, in respect of each financial year and within three months after the end thereof, a statement of accounts relating to the Funds ("the Primary Healthcare Fund established under, the Social Health Insurance Fund established underand the Emergency, Chronic and Critical Illness Fund established under;") established under this Act and showing the expenditure incurred from the Funds ("the Primary Healthcare Fund established under, the Social Health Insurance Fund established underand the Emergency, Chronic and Critical Illness Fund established under;") , and such details as the Public Sector Accounting Standards Board may prescribe from time to time, in accordance with the provisions of the Public Finance Management Act, ( No. 18 of 2012 ) and the Public Audit Act, ( No. 34 of 2015 ); Section 14(4)(h) prepare quarterly and annual financial and non-financial reports in a format prescribed by the Public Sector Accounting Standards Board and submit the same to the National Treasury with copies to the Controller of Budget and the Commission on Revenue Allocation; and Section 14(4)(i) implement any recommendations from the Board for policy guidance in furtherance of the objects and purpose of the Funds ("the Primary Healthcare Fund established under, the Social Health Insurance Fund established underand the Emergency, Chronic and Critical Illness Fund established under;") established under this Act. Section 14(5) The existing government financial and procurement regulations shall, to the extent they relate to the administration of public funds established under the Public Finance Management Act, ( No. 18 of 2012 ) apply in the administration of the Primary Healthcare Fund, the Social Health Insurance Fund and the Emergency, Chronic and Critical Illness Fund. Section 14(6) The administrator of the Funds ("the Primary Healthcare Fund established under, the Social Health Insurance Fund established underand the Emergency, Chronic and Critical Illness Fund established under;") under sub-section (3), shall ensure that the monies held in the Primary Healthcare Fund , the Social Health Insurance Fund and the Emergency, Chronic and Critical Illness Fund , including any earnings or accruals, are spent only for the purposes for which these Funds ("the Primary Healthcare Fund established under, the Social Health Insurance Fund established underand the Emergency, Chronic and Critical Illness Fund established under;") are established.

Section 14Verify source

§ 15ESTABLISHMENT OF THE SOCIAL HEALTH AUTHORITY - 15. Tenure of office of the Chief Executive OfficerProvision

The Chief Executive Officer holds office for three years and is eligible for appointment for one further three-year term.

Section 15. Tenure of office of the Chief Executive Officer Section The Chief Executive Officer shall hold office for a period of three years and shall be eligible for appointment for one further term of three years.

Section 15Verify source

§ 16ESTABLISHMENT OF THE SOCIAL HEALTH AUTHORITY - 16. Corporation SecretaryProvision

Creates a Corporation Secretary post to be competitively recruited and appointed by the Board and lists the Secretary’s qualifications and duties.

Section 16. Corporation Secretary Section 16(1) There shall be a Corporation Secretary who corporation shall be competitively recruited and appointed by the Board on such terms as the Board may, on the advice of the Salaries and Remuneration Commission, determine. Section 16(2)(a) holds a bachelor’s degree in law from a university recognized in Kenya; Section 16(2)(b) is an Advocate of the High Court of Kenya; Section 16(2)(c) has at least five years’ experience as a corporation secretary or a similar governance role; Section 16(2)(d) is a member in good standing of the Institute of Certified Public Secretaries of Kenya; and Section 16(2)(e) meets the requirements of Chapter Six of the Constitution. Section 16(3)(a) in consultation with the Chairperson of the Board , issue notices for meetings of the Board ; Section 16(3)(b) keep, in custody, the records of the deliberations, decisions and resolutions of the Board ; Section 16(3)(c) transmit decisions and resolutions of the Board to the Chief Executive Officer for execution, implementation and other relevant action; Section 16(3)(d) provide guidance to the Board on their duties and responsibilities on matters relating to governance; and Section 16(3)(e) perform such other duties as the Board may direct.

Section 16Verify source

§ 17ESTABLISHMENT OF THE SOCIAL HEALTH AUTHORITY - 17. StaffProvision

The Board may appoint the staff needed for the Authority to perform its functions, on terms determined by the Board with advice from the Salaries and Remuneration Commission.

Section 17. Staff Section The Board may appoint such staff as may be necessary for the proper discharge of the functions of the Authority ("the Social Health Authority established under;") under this Act, upon such terms and conditions of service as the Board may determine upon the advice of the Salaries and Remuneration Commission.

Section 17Verify source

§ 18ESTABLISHMENT OF THE SOCIAL HEALTH AUTHORITY - 18. Protection from personal liabilityProvision

Members of the Board and officers, employees or agents of the Authority are not personally liable for actions done in good faith while executing the Authority's functions or powers, but remain individually responsible for unlawful or criminal acts.

Section 18. Protection from personal liability Section 18(1) No matter or thing done by a member of the Board or an officer, employee or agent of the Authority ("the Social Health Authority established under;") shall, if the matter or thing as done in good faith in the execution of the functions or powers of the Authority ("the Social Health Authority established under;") , render the member, officer, employee or agent personally liable for any action, claim or demand whatsoever. Section 18(2) Notwithstanding subsection (1), nothing in this section shall exempt a member of the Board , officer, employee or agent of the Authority ("the Social Health Authority established under;") from individual responsibility for unlawful or criminal act committed by the member of the Board , officer, employee or agent of the Authority ("the Social Health Authority established under;") .

Section 18Verify source

§ 19ESTABLISHMENT OF THE SOCIAL HEALTH AUTHORITY - 19. Common seal of theAuthorityProvision

There is a common seal kept in the custody of the Corporation Secretary and the Board must nominate a member to authenticate the seal when the Chairperson or Chief Executive Officer is absent.

Section 19. Common seal of theAuthority Section 19(1) There shall be a common seal of the Authority ("the Social Health Authority established under;") which shall be kept in the custody of the Corporation Secretary and shall not be used except on the direction of the Board . Section 19(2) The affixing of the common seal of the Authority ("the Social Health Authority established under;") shall be authenticated by the signatures of the Chairperson and the Chief Executive Officer and any document required by law to be made under seal and all decisions of the Board may be authenticated by the signatures of the Chairperson and the Chief Executive Officer. Section 19(3) The Board shall, in the absence of either the Chairperson or the Chief Executive Officer, in any particular matter, nominate one member to authenticate the seal of the Authority ("the Social Health Authority established under;") on behalf of either the Chairperson or the Chief Executive Officer.

Section 19Verify source

§ 4ESTABLISHMENT OF THE SOCIAL HEALTH AUTHORITY - 4. Establishment of the Social HealthAuthorityProvision

Establishes an Authority to be known as the Social Health Authority.

Section 4. Establishment of the Social HealthAuthority Section 4(1) There is established an Authority ("the Social Health Authority established under;") to be known as the Social Health Authority ("the Social Health Authority established under;") . Section 4(2)(a) suing and being sued; Section 4(2)(b) taking, purchasing or otherwise acquiring, holding, charging and disposing of movable and immovable property; Section 4(2)(c) receiving and borrowing money; and Section 4(2)(d) doing or performing such other things or acts necessary for the proper performance of its functions under this Act. Section 4(3) The provisions of the First Schedule shall have effect with respect to the Authority ("the Social Health Authority established under;") .

Section 4Verify source

§ 5ESTABLISHMENT OF THE SOCIAL HEALTH AUTHORITY - 5. Functions of theAuthorityProvision

The Authority registers the beneficiaries in accordance with this Act.

Section 5. Functions of theAuthority Section register the beneficiaries in accordance with this Act;

Section 5Verify source

§ 6ESTABLISHMENT OF THE SOCIAL HEALTH AUTHORITY - 6. Powers of theAuthorityProvision

Section 6 gives the Social Health Authority broad powers to perform its functions and lists specific powers relating to assets, funds, bank accounts and associations; it also forbids disposing of immovable property without prior National Assembly approval.

Section 6. Powers of theAuthority Section 6(1) The Authority ("the Social Health Authority established under;") shall have all the powers necessary for the performance of its functions under this Act. Section 6(2)(a) manage, control and administer the assets of the Authority ("the Social Health Authority established under;") in such manner and for such purpose as best promotes the objects for which the Authority ("the Social Health Authority established under;") is established in accordance with the Public Procurement and Assets Disposal Act, ( No. 33 of 2015 ): Provided that the Authority ("the Social Health Authority established under;") shall not charge or dispose of any immovable property without the prior approval of the National Assembly; Section 6(2)(b) receive any gifts, grants, donations or endowments made to the Fund or any other monies in respect of the Fund and make disbursements therefrom in accordance with the provisions of this Act; Section 6(2)(c) open a banking account or banking accounts for the Fund with authorization from the National Treasury; and Section 6(2)(d) enter into association with such other bodies organizations, within or outside Kenya, as it may consider desirable or appropriate and in furtherance of the purpose for which the Fund is established.

Section 6Verify source

§ 7ESTABLISHMENT OF THE SOCIAL HEALTH AUTHORITY - 7. TheBoardof theAuthorityProvision

Sets out the membership of the Authority's Board (including a non-executive Chairperson appointed by the President, specified Principal Secretaries or representatives, the Director-General for Health, representatives from county and sector bodies, the Chief Executive Officer as an ex‑officio member) and provides that certain members are appointed by the Cabinet Secretary by Gazette notice; members serve three-year terms and may be re-appointed for one further three-year term; appointments must afford equal opportunity and regional balance.

Section 7. TheBoardof theAuthority Section 7(1)(a) a non-executive Chairperson, who shall be appointed by the President; Section 7(1)(b) the Principal Secretary in the ministry for the time being responsible for matters relating to health or a designated representative; Section 7(1)(c) the Principal Secretary in the ministry for the time being responsible for matters relating to finance or a designated representative; Section 7(1)(d) the Director-General for Health; Section 7(1)(e) a representative of the County Executive Committee Health Caucus; Section 7(1)(f) one person, not being a Governor, nominated by the Council of County Governors with knowledge in field of finance, accounting, health economics, law or business and management; Section 7(1)(g) one person, not being a public officer with proven experience in matters of health insurance, health financing, financial management, health economics, healthcare administration; Section 7(1)(h) the Kenya Medical Association; Section 7(1)(h)(i) the Kenya Medical Association; Section 7(1)(h)(ii) the informal sector association; Section 7(1)(h)(iii) the consortium of healthcare providers; and Section 7(1)(h)(iv) the Central Organization of Trade Unions-Kenya. Section 7(1)(i) the Chief Executive Officer of the Authority ("the Social Health Authority established under;") , who shall be an ex-officio member of the Board . Section 7(2) The members of the Board nominated under subsection (1) (f), (g) and (h) shall be appointed by the Cabinet Secretary by Notice in the Gazette . Section 7(3) The Chairperson and the members of the Board appointed under subsection (1) shall serve for a term of three years and shall be eligible for re-appointment for one further term of three years. Section 7(4) In appointing persons as members of the Board under subsection (1)(f), (g) and (h), the Cabinet Secretary shall ensure that the appointments afford equal opportunity to men and women, youth, persons with disabilities, minorities and marginalized groups and ensure regional balance.

Section 7Verify source

§ 8ESTABLISHMENT OF THE SOCIAL HEALTH AUTHORITY - 8. Qualifications for appointmentOffence

Sets minimum qualifications and disqualifications for appointment, including citizenship, education, specified experience, and Chapter Six compliance; lists specific disqualifying circumstances such as certain convictions, unsound mind, undischarged bankruptcy, industry roles in insurance, and misuse of public office.

Section 8. Qualifications for appointment Section 8(1)(a) is a citizen of Kenya; Section 8(1)(b) holds a minimum of a bachelor’s degree from a university recognized in Kenya; Section 8(1)(c) has knowledge and experience of not less than ten years in data science, information technology, health governance, health administration, health policy, finance or economics, five of which shall be at managerial level; and Section 8(1)(d) meets the requirements of Chapter Six of the Constitution. Section 8(2)(a) has at any time been convicted of a criminal offence and sentenced to a term of imprisonment exceeding six months; Section 8(2)(b) is declared to be of unsound mind; Section 8(2)(c) is an undischarged bankrupt; Section 8(2)(d) is a director, officer, employee or shareholder of any insurer, broker, insurance agent or any other member of the insurance industry; or Section 8(2)(e) has been found in accordance with any law or parliamentary reports to have misused or abused a state office or public office or in any way to have contravened the provisions of Chapter Six of the Constitution.

Section 8Verify source

§ 9ESTABLISHMENT OF THE SOCIAL HEALTH AUTHORITY - 9. Vacancy of the officeProvision

Resignation from office must be by notice in writing to the appointing authority.

Section 9. Vacancy of the office Section resigns from office by notice in writing to the appointing authority;

Section 9Verify source

Part III

PRIMARY HEALTHCARE FUND

§ 20PRIMARY HEALTHCARE FUND - 20. Establishment of thePrimary Healthcare FundProvision

A fund called the Primary Healthcare Fund is established to purchase primary healthcare services from health facilities.

Section 20. Establishment of thePrimary Healthcare Fund Section There is established a Fund to be known as the Primary Healthcare Fund whose object shall be to purchase primary healthcare services from health facilities.

Section 20Verify source

§ 21PRIMARY HEALTHCARE FUND - 21. Sources ofFundsProvision

The Fund's source is monies appropriated by the National Assembly.

Section 21. Sources ofFunds Section monies appropriated by the National Assembly;

Section 21Verify source

§ 22PRIMARY HEALTHCARE FUND - 22. Expenditure of the FundProvision

Payments for expenses of the Fund are to be made from the Fund; the Authority must prepare annual budget estimates at the start of each financial year; any Board revision of approved budget estimates must be approved by the National Assembly in the supplementary budget.

Section 22. Expenditure of the Fund Section 22(1) There shall be paid out of the Fund payments in respect of any expenses incurred in pursuance of the object and purpose for which the Fund is established. Section 22(2) The expenditure incurred on the Fund shall be limited to annual budget estimates prepared by the Authority ("the Social Health Authority established under;") at the beginning of the financial year to which they relate. Section 22(3) Any revision of the approved budget estimates by the Board shall be approved by the National Assembly in the supplementary budget estimates.

Section 22Verify source

§ 23PRIMARY HEALTHCARE FUND - 23. Capital of the FundProvision

The Fund's capital is to be as appropriated by the National Assembly or from any other source provided for under this Act.

Section 23. Capital of the Fund Section The capital of the Fund shall be as appropriated by the National Assembly or from any other source provided for under this Act.

Section 23Verify source

§ 24PRIMARY HEALTHCARE FUND - 24. Implementation of thePrimary Healthcare FundProvision

The Cabinet Secretary shall, in consultation with the Board, make regulations for the implementation of the Primary Healthcare Fund.

Section 24. Implementation of thePrimary Healthcare Fund Section The Cabinet Secretary shall in consultation with the Board make regulations for the implementation of the Primary Healthcare Fund .

Section 24Verify source

Part IV

THE SOCIAL HEALTH INSURANCE FUND

§ 25THE SOCIAL HEALTH INSURANCE FUND - 25. Establishment of the Social Health Insurance FundProvision

Establishes the Social Health Insurance Fund and lists its funding sources.

Section 25. Establishment of the Social Health Insurance Fund Section 25(1) There is established a Fund be known as the Social Health Insurance Fund. Section 25(2)(a) contributions under the Act; Section 25(2)(b) monies appropriated by the National Assembly for indigent and vulnerable persons; and Section 25(2)(c) gifts, grants, innovative financing mechanisms or donations.

Section 25Verify source

§ 26THE SOCIAL HEALTH INSURANCE FUND - 26. RegistrationCommencement

This section requires Kenyans to register as members of the Social Health Insurance Fund; allows ordinarily resident non‑Kenyans to be eligible; requires newborns to be registered at birth; sets registration procedures to be prescribed by the Cabinet Secretary; requires proof of registration and contribution to access public services; requires short‑term non‑Kenyan visitors (< twelve months) to have designated travel health insurance; and requires the Cabinet Secretary to establish measures to implement the travel insurance requirement.

Section 26. Registration Section 26(1) Every Kenyan shall register as a member of the Social Health Insurance Fund. Section 26(2) A person who, being a non-Kenyan, and is ordinarily resident in Kenya, shall be eligible for registration as a member of the Social Health Insurance Fund. Section 26(3) A child born after commencement of this Act shall be registered at birth as a member of the Social Health Insurance Fund. Section 26(4) Registration shall be conducted continuously at various points in such manner as shall be prescribed by the Cabinet Secretary . Section 26(5) Any person who is registerable as a member under this Act shall produce proof of compliance with the provisions of this Act on registration and contribution as a precondition of dealing with or accessing public services from the national government, county government or a national or county government entities. Section 26(6) A person who is a non-Kenyan that intends to enter and remain in the territory of Kenya for a period of less than twelve months shall be required to be in possession of a travel health insurance cover as may be designated by the Cabinet Secretary . Section 26(7) The Cabinet Secretary shall establish the policy, regulatory or administrative measures to give effect to sub-section (6).

Section 26Verify source

§ 27THE SOCIAL HEALTH INSURANCE FUND - 27. ContributionsOffence

Multiple classes of persons and governments must contribute to the Social Health Insurance Fund; contribution methods vary by income source; access to services requires up-to-date contributions; penalty of 2% applies to overdue contributions.

Section 27. Contributions Section 27(1)(a) every Kenyan household ; Section 27(1)(b) a non-Kenyan resident, ordinarily residing in Kenya for a period exceeding twelve months; Section 27(1)(c) the national government; Section 27(1)(d) a county government; and Section 27(1)(e) any other employer . Section 27(2)(a) in the case of a household whose income is derived from salaried employment, by a monthly statutory deduction from the wages or salary by the employer at a rate prescribed under this Act; Section 27(2)(b) in the case of a household whose income is not derived from salaried employment, by an annual contribution of a proportion of household income as determined by the means testing instrument in the manner prescribed under this Act; Section 27(2)(c) in the case of households in need of financial assistance as determined by the means testing instrument, by the government at a rate apportioned from funds appropriated by Parliament and County Assemblies for that purpose as prescribed under this Act; Section 27(2)(d) in the case of persons under lawful custody, by the Government from funds appropriated by Parliament for that purpose at a rate prescribed under this Act; Section 27(2)(e) in case of a person who is a permanent resident in Kenya, by such person at a rate as may be prescribed under this Act; and Section 27(2)(f) in the case of any other person, by the person himself out of his own funds in the manner prescribed under this Act. Section 27(3) A person referred to in subsection (2)(b) shall pay their contributions on an annual basis. Section 27(4) A person shall only access healthcare services under this Act where their contributions to the Social Health Insurance Fund are up to date and active. Section 27(5) The government shall ensure that premium financing products are provided for non-salaried persons for the payment of social health insurance. Section 27(6) Any person who fails to pay any contribution in respect of any period on or before the day on which payment is due shall be liable to a penalty equal to two percent of the amount due for contribution for the period which the contribution remains unpaid and the total annual contributions. Section 27(7) A person shall pay all outstanding contributions and penalties accrued before resuming access to the healthcare services provided under this Act.

Section 27Verify source

Part IX

MISCELLANEOUS PROVISIONS

§ 46MISCELLANEOUS PROVISIONS - 46. Stakeholder engagementProvision

Section 46. Stakeholder engagement Section 46(1) The Authority ("the Social Health Authority established under;") shall facilitate public participation and stakeholder engagement in the carrying out of its functions under this Act. Section 46(2) The Cabinet Secretary shall prescribe regulations on the modalities of engaging stakeholders at the national and county level.

Section 46Verify source

§ 47MISCELLANEOUS PROVISIONS - 47. DigitizationProvision

Section 47 requires digitization of processes and services under the Act; every Kenyan must be uniquely identified for health services; digitization must conform to the Data Protection Act; and the Cabinet Secretary must make regulations to implement this section.

Section 47. Digitization Section 47(1) All processes and services under this Act shall continue to be digitized using appropriate, reliable, secure, inter-operable, verifiable and responsive technology through an information system. Section 47(2)(a) registration of members; Section 47(2)(b) member identification; Section 47(2)(c) contributions to the Fund; Section 47(2)(d) empanelment ("enrolment of a health care provider into the list of health care service facilities approved by the Board;") of facilities; Section 47(2)(e) execution of contracts; Section 47(2)(f) member identification; Section 47(2)(g) notification and preauthorization; Section 47(2)(h) claims management; and Section 47(2)(i) settlement of claims. Section 47(3) Every Kenyan shall be uniquely identified for purposes of provision of health services under this Act. Section 47(4) The digitization of processes and services under this Act shall conform to the provisions of the Data Protection Act, ( No. 24 of 2019 ) and all other relevant laws. Section 47(5) The Cabinet Secretary shall make regulations for the better carrying out of the provisions of this section.

Section 47Verify source

§ 48MISCELLANEOUS PROVISIONS - 48. Offences and penaltiesOffence

Section 48 creates offences for employers who fail to pay required contributions or unlawfully deduct from employees' wages, and for persons who make false statements or impersonate others to obtain benefits; it sets criminal penalties and administrative sanctions including fines, imprisonment, suspension and removal from registers.

Section 48. Offences and penalties Section 48(1)(a) fails without lawful excuse to pay to the Social Health Insurance Fund within the period prescribed by this Act any contribution which he or she is liable as a contributing employer to pay under this Act; or Section 48(1)(b) knowingly makes any deduction from the wages of the employee in respect of any contribution which he or she is liable as a contributing employer to pay under this Act, other than a deduction which he or she is authorized to make by this Act; or Section 48(1)(c) for the purpose of obtaining any benefit for himself or herself or for any other person, knowingly makes any false statement or representation, or produces or furnishes, or causes to be produced or furnished, any document or information which he or she knows to be false in any material particular, Section 48(2) A person who misappropriates any of the funds or assets of the Fund, or assists or causes any person to misappropriate or apply funds, otherwise than in the manner provided in the Act, commits an offence and shall upon conviction, be liable to imprisonment for a term not exceeding five years or to a fine not exceeding ten million shillings or to both. Section 48(3) Any person who, for the purpose of obtaining the payment of any benefit under this Act, knowingly makes any false statement, whether orally or in writing, commits an offence and is liable on conviction to a fine not exceeding one million shillings or to imprisonment for a term not exceeding sixty months, or to both. Section 48(4) Any person who with intent to obtain the payment of any benefit under this Act, impersonates any person whether living or dead, commits an offence and is liable on conviction to a fine not exceeding one million shillings or to imprisonment for a term not exceeding three years, or to both. Section 48(5)(a) a fine not exceeding two million shillings; Section 48(5)(b) suspension; or Section 48(5)(c) removal from the register of empaneled and contracted healthcare providers. Section 48(6) The Authority ("the Social Health Authority established under;") shall cause the name of every healthcare provider or health facility suspended under subsection (5) (b) to be notified in the Gazette and such institution shall not, during the suspension, be entitled to any benefit from the Fund. Section 48(7) The Board shall cause the name of every healthcare provider or health facility removed from the register under subsection (5)(c) to be notified in the Gazette , at least two newspapers of national circulation and at the official website of the Authority ("the Social Health Authority established under;") . Section 48(8) A healthcare provider or health facility which has been removed from the register under subsection (5) (c) shall not be entitled to receive any benefit from the Authority ("the Social Health Authority established under;") .

Section 48Verify source

§ 49MISCELLANEOUS PROVISIONS - 49. Recovery of sums due under this ActOffence

Section 49 allows a court to order a convicted person to pay unlawfully obtained contributions or other sums (and penalties) to the Authority; the Authority may recover sums as civil debts; authorized officers of the Authority may institute proceedings.

Section 49. Recovery of sums due under this Act Section 49(1) The court before which any person is convicted of an offence under this Act may, without prejudice to any civil remedy, order such person to pay to the Authority ("the Social Health Authority established under;") , as the case may be, the amount of any contribution or any other sum that was not obtained in a lawful manner, together with any penalty found to be due from such person to the Authority ("the Social Health Authority established under;") and any sum so ordered shall be recoverable as a fine and paid into the Funds ("the Primary Healthcare Fund established under, the Social Health Insurance Fund established underand the Emergency, Chronic and Critical Illness Fund established under;") . Section 49(2) All sums due to the Authority ("the Social Health Authority established under;") shall be recoverable as debts due to the Authority ("the Social Health Authority established under;") , and without prejudice to any other remedy, may be recovered by the Authority ("the Social Health Authority established under;") summarily as a civil debt. Section 49(3) All criminal and civil proceedings under this Act may, without prejudice to any other power in that behalf, be instituted by any authorized officer of the Authority ("the Social Health Authority established under;") . Section 49(4) All sums recovered by legal proceedings in respect of monies which should have been paid into the Funds ("the Primary Healthcare Fund established under, the Social Health Insurance Fund established underand the Emergency, Chronic and Critical Illness Fund established under;") shall, when recovered, be paid into the Funds ("the Primary Healthcare Fund established under, the Social Health Insurance Fund established underand the Emergency, Chronic and Critical Illness Fund established under;") . Section 49(5) Despite any other written law, the assets of the Funds ("the Primary Healthcare Fund established under, the Social Health Insurance Fund established underand the Emergency, Chronic and Critical Illness Fund established under;") shall not be liable to attachment under any process of law.

Section 49Verify source

§ 50MISCELLANEOUS PROVISIONS - 50. RegulationsInterpretation

The Cabinet Secretary must, in consultation with the Board, make regulations to carry out this Act.

Section 50. Regulations Section 50(1) The Cabinet Secretary shall, in consultation with the Board , make Regulations for the better carrying out of the provisions of this Act. Section 50(2)(a) any matters incidental to the payment and collection of any contributions under this Act; Section 50(2)(b) the amount and rates of contributions payable by contributors into the Fund; Section 50(2)(c) the manner of the making and determination of the healthcare benefits package; Section 50(2)(d) the manner of the making and determination of any claim to any benefit; Section 50(2)(e) the settlement of valid claims; Section 50(2)(f) the process of enrolment of healthcare providers and healthcare facilities on the list of approved healthcare providers and healthcare facilities; and Section 50(2)(g) anything which is required to be prescribed for the better giving effect of the provisions of this Act. Section 50(3)(a) the purpose and objective of the delegation under this section is to enable the Cabinet Secretary to make regulations for better carrying into effect the provisions of this Act; and Section 50(3)(b) the authority of the Cabinet Secretary to make regulations under this Act shall be limited to bringing into effect the provisions of this Act and fulfilment of the objectives specified under this section. Section 50(4)(a) the Statutory Instruments Act, ( No. 23 of 2013 ); Section 50(4)(b) the Interpretation and General Provisions Act, ( Cap. 2 ); Section 50(4)(c) the general rules of international law as specified under Article 2(5) of the Constitution; and Section 50(4)(d) any treaty and convention ratified by Kenya under Article 2(6) of the Constitution.

Section 50Verify source

§ 51MISCELLANEOUS PROVISIONS - 51. Conflict with other lawsProvision

If there is any inconsistency on matters related to provision of social health insurance, this Act prevails over any other legislation.

Section 51. Conflict with other laws Section This Act shall prevail in the case of any inconsistency between this Act and any other legislation on matters related to provision of social health insurance.

Section 51Verify source

§ 52MISCELLANEOUS PROVISIONS - 52. Application ofCap. 487Provision

The provisions of the Insurance Act apply to the Authority only for claims administration services.

Section 52. Application ofCap. 487 Section The provisions of the Insurance Act shall apply to the Authority ("the Social Health Authority established under;") only in respect to claims administration services.

Section 52Verify source

§ 53MISCELLANEOUS PROVISIONS - 53. General penaltyOffence

A person convicted of an offence under this Act for which no other penalty is prescribed is liable to a fine up to one million shillings, or if a natural person, to imprisonment for up to two years, or both.

Section 53. General penalty Section A person convicted of an offence under this Act for which no other penalty is prescribed shall be liable to a fine not exceeding one million shillings or, in the case of a natural person, to imprisonment for a term not exceeding two years, or to both.

Section 53Verify source

§ 54MISCELLANEOUS PROVISIONS - 54. Repeal of No. 9 of 1998Repeal

The National Health Insurance Fund Act, 1998 is repealed.

Section 54. Repeal of No. 9 of 1998 Section The National Health Insurance Fund Act, 1998 is repealed.

Section 54Verify source

§ 55MISCELLANEOUS PROVISIONS - 55. Winding upProvision

On winding up any of the Funds established under this Act, the cash balances shall be transferred to the Exchequer and other assets shall be transferred to the National Treasury.

Section 55. Winding up Section In the event of winding up of any of the Funds ("the Primary Healthcare Fund established under, the Social Health Insurance Fund established underand the Emergency, Chronic and Critical Illness Fund established under;") established under this Act, the cash balances shall be transferred to the Exchequer while other assets shall be transferred to the National Treasury.

Section 55Verify source

Part V

THE EMERGENCY, CHRONIC AND CRITICAL ILLNESS FUND

§ 28THE EMERGENCY, CHRONIC AND CRITICAL ILLNESS FUND - 28. Establishment of theEmergency, Chronic and Critical Illness FundProvision

Establishes the Emergency, Chronic and Critical Illness Fund to defray the costs of managing chronic illnesses after depletion of social health insurance cover.

Section 28. Establishment of theEmergency, Chronic and Critical Illness Fund Section defray the costs of management of chronic illnesses after depletion of the social health insurance cover; and

Section 28Verify source

§ 29THE EMERGENCY, CHRONIC AND CRITICAL ILLNESS FUND - 29. Sources of fundsProvision

Sources of funds include monies appropriated by the National Assembly.

Section 29. Sources of funds Section monies appropriated by the National Assembly;

Section 29Verify source

§ 30THE EMERGENCY, CHRONIC AND CRITICAL ILLNESS FUND - 30. Implementation ofEmergency, Chronic and Critical Illness FundProvision

The Cabinet Secretary must, in consultation with the Board, make regulations to implement the Emergency, Chronic and Critical Illness Fund.

Section 30. Implementation ofEmergency, Chronic and Critical Illness Fund Section The Cabinet Secretary shall in consultation with the Board make regulations for the implementation of the Emergency, Chronic and Critical Illness Fund .

Section 30Verify source

Part VI

BENEFITS, TARRIFS, EMPANELMENT, CONTRACTING AND CLAIMS

§ 31BENEFITS, TARRIFS, EMPANELMENT, CONTRACTING AND CLAIMS - 31. BenefitsProvision

Every beneficiary is entitled to an essential healthcare benefits package; beneficiaries are not prevented from taking private health insurance cover.

Section 31. Benefits Section 31(1) Every beneficiary shall be entitled to an essential healthcare benefits package prescribed by the Cabinet Secretary in consultation with the Board . Section 31(2) Notwithstanding the provisions of this Act, nothing shall be construed to preclude any beneficiary from taking private health insurance cover.

Section 31Verify source

§ 32BENEFITS, TARRIFS, EMPANELMENT, CONTRACTING AND CLAIMS - 32. TariffsProvision

The Cabinet Secretary must, in consultation with the Board, prescribe the tariffs for the benefits package under this Act.

Section 32. Tariffs Section 32(1) The benefits payable under this Act shall be based on a tariff . Section 32(2) The Cabinet Secretary shall, in consultation with the Board , prescribe the tariffs applicable to the benefits package under this Act. Section 32(3) The tariffs referred to under subsection (1), maybe reviewed from time to time.

Section 32Verify source

§ 33BENEFITS, TARRIFS, EMPANELMENT, CONTRACTING AND CLAIMS - 33. EmpanelmentProvision

The Social Health Authority must pay empaneled and contracted healthcare providers or facilities from the specified Funds; providers must apply for empanelment; the Authority may contract empaneled providers within 30 days of publication; the accrediting body may revoke accreditation at any time; aggrieved providers may appeal to the Dispute Resolution Tribunal within 30 days.

Section 33. Empanelment Section 33(1) The Authority ("the Social Health Authority established under;") shall make payments out of the Funds ("the Primary Healthcare Fund established under, the Social Health Insurance Fund established underand the Emergency, Chronic and Critical Illness Fund established under;") to healthcare providers or health care facilities that are empaneled and contracted in accordance with the provisions of this Act. Section 33(2) A healthcare provider or healthcare facility seeking to be empanelled under the Act shall make an application to the body responsible for accreditation for quality of care in the manner prescribed by the Cabinet Secretary . Section 33(3) Upon the publication of the list of empanelled healthcare providers and healthcare facilities on the website and in the Kenya Gazette , the Authority ("the Social Health Authority established under;") may contract the healthcare providers or healthcare facilities within thirty days of the date of the publication of the list. Section 33(4) The body under subsection (2) may, at any time, revoke any accreditation under this section. Section 33(5) A healthcare provider or healthcare facility aggrieved by the decision of the body under subsection (2) may appeal to the Dispute Resolution Tribunal within thirty days of the decision of the Board .

Section 33Verify source

§ 34BENEFITS, TARRIFS, EMPANELMENT, CONTRACTING AND CLAIMS - 34. ContractingOffence

The Authority may contract with qualifying healthcare providers and must publish contracted providers; it must terminate contracts if providers fail to meet criteria and revoke declarations on termination; displaying identification without Authority permission is an offence punishable by up to a one million fine or up to two years imprisonment.

Section 34. Contracting Section 34(1) The Authority ("the Social Health Authority established under;") may from time to time negotiate and enter into contracts with healthcare service providers and healthcare facilities who qualify under section 33 (3) for the provision of health services to the beneficiaries. Section 34(2) The Authority ("the Social Health Authority established under;") shall publish on its website and in such other manner as the Authority ("the Social Health Authority established under;") may deem appropriate, the health service providers and healthcare facilities referred to in subsection (1) to be contracted health service providers for purposes of this Act. Section 34(3) A publication under this section shall be subject to fulfillment by the healthcare service provider and healthcare facility of such criteria, including meeting quality standards set by the Cabinet Secretary in accordance with section 33 (2). Section 34(4) Every contracted healthcare provider and healthcare facility shall be issued with such identification as may be prescribed by the Authority ("the Social Health Authority established under;") and such identification shall be displayed in a conspicuous position. Section 34(5) The Authority ("the Social Health Authority established under;") shall terminate the contract with any healthcare provider and healthcare facility where such healthcare provider or healthcare facility fails to meet the criteria prescribed by the Cabinet Secretary under subsection (3). Section 34(6) Upon termination of a contract under subsection (5) the Authority ("the Social Health Authority established under;") shall, by notice in the Gazette , revoke the declaration made under subsection (3). Section 34(7) Any health care provider who, or health facility which displays the identification referred to in subsection (4) without permission of the Authority ("the Social Health Authority established under;") commits an offence and is liable upon conviction to a fine not exceeding one million, or to imprisonment for a term not exceeding two years or to both.

Section 34Verify source

§ 35BENEFITS, TARRIFS, EMPANELMENT, CONTRACTING AND CLAIMS - 35. Claims ManagementProvision

Establishes a Claims Management Office within the Authority to handle review, processing, validation and related claims-management tasks and empowers it to delegate some functions; requires the Cabinet Secretary to make regulations.

Section 35. Claims Management Section 35(1) There is established within the Authority ("the Social Health Authority established under;") an office to be known as the Claims Management Office which shall review and process the claims made under this Act. Section 35(2)(a) reviewing, processing and validating medical claims from healthcare providers and healthcare facilities; Section 35(2)(b) appraising medical claims based on the benefit package; Section 35(2)(c) issuing pre-authorizations for access to healthcare services based on the benefit package; Section 35(2)(d) developing an e-claims management system; Section 35(2)(e) undertaking quality assurance surveillance in respect of claims; Section 35(2)(f) establishing systems and controls for detecting and identifying fraud appropriate to the Fund’s exposure and vulnerability; Section 35(2)(g) sensitizing claimants on the consequences of submitting false and fraudulent claims; Section 35(2)(h) collecting and analyzing data for purposes of claim management; Section 35(2)(i) preparing quarterly reports on submission to the to the Board and the Cabinet Secretary ; and Section 35(2)(j) performing any other functions as may be necessary for the better carrying out of its functions under this Act. Section 35(3) The Claims Management Office may delegate the performance of its functions under subsection 2(a) and (b) to a suitable entity. Section 35(4) The entity referred to under subsection (3) shall be a medical insurance provider and a claim settling agent as defined and licensed by the Insurance Regulatory Authority ("the Social Health Authority established under;") under the Insurance Act, ( Cap. 487 ): Provided that a suitable number of entities shall be contracted to manage the claims from the zones identified in the manner prescribed in the Regulations. Section 35(5) The Cabinet Secretary shall make regulations for the better carrying out of the provisions of this section.

Section 35Verify source

§ 36BENEFITS, TARRIFS, EMPANELMENT, CONTRACTING AND CLAIMS - 36. Settlement of claimsProvision

The Authority must pay contracted healthcare providers or facilities when the Claims Management Office submits a claim; the Cabinet Secretary must make regulations to implement this section.

Section 36. Settlement of claims Section 36(1) The Authority ("the Social Health Authority established under;") shall make payments to a contracted healthcare provider or healthcare facility upon submission of a claim by the Claims Management Office. Section 36(2) The Cabinet Secretary shall make regulations for the better carrying out of the provisions of this section.

Section 36Verify source

Part VII

FINANCIAL PROVISIONS

§ 37FINANCIAL PROVISIONS - 37. Financial yearProvision

The financial year of the Authority shall be the period of twelve months ending on the thirtieth day of June in each year.

Section 37. Financial year Section The financial year of the Authority ("the Social Health Authority established under;") shall be the period of twelve months ending on the thirtieth day of June in each year.

Section 37Verify source

§ 38FINANCIAL PROVISIONS - 38. Retention of receipts and earningsProvision

The Authority must retain all receipts, earnings and accruals to the Authority and the balance of the Funds at the close of each financial year for the purposes of the Funds.

Section 38. Retention of receipts and earnings Section All receipts, earnings and accruals to the Authority ("the Social Health Authority established under;") and the balance of the Funds ("the Primary Healthcare Fund established under, the Social Health Insurance Fund established underand the Emergency, Chronic and Critical Illness Fund established under;") at the close of each financial year shall be retained by the Authority ("the Social Health Authority established under;") for the purposes of the Funds ("the Primary Healthcare Fund established under, the Social Health Insurance Fund established underand the Emergency, Chronic and Critical Illness Fund established under;") .

Section 38Verify source

§ 39FINANCIAL PROVISIONS - 39. Annual estimatesCommencement

The Authority must prepare annual revenue and expenditure estimates within three months after the end of the financial year; the Board must approve those estimates before the start of the next financial year.

Section 39. Annual estimates Section 39(1) The Authority ("the Social Health Authority established under;") shall, within three months after the end of the financial year, cause to be prepared estimates of its revenue and expenditure for that financial year. Section 39(2)(a) the payment of all the claims and benefits of the contributors in respect of medical and healthcare expenses incurred by them or their named beneficiaries pursuant to the provisions of this Act; Section 39(2)(b) the payment of salaries, allowances and other charges in respect of the staff of the Authority ("the Social Health Authority established under;") ; Section 39(2)(c) the payment of pensions, gratuities and other charges in respect of retirement benefits which are payable out of the funds of the Authority ("the Social Health Authority established under;") ; Section 39(2)(d) the proper maintenance of buildings and grounds of the Authority ("the Social Health Authority established under;") ; Section 39(2)(e) the acquisition, maintenance, repair and replacement of the equipment and other movable property of the Authority ("the Social Health Authority established under;") ; or Section 39(2)(f) the creation of such reserve funds to meet future or contingent liabilities in respect of retirement benefits, insurance or replacement of buildings or equipment, or in respect of such other matters as the Authority ("the Social Health Authority established under;") may consider appropriate. Section 39(3) The annual estimates shall be approved by the Board before the commencement of the financial year to which they relate and after the approval, the annual estimates shall not be increased without prior consent of the Board . Section 39(4) No expenditure shall be incurred for the purposes of the Authority ("the Social Health Authority established under;") except in accordance with the annual estimates approved under subsection (3).

Section 39Verify source

§ 40FINANCIAL PROVISIONS - 40. Expenses of administering theFundsProvision

Administrative expenses incurred by the Board are to be paid out of the Authority's finances, and those expenses must not exceed five percent of the Fund's annual expenditure.

Section 40. Expenses of administering theFunds Section 40(1) There shall be paid out of the finances of the Authority ("the Social Health Authority established under;") such administrative expenses as may be incurred by the Board in the exercise of its powers or the performance of its functions under this Act. Section 40(2) The administrative expenses referred to under subsection (1) shall not exceed five percent of the annual expenditure of the Fund.

Section 40Verify source

§ 41FINANCIAL PROVISIONS - 41. Accounts and auditProvision

The Board must keep proper books and records of the Authority's income, expenditure, assets and liabilities.

Section 41. Accounts and audit Section 41(1) The Board shall cause to be kept all proper books and records of accounts of the income, expenditure, assets and liabilities of the Authority ("the Social Health Authority established under;") . Section 41(2)(a) a statement of income and expenditure of the Authority ("the Social Health Authority established under;") during the year; and Section 41(2)(b) statement of the assets and liabilities of the Authority ("the Social Health Authority established under;") on the last day of that year. Section 41(3) The accounts of the Authority ("the Social Health Authority established under;") shall be audited and reported upon in accordance with the provisions of the Public Finance Management Act, ( No. 18 of 2012 ) and the Public Audit Act, ( No. 34 of 2015 )

Section 41Verify source

§ 42FINANCIAL PROVISIONS - 42. Annual reportProvision

The Board must prepare and submit an annual report within three months after each financial year to the Cabinet Secretary; the Cabinet Secretary must transmit that report to Parliament within three months of submission.

Section 42. Annual report Section 42(1) The Board shall, within three months after the end of each financial year, prepare and submit to the Cabinet Secretary a report of the operations of the Authority ("the Social Health Authority established under;") for the immediately preceding year. Section 42(2) The Cabinet Secretary shall, within three months of submission of the report under subsection (1), transmit the report to Parliament.

Section 42Verify source

Part VIII

DISPUTE RESOLUTION TRIBUNAL

§ 43DISPUTE RESOLUTION TRIBUNAL - 43. Dispute ResolutionProvision

People aggrieved by decisions under the Act may appeal to the Dispute Resolution Tribunal within one month; the Tribunal may alter the Board's decision; Tribunal orders may be appealed to the High Court within twenty-one days.

Section 43. Dispute Resolution Section 43(1) A person aggrieved by a decision made under this Act may, within one month from the date of the decision, appeal to the Dispute Resolution Tribunal for a review of such decision. Section 43(2) The Tribunal may uphold, reverse, revoke or vary the decision of the Board appealed under subsection (1). Section 43(3) A person who is not satisfied with an order made by the Tribunal under subsection (2) may appeal to the High Court within twenty-one days from the date the order is made.

Section 43Verify source

§ 44DISPUTE RESOLUTION TRIBUNAL - 44. Establishment ofDispute Resolution TribunalProvision

Establishes a Dispute Resolution Tribunal, sets appointment authorities for its Chairperson and other members, fixes members' three-year terms with eligibility for one re-appointment, specifies quorum, entitles members to allowances determined by the Cabinet Secretary (in consultation with the Salaries and Remuneration Commission), and requires the Cabinet Secretary to prescribe operational procedures.

Section 44. Establishment ofDispute Resolution Tribunal Section 44(1) There is established a Tribunal to be known as the Dispute Resolution Tribunal for the purpose of hearing and determining complaints, disputes and appeals in accordance with this Act or any other written law. Section 44(2)(a) a Chairperson who shall be appointed by the President from among persons qualified to be judges of the High Court; and Section 44(2)(b) four other persons who shall be appointed by the Judicial Service Commission and shall possess knowledge and experience in health, health economics, business administration, insurance and who are not in the employment of the Government or the Board and are not health service providers. Section 44(3) The members of the Tribunal shall hold office for a period of three years and shall be eligible for re-appointment for one further term of three years. Section 44(4) The quorum for a meeting of the Tribunal shall be the Chairperson and two other members. Section 44(5) The members of the Tribunal shall be entitled to receive such allowances as the Cabinet Secretary , in consultation with the Salaries and Remuneration Commission, may determine. Section 44(6) The Cabinet Secretary shall prescribe procedures for the operationalization of the Tribunal.

Section 44Verify source

§ 45DISPUTE RESOLUTION TRIBUNAL - 45. Vacancy in theDispute Resolution TribunalProvision

Vacancy in theDispute Resolution Tribunal Section dies;

Section 45. Vacancy in theDispute Resolution Tribunal Section dies;

Section 45Verify source

Legislative relationships

12 referenced instruments

Names are derived from the stored provision headings and citation-enrichment layer. Treat this as a research index and verify each relationship against the source text.

A–F

8 instruments

Act States that the objects of the Act
Section 3
Authority may institute proceedings. Section 49. Recovery of sums due under this Act
Section 49
Board under this Act
Section 11
Cabinet Secretary to make regulations under this Act
Section 50
Data Protection Act
Section 47
Fund and make disbursements therefrom in accordance with the provisions of this Act
Section 6
Fund shall be as appropriated by the National Assembly or from any other source provided for under this Act
Section 23
Funds established under this Act
Section 55

G–M

1 instrument

Insurance Act
Section 52

N–S

3 instruments

No. 9 of 1998 The National Health Insurance Fund Act, 1998
Section 54
Public Finance Management Act
Sections 14, 41
Social Health Insurance Fund. Section 26(3) A child born after commencement of this Act
Section 26

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