SHA optical, hearing aid and wheelchair benefits
What SHA lists for spectacles, hearing aids, wheelchairs and overseas treatment, and how a Kenyan optician or device supplier bills around those limits.
By Achekam · · 4 min read · For Healthcare businesses in Kenya
An optician in Kisumu fits a schoolchild with her first pair of glasses. A hearing clinic in Nairobi assesses a teenager whose school results have been slipping because he cannot follow lessons. A mobility supplier in Mombasa delivers a wheelchair to a family after a stroke. In each case, the family's first question is the same: will SHA pay?
The Social Health Authority's answers are specific, with amounts, age limits and household limits that a provider needs to know before the patient leaves with the device. This article sets out what SHA lists for optical care, assistive devices and overseas treatment at the time of writing, and how a provider in Kenya can invoice clearly when part of the cost falls outside the cover. Tariffs change, so check SHA's page before relying on any figure.
Spectacles and the household limit
SHA's optical benefit pays KES 950 for dispensing eyeglasses, with a limit of KES 1,000 per household per annum.
Two features catch providers and families out:
- The limit is per household. If one child in a family has already had glasses dispensed under SHA this year, the household limit may already be largely used. A second child's glasses in the same year may not be covered.
- The amount is for dispensing. Frames and lenses priced above what SHA pays leave a difference. Whether and how that difference may be charged to the patient depends on your arrangements with SHA, so confirm the position before quoting a family a price.
Refractive errors in the first year: under-18s only
SHA says that in the first year, treatment of refractive errors is limited to beneficiaries below eighteen years. An adult who comes in for a sight test and new glasses expecting SHA to pay may find that, during that first year, the cover does not extend to them.
Tell adult patients this at booking, not at the counter, and offer a clear private price.
Hearing aids and wheelchairs
SHA's assistive devices tariff lists hearing aids at KES 55,000 and wheelchairs at KES 15,000, with one device per household per year. Hearing aids are limited to people aged 18 years and below, and issued once per lifetime.
Each of those conditions changes what a provider should check before fitting:
| Condition SHA lists | What to check first |
|---|---|
| One device per household per year | Whether anyone in the household has received a device under SHA this year |
| Hearing aids for people aged 18 and below | The patient's age |
| Hearing aids issued once per lifetime | Whether the patient has ever received a hearing aid under SHA |
SHA also says this package will be rolled out subject to budgetary allocation. In practice that means a listed benefit may not yet be available when a patient needs it. Before fitting a device on the understanding that SHA will pay, confirm that the package is actually being paid, and have a fallback agreed with the family if it is not.
Overseas treatment
SHA's overseas treatment package covers medical and surgical procedures not available locally through empanelled overseas providers, with a limit of KES 500,000 per person per annum. A local provider that refers a patient abroad can point the family to this package and its limit, so they know what SHA lists for that treatment before plans are made.
SHA runs three funds in all: the Primary Healthcare Fund, the Social Health Insurance Fund and the Emergency, Chronic & Critical Illness Fund. The SHA benefit tariffs page lists the optical, assistive device and overseas packages with their tariffs and conditions, alongside the rest of SHA's benefits.
Invoicing SHA and the patient separately
When part of a device's cost falls to SHA and part to the family, a single invoice muddles who owes what. A cleaner approach is two invoices.
- An invoice to SHA for the covered amount, set up with SHA as its own customer.
- An invoice to the patient for anything the family has agreed to pay, such as upgraded lenses or a device SHA will not cover this year.
On Achekam, invoices start as drafts that can be changed or deleted, so the SHA invoice can wait as a draft until cover is confirmed. Issuing one takes the next number in its sequence and posts it to the ledger. Receivables are then aged into 0-30, 31-60, 61-90, 91-120 and over 120 days, with overdue totals, so the provider can see separately how long SHA takes to pay and which families still owe a balance. The common-care tariffs SHA lists for facilities, and how to treat SHA as a customer, are covered in what SHA pays Kenyan facilities for common care.
Setting devices up as items
Frames, lenses, hearing aids and wheelchairs are stock, and they are worth setting up properly. Achekam's Item Master, in the Accounting menu, lists and creates products with SKU, name, category, selling and cost price, opening quantity and VAT treatment; it needs the Point of Sale, Warehousing or Wholesale add-on.
Set each device model up as its own item with its cost price, so the margin on each sale is visible, and so you can see when a device sold at a price close to SHA's tariff leaves little or nothing after cost. The general approach to setting items up before selling them is in setting up dispensary items before the first sale.
Achekam does not check a patient's SHA eligibility, household limits or device history; the provider does that through SHA's own processes.
At the front desk
Add three questions to every booking for glasses or a device: the patient's age, whether anyone in the household has used the benefit this year, and whether the patient has had a hearing aid under SHA before. With those answers, the provider can tell the family what SHA is likely to cover before any work is done.
General guidance only, not advice on your own circumstances. Tax and payroll rules change: check the current position with the authority or your adviser.
