• By Raymond Momanyi

Does SHA/SHIF Cover Maternity in Kenya? Understanding Waiting Periods and How to Combine It with Private Medical Insurance

Bringing a new life into the world is a beautiful journey — but it also comes with serious financial planning. In Kenya, maternity care costs can stretch from Ksh 10,000 in public hospitals to over Ksh 250,000 in private ones. With the new Social Health Authority (SHA) and the Social Health Insurance Fund (SHIF) replacing NHIF, many Kenyans are asking: Does SHIF actually cover maternity? How does it work? And if you already have private medical insurance, can it supplement SHIF?

Imana Insurance Kenya breaks it all down — the benefits, limits, and waiting periods under both SHIF and private health insurance — so you can make informed choices for your family’s maternity plan. 

Maternity cover under SHA/SHIF (public scheme)

What is SHA/SHIF?

• The Social Health Authority (SHA) is the new public-health insurance umbrella in Kenya, created under the Social Health Insurance Act. 
• Under it is the Social Health Insurance Fund (SHIF) which pools resources for in-patient, certain benefits etc. 
• The “benefit package” summary shows that maternity, newborn & child-health services are included. 

What does SHA/SHIF maternity cover include?

From the benefit summary:

• For maternity/newborn/child-health: “antenatal care, delivery, after-care for mother & newborn, midwifery, operating/recovery/maternity ward & other room charges including meals, newborn Vitamin K & immunisation, provision of warmth & newborn resuscitation, diagnostic tests, transfusion, oxygen, postnatal family-planning”.
• Tariffs listed: Normal delivery KES 11,200; Caesarean section KES 32,600 (in Level 2-3 facilities) under SHIF’s package. 

Key conditions / waiting periods / limitations

• The SHIF benefit summary shows a “max stay 48 hrs for normal delivery / 72 hrs for C-section” in that category. 
• In the FAQ document: “Q85. Is there a waiting period to access services? Q86. No waiting period.” — for SHA general registration/benefits. 
• However, online SHA reporting:

• “The new Social Health Insurance Fund (SHIF) … Maternity - For deliveries, SHIF will only remit Sh11,200 for normal deliveries and Sh32,600 for Caesarian section. Hospital stay - Hospital stay is restricted to only 48hrs for normal delivery and 72hrs for C-Section.” 

• So: While the scheme says “no waiting period” in some general benefit sense, maternity cover under SHIF still has quite tight cost/tariff caps, and strict stay-limits.
• Also note: The amounts (KES 11,200 / 32,600) are much lower than what many private hospitals charge for maternity care in Kenya.

How it works / supplementing other cover

• Because these tariffs (KES 11,200 / 32,600) are low relative to the cost of maternity in many private hospitals, many individuals will still incur additional out-of‐pocket or rely on top-up/private cover.
• You may use SHIF as your foundational public cover; then private medical insurance or a specific maternity rider can supplement it by picking up the excess.
• Key point: Being registered and up-to-date on contributions to SHIF is critical — if your registration or contributions aren't current you could be liable for payment yourself. (General principle from health insurance guidance).
• For expectant mothers: while SHIF may not require a long waiting period (or may have none depending on registration) the benefit limits and conditions mean you must check whether the expected hospital and delivery costs will be covered, or whether you’ll need top-up cover.

Maternity cover under Private Medical Insurance

Typical scope & waiting periods

• Private insurers in Kenya often offer maternity benefits as part of inpatient cover or as specific rider. According to a blog: waiting periods for maternity typically 10-12 months for individual/family plans. 
• Example: On the “Betterlife” plan from Madison Insurance Company Ltd: waiting period for maternity – 10 months. 
• Example: Another insurer: “maternity: 9 months waiting period” in benefits table.
• On what the maternity cover includes: prenatal visits, delivery (normal & C-section), complications of pregnancy, postnatal care.

What is covered, what is not

Covered:

• Consultation, tests, ultrasound scans, delivery (normal & C-section), hospital stay and theatre/maternity ward charges, newborn care (depending on plan). imana.co.ke
  
  

Not covered / limitations:

• If you join the plan after you are already pregnant, many insurers will exclude maternity benefit until the waiting period lapses. “Insurance companies in Kenya do not offer maternity cover if you are already expecting.”
• Infertility treatments/IVF are often excluded or have higher waiting periods.
• Sub‐limits may apply (maximum amount payable) and hospital category may matter (private high-cost hospitals often cost more than the benefit limit).

How private cover supplements SHIF/NHIF base

• Many private insurers assume the individual has public cover (NHIF/SHIF) and calculate their benefit net of that. According to one guide: “When you buy a commercial medical insurance policy … your insurance is calculated net of the NHIF contribution… Because membership in NHIF is mandatory…” imana.co.ke
• Thus: You may use private insurance to cover the gap left by public cover + hospital costs beyond what SHIF pays.
• If you have private cover with maternity benefit, you often still need to meet the waiting period — so planning ahead (before you conceive) is key.

Comparing & Planning – What you need to ask

• Waiting period: Do you join the plan now and then wait x months before maternity-benefit kicks in? For private insurance this is typically 10-12 months or more. For SHIF the formal documentation says “no waiting period” but the benefit limit and conditions are constrained.
• Benefit limit/tariff: What amount is paid for delivery / C-section / complications? E.g. SHIF shows KES 11,200 / 32,600. Are those enough to cover your expected hospital choice? Many private hospitals cost much more.
• Hospital category: Are you planning to use a high-end private hospital? Then check the benefit covers the charges or whether you’ll need co-payment.
• Supplement / gap cover: If you will use private hospital care, consider a private medical plan or maternity rider that covers the excess beyond SHIF/NHIF.
• Pre-existing pregnancy: If you’re already pregnant, most private plans will not cover maternity (or you’ll have to wait). Joining early is better.
• Registration & contributions: For SHIF, ensure your registration is correct, contributions are paid, so you actually qualify for benefits.
• Services included: Check whether antenatal, postnatal care, newborn care, complications are included.
• Exclusions: Infertility, elective procedures, outside-panel hospitals, etc.
• Review links: For further reading at Imana: Maternity Insurance Covers in Kenya on the Imana site.
  imana.co.ke

Your Takeaway

If I were speaking straight:

• Don’t rely on “just SHIF” for high-cost private maternity. The numbers (KES 11k/32k) likely leave a gap.
• Get private medical cover before you plan to conceive — so the waiting period (for private plans) is out of the way.
• Use SHIF as your backbone base public cover; use private cover to “top-up”.
• If you’re already pregnant: check what cover you have, talk to your broker (like us at Imana) about gap cover / hospital choice.
• Plan early. Waiting periods aren’t just bureaucracy — they matter.

Call to Action

If you’re ready to compare quotes or find the best maternity + family medical cover: visit www.imana.co.ke
or www.mykava.co.ke (via our partner MyKava).
Call or WhatsApp +254 796 209 402 and let’s get you covered.

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