How State bungled rollout of tourist health cover

Tourists disembark from Flydubai plane in Mombasa. [File, Standard]

Tourists are being forced to buy a State-backed health insurance scheme that has, however, not been helpful.

Despite taking the $44 cover, many travellers have reported being forced to pay out of pocket at local hospitals to cater for medical emergencies or fall back on insurance covers taken in their home markets that are not recognised by Kenya.

Adding to the frustrations experienced by travellers has been the lack of consensus within the government. While President William Ruto and the Ministry of Health say tourists with valid insurance would be exempt from purchasing the Kenyan cover, aviation and immigration authorities insist all foreigners need to buy the Kenyan cover.

There are also concerns that the law was not followed in procuring the insurance firms that are currently underwriting the scheme, which was also despite an advisory by the Public Procurement Regulatory Authority (PPRA) that had said all premiums should be collected by the Social Health Authority (SHA).

The cracks within the government played out last week when President William Ruto told private sector players that tourists with valid travel insurance would be exempt from Kenya’s insurance requirement.

According to a statement by the Kenya Private Sector Alliance (Kepsa), “the President directed that travellers entering Kenya with valid travel insurance cover be exempted from the newly introduced mandatory $44 inbound travel insurance fee, including any related processing or system charges”.

The President made the clarification during the sixth Kepsa Presidential Roundtable, held on November 4.

This is a direct contradiction with directives by some of the state agencies charged with overseeing aviation and immigration in the country, including the Kenya Civil Aviation Authority (KCAA). The Authority had in October directed airlines to verify that their passengers had purchased the new insurance cover before they allowed them to board.

KCAA in a circular October 9, which was issued days after the policy came into effect on October 5, notified airlines operating passenger flights into Kenya of the new policy and requiring them to ensure that their customers have the insurance cover.

“All non-exempt travellers, including those who already hold foreign travel health insurance, must obtain the mandatory inbound travel health insurance cover from local insurers. There is no procedure for verifying or accepting foreign travel insurance certificates for this requirement,” said KCAA in the circular, which is now being seen as regulatory overreach.

“Air operators are requested to take the following measures; inform passengers at booking and before departure of the requirement... request and verify documentary evidence of compliance at check-in before boarding.”

Kenya started requiring foreign travellers to have inbound health insurance on October 5 this year as part of rolling out the Social Health Insurance Act 2023. The Act makes it mandatory for non-Kenyans coming to the country for a period of less than 12 months to have a travel health insurance cover.

The policy is intended to protect the national health system from unpaid visitor bills.

Observers however note that the law does not require tourists to buy the cover from Kenyan underwriters if they have valid travel insurance, a position they note was clarified in August by the CS Health and has now been further clarified by the President.  In August, Health CS Adan Duale clarified that travellers with compliant home-country insurance would not be required to buy Kenya’s new insurance when it was rolled out. 

The Ministry of Health’s position has seen many question KCAA’s directive, including government insiders.

“KCAA has no function under the Social Health Insurance Act, 2023. Its circular nonetheless conscripts airlines to verify a health-insurance condition before boarding,” reads a brief on the implementation of the health cover prepared for the Ministries of Health and Interior.

The report noted that while the objective of protecting Kenya’s health system from unpaid visitor medical bills is legitimate, it faults how the scheme was implemented.

It noted that authorities started blocking entry into Kenya for visitors without travel insurance on October 6, despite a court injunction having been in place since August that had suspended its implementation. The High Court in Marsabit, which had in August issued the injunction, however, ruled on October 7, clearing the implementation of the scheme.

The brief also noted that there is no record of how the insurers were sourced which was despite a prior PPRA advisory to the Ministries of Health and Interior that they should follow the Public Procurement and Assets Disposal Act in recruiting suppliers.

Plans to implement the mandatory cover for foreigners coming to Kenya started in late 2024, when the State Department of Immigration on December 20, 2024 floated a restricted tender for visitor insurance underwriters. The mode of procurement was opposed the insurance sector. The Association of Kenya Insurers argued that the government had not justified floating a restricted tender and this amounted to discrimination. The State Department cancelled the tender after PPRA raised concerns.

The government would, however, go ahead and later in 2025 select the insurers to underwrite the scheme in a process that has been contested.

In July 2026, the Ministry of Health gazetted the minimum policy benefits for the mandatory inbound travel insurance health.

According to the Gazette notice, the policy has a benefit of up to $50,000, which would cater for medical expenses, emergency transportation, prescribed medicines, mental health and in case of death, the repatriation remains to their home countries.

But the Ministry did not publish a list of insurers in the notice, which has been among the issues of contention.

Kenya’s eCitizen announced the $44 premium on August 20 this year in a notice to the travel industry, further saying that it would be purchased through eTA for eTA required travellers and eCitizen platform for the other travellers.

PPRA had in June 2025 written to the PSs of Immigration and Citizen services Belio Kipsang and Medical Service Ouma Oluga in which it noted that all premiums should go to SHA, while also cautioning them to comply with the public procurement Act, particularly section 44 that focuses on the responsibilities of an accounting officer.

“We therefore expect that you will manage the subject matter in compliance with the relevant legislation and ensure that all premiums related to the inbound travel health insurance for non-Kenyans entering Kenya for a period less that 12 months is collected by the Social Health Authority and any public procurement related issues is undertaken in accordance with the Act while taking into considerations provisions of Section 44 of the Act,” said PPRA in the June 2025 letter to the two PSs, a position it confirmed on September 18 this year in documents filed at the HIgh Court in Kiambu.

Despite the advisory, SHA currently appears to have no defined role in the collection of the money and paying for hospital bills whenever claims emerge or even access and control of the data of the travellers taking the cover.

The brief prepared for the two ministries noted that SHA should be collecting and administering the scheme, which it notes what an advisory by PPRA on June 25 last year.

“Visitors are paying without access to care and the scheme runs on a contract issued by bodies with no mandate under the SHA Act. SHA has the mandate and the means to put the scheme on a lawful and working footing,” reads the brief, noting that the current arrangements had also strained relations between the Ministry of Health and Insurance Regulatory Authority.

“The handling of the programme has generated significant industry disquiet and that the concerns raised about procurement, the custody of premiums and the exclusion of SHA deserve a hearing rather than exclusion from the process. Where industry participants are shut out of consultation on a scheme that depends on their participation, the quality of the scheme suffers.”

Other than the court case that had been filed in Marsabit, there are other cases that are pending in court that want the government to disclose the approved insurers and selection criteria as well as challenging the scheme for lack of public participation, lack of a framework for collection, custody, remittance, audit and accountability of the money.

Travelers to Kenya who have bought the insurance cover tell of different stories, many of them of rejection at local hospitals, unanswered calls to the numbers indicated on the policy documents and eventually ended up paying out of pocket or relying on their home insurers.

In many online forums, tourists dismiss the travel insurance scheme by Kenya as another tax that might dissuade them from travelling to Kenya in coming years.

Veteran hotelier Mohamed Hersi said the move could be costly for Kenya that is aiming to increase tourist numbers to five million by 2028, about double the number of international visitors to Kenya in 2025 which stood at 2.7 million.

“This is a tax wearing a stethoscope, and it is aimed squarely at the industry that earns this country more foreign exchange than almost anything else,” he said in a post on October 9.

“Nowhere in the circular does the government make any provision for a visitor's existing policy. The question is not whether the visitor is insured. The question is whether the visitor has paid us.”

“Kenya's tourism earnings rose to Sh501.34 billion in 2025. Lose even three percent of that through cancellations, diverted bookings and families who simply choose elsewhere, and we forfeit roughly Sh15 billion. No insurance premium pool will recover that. That is the very definition of penny-wise and pound-foolish.”