Social Health Insurance Act
2. Interpretation
2. Interpretation
"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 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.Source: Kenya Law