Healthcare Reimbursement in Kenya: Who Reimburses What Depending on Your Situation

The CLEISS does not list Kenya among the countries that have concluded a bilateral social security agreement with France. No coordination therefore exists between the schemes: no form to maintain rights between the two countries, no aggregation of periods, no cross-coverage. France Diplomatie (the French foreign ministry) considers it imperative to take out an assistance contract or insurance covering all medical costs (including surgery and hospitalisation) and repatriation: hospitalisation costs can be very high and the embassy never covers them.

Four players may be involved depending on status: the Social Health Authority (SHA) for the Kenyan system, the French scheme kept in place for the seconded employee, the CFE and international health insurance. The notions of reimbursement basis and out-of-pocket cost help you compare offers. How the facilities work is presented in the page on the Kenyan healthcare system. The conversions use the Central Bank of Kenya rate of 5 October 2026: 146.20 shillings (KES) to €1.

The employee on a local contract falls under the Kenyan schemes. Their employer deducts the SHIF contribution of 2.75% of gross pay and pays it over to the SHA; the employee can then be treated in contracted facilities, within the limits of SHA benefits. The contract states whether the employer adds complementary cover; the employer’s obligations and the tax treatment of that cover are presented in the page on working in Kenya. See the glossary entry on the local contract.

The seconded employee sent by a French employer remains affiliated to the French compulsory scheme for 3 years, renewable once, with contributions paid in France as if they were working there; local contributions may be added. Care is covered within the limit of the benefits they would have received in France for the same care, on paid invoices sent to their fund with form S 3125c “care received abroad”. Dependants who accompany them follow the same procedure, while those who stay in France continue to deal with the fund; sick leave is notified to the fund within 48 hours and a work accident to the employer within 24 hours (CLEISS). See seconded or expat and the glossary entry on the seconded employee.

The self-employed person has no employer to enrol them. If they reside in Kenya and hold an Alien ID, they can register with the SHA, where non-employees contribute 2.75% of their household income, determined by a means test, with a minimum of 300 KES a month. They can also join the CFE or take out international insurance; see digital nomad insurance for remote workers.

The student under 30 can join the CFE youth plan (from €57 a month) or take out international student insurance; registration with the SHA remains possible for a resident holding an Alien ID. See student insurance abroad.

The spouse and children follow the status of the holder: dependants of the seconded employee for the French scheme, household members in an SHA registration, beneficiaries of a family contract with the CFE or an insurer. The family that stays in France continues to deal with its fund of affiliation; children who accompany the seconded employee no longer give entitlement to French family benefits. See expat family insurance and the guide to children’s cover abroad.

The retiree is not covered by form S1, which is valid in the European Union. The CLEISS indicates three solutions in a country with no agreement: the local scheme, voluntary enrolment in the CFE and private insurance. During temporary stays in France, they are covered if they receive an old-age pension corresponding to at least 15 years of insurance in France and carry on no professional activity. Outside France, they pay neither the CSG, nor the CRDS, nor the Casa when their tax residence is no longer in France; a health insurance contribution is withheld from their pensions if they are dependent on a French scheme: 3.2% on the basic pension, 4.2% on the complementary pension and 7.1% for a self-employed worker’s retirement pension. See the guide to retirees’ health insurance abroad and the page on retiring in Kenya.

The CFE reimburses according to the country of care, by rates or flat amounts applied to actual expenses, with no health questionnaire; it covers GP consultations, medicines, tests, hospitalisation, maternity, dental care, emergency transport and vaccines, including during stays of less than three months in France, with third-party payment in French public and private hospitals. Cover is immediate if enrolment takes place before departure or within three months of settling; beyond that, cover starts after three months before age 45 and six months from age 45. Plans start at €87 a month (main plan), €57 (youth plan) and €147 (retirees’ plan). The guide to CFE reimbursements details this mechanism.

International health insurance at first-euro level reimburses actual costs within its ceilings, after any excess, waiting periods and exclusions. With direct billing, the insurer pays the facility, which avoids advancing hospitalisation costs that France Diplomatie describes as potentially very high. Policies are compared on the annual ceiling, the coverage zone, evacuation and the handling of medical history; see the guide to the coverage zone.

The tourist takes out, before departure, insurance covering medical costs and repatriation, which France Diplomatie describes as imperative. Outside the European Union, Assurance Maladie (the French national health insurance) may cover urgent and unforeseen care on the insured person’s return: they send the paid invoices with form S3125 to their fund, which reimburses on the basis of, and within the limit of, the flat-rate French tariffs in force, and not on actual expenses; the medical adviser assesses the urgency and daily allowances are not paid for sick leave outside Europe. See long-stay travel insurance.

On returning to France, resuming a professional activity opens affiliation from the first hour worked, with no waiting period. Without an activity, universal health protection opens on a stable-residence criterion, with in principle a 3-month waiting period; a CFE member can, under conditions, access the expatriate scheme for the 3 months following their return (CLEISS). See reducing the waiting period and the page on return to France.

• Consultation: the SHA primary healthcare fund covers consultations, diagnostics, tests, X-rays and ultrasounds in contracted facilities; French rules on paid invoices for the seconded employee; scales of the country of care for the CFE; actual costs within ceilings for a first-euro policy.
• Hospitalisation: the SHIF covers stays, surgery, dialysis, mental health and oncology in contracted facilities, with annual ceilings, for example 400,000 KES per person per year for cancer care (about €2,740); French scheme for the seconded employee, who advances the costs; covered by the CFE; direct billing possible with an international policy.
• Medicines: the SHA covers medicines prescribed during a consultation in contracted facilities; reimbursed according to the CFE scales or the ceilings of an international policy.
• Dental: the SHA provides a limit of 2,000 KES per household per year for oral health (about €14), with a rollout subject to the availability of resources; included in the CFE according to its scales and in most international policies, with an annual ceiling.
• Optical: the SHA includes eye examinations and glasses in its primary healthcare fund, within the limit of 1,000 KES per household per year (about €7), with treatment of refractive errors reserved for under-18s in the first year of implementation; an item absent from the list of care cited by the CFE, and covered by some international policies with ceilings per period.
• Maternity: the SHA covers prenatal and postnatal follow-up, normal or assisted delivery and caesarean section; the CFE requires conception after enrolment; international policies generally apply a waiting period.

The reimbursement guide and the page on expat health insurance give benchmarks; Expavy helps you test these options against your situation.