Where to appeal an SHA decision you disagree with
Social Health Insurance Act, 2023; Social Health Insurance Rules, 2024 · sources read 4 Oct 2026
Take it to the Dispute Resolution Tribunal set up under the Social Health Insurance Act within one month (30 days) of the decision. If you disagree with the Tribunal, you can appeal to the High Court within 21 days of its order.
- How long
- The Tribunal must hear and decide a complaint within six months of filing
- Deadline
- One month from the decision to go to the Tribunal
- Deadline
- 21 days from the Tribunal's order to appeal to the High Court
- Where
- SHA customer care first (0800 720 601, complaints@sha.go.ke); then the Dispute Resolution Tribunal under the Social Health Insurance Act; then the High Court
What you need
- A written complaint, with an affidavit signed by you confirming the grounds
- Copies of the supporting documents you will rely on
Steps
- Raise it with SHA first: call the toll-free line 0800 720 601 or email complaints@sha.go.ke.
- If you are still not satisfied, file a complaint with the Dispute Resolution Tribunal within one month of the decision.
- Serve the complaint on the other side (for example SHA or the hospital) within 7 days of filing it.
- If you disagree with the Tribunal's order, appeal to the High Court within 21 days.
Watch out
- The time runs from the date the decision was made, not from when you complained to SHA. Act early.
- Filing fees follow the Judiciary's guidelines. Ask the Tribunal registry what applies to you.
- These time limits are fixed by the Act, so a contract or an internal complaint process cannot change them.
- The Act calls it simply the Dispute Resolution Tribunal (set up under section 44). It hears complaints, disputes and appeals under the Social Health Insurance Act.
Who this covers
- Any person aggrieved by a decision made under the Social Health Insurance Act.
- Anyone with a dispute over a decision made under the SHI Act: registration of members, empanelment of providers and facilities, contracting, preauthorisation, settlement of claims, provider payments and refunds, or any other decision under the Act.
- You can also complain when SHA or a provider fails to do something the Act requires, not only about a decision it made.
Official sources (5)
- SHA Contract Pack 2026-2029, Part A: Master General Terms and Conditions (Part 2), clause 33.3 'Statutory rights of appeal' sha.go.ke · read 2 Oct 2026
- Social Health Insurance (Tribunal Procedure) Rules, 2024 (L.N. 48 of 2024), Kenya Law revised copy as at 8 March 2024 libraryir.parliament.go.ke · read 2 Oct 2026
- Social Health Insurance (Tribunal Procedure) Rules, 2024, Kenya Gazette Supplement No. 59 (Legislative Supplement No. 27), L.N. 48 libraryir.parliament.go.ke · read 4 Oct 2026
- SHA FAQ: How can individuals file complaints or seek assistance under SHA? sha.go.ke · read 2 Oct 2026
- Social Health Insurance Act, 2023 (No. 16 of 2023) new.kenyalaw.org · read 4 Oct 2026