SHA Dental Coverage: What's Included and What's Not

You have a toothache. Does SHA cover the dentist?

The short answer: sort of. The longer answer involves knowing exactly what's covered and what's not.

Here's the complete picture of dental coverage under SHA.

Table of Contents

• Does SHA Cover Dental Care?
  • What's Covered
  • What's NOT Covered
• How SHA Dental Coverage Works
  • Accessing Dental Services
  • SHA-Accredited Dental Facilities
• SHA Dental Coverage Limits
  • Outpatient Dental
  • Emergency Dental
• What Counts as a Dental Emergency?
• Common Dental Treatments and SHA Coverage
  • Extractions
  • Fillings
  • Root Canals
  • Dental X-rays
  • Professional Cleaning
• Getting the Most from SHA Dental
  • Tip 1: Know Your Facilities
  • Tip 2: Go for Emergencies First
  • Tip 3: Use University Dental Schools
  • Tip 4: Budget for What's Not Covered
  • Tip 5: Consider Dental Top-Up
• SHA vs Private Dental Insurance
• Private Dental Insurance Options
  • AAR
  • Jubilee
  • Britam
  • Standalone Dental Plans
• Cost of Dental Care Without Insurance
• Common Questions
  • "Can I see any dentist with SHA?"
  • "Does SHA cover children's dental?"
  • "What about wisdom tooth removal?"
  • "Can I claim for dental work I paid for privately?"
  • "Is dental checkup covered?"
• Taking Care of Your Teeth
  • Daily Care
  • Regular Checkups
  • Cost-Saving Tips
• The Bottom Line
• Next Steps

Does SHA Cover Dental Care?

Partially. SHA includes some dental services, but it's limited compared to private dental insurance.

What's Covered

What's NOT Covered

How SHA Dental Coverage Works

Accessing Dental Services

Step 1: Visit SHA-accredited facility Not all SHA facilities have dental services. Check if your preferred facility has a dental unit.

Step 2: Get assessed The dentist will examine you and determine if treatment is covered under SHA benefits.

Step 3: Treatment or referral Basic treatments may be done on-site. Complex cases may need referral to specialized facilities.

SHA-Accredited Dental Facilities

SHA covers dental services at:

• Government hospitals with dental units
• Level 4 and 5 county hospitals
• Some accredited private dental facilities
• University dental schools (Nairobi, Moi)

To find dental facilities:

1. Check SHA app for dental-capable facilities
2. Call facility before visiting to confirm dental services
3. Ask about specific treatments available

SHA Dental Coverage Limits

Outpatient Dental

Dental care falls under your outpatient benefits.

Example: If your outpatient limit is KES 50,000/year and you spend KES 5,000 on dental, you have KES 45,000 left for other outpatient services.

Emergency Dental

True dental emergencies (trauma, severe infection) may be covered under emergency provisions:

• Tooth knocked out in accident
• Dental abscess requiring drainage
• Jaw fracture
• Severe bleeding after extraction

What Counts as a Dental Emergency?

For true emergencies, go to the nearest hospital with dental services. SHA will cover stabilization treatment.

Common Dental Treatments and SHA Coverage

Extractions

Covered? Yes, at SHA-accredited facilities.

Process:

1. Dentist assesses the tooth
2. If extraction is needed, it's done under outpatient
3. Medications prescribed if needed

Cost without insurance: KES 1,000–5,000 depending on complexity

Fillings

Covered? Yes, basic fillings at accredited facilities.

Types:

• Amalgam (silver) fillings — More likely covered
• Composite (white) fillings — May require top-up payment

Cost without insurance: KES 1,500–5,000

Root Canals

Covered? Limited. Availability depends on facility.

Reality:

• Most public hospitals don't do root canals
• Referral to specialized facility may be needed
• May fall outside SHA coverage at private facilities

Cost without insurance: KES 10,000–30,000

Dental X-rays

Covered? Yes, when medically necessary.

Usually available at larger hospitals with dental units.

Cost without insurance: KES 500–2,000

Professional Cleaning

Covered? Generally no — considered preventive/cosmetic.

Cost without insurance: KES 2,000–5,000

Getting the Most from SHA Dental

Tip 1: Know Your Facilities

Before you need dental care:

1. Find SHA-accredited facilities near you with dental units
2. Call to confirm what treatments they offer
3. Know their operating hours (dental often limited)

Tip 2: Go for Emergencies First

If you have a dental emergency, SHA covers it. Don't delay treatment thinking it's not covered.

Tip 3: Use University Dental Schools

University of Nairobi and Moi University dental schools:

• Often SHA-accredited
• Lower costs
• Supervised by qualified dentists
• Good for non-urgent treatments

Tip 4: Budget for What's Not Covered

SHA won't cover everything. Budget separately for:

• Regular checkups
• Cleanings
• Cosmetic work
• Advanced treatments

Tip 5: Consider Dental Top-Up

If dental care is important to you, private insurance with dental benefits fills the gap.

SHA vs Private Dental Insurance

Private Dental Insurance Options

If you need comprehensive dental cover, consider private insurance with dental benefits:

AAR

• Dental included in most plans
• Annual limits KES 25,000–75,000
• Covers cleanings, fillings, extractions, root canals

Jubilee

• Dental as add-on or included
• Annual limits vary
• Good network of dental providers

Britam

• Dental benefits available
• Mid-range coverage
• Check specific plan details

Standalone Dental Plans

Some providers offer dental-only coverage:

• Lower premiums (KES 10,000–25,000/year)
• Focused dental benefits
• Often include preventive care

Cost of Dental Care Without Insurance

For reference, here's what you might pay out of pocket:

Common Questions

"Can I see any dentist with SHA?"

No. You must visit SHA-accredited facilities. Not all dentists accept SHA, and many private dental clinics don't.

"Does SHA cover children's dental?"

Same rules apply. Basic treatments at accredited facilities. Orthodontics (braces) are not covered.

"What about wisdom tooth removal?"

If medically necessary (impaction, infection), extraction is covered at facilities that perform it.

"Can I claim for dental work I paid for privately?"

If the facility wasn't SHA-accredited, reimbursement is unlikely. SHA generally requires using network providers.

"Is dental checkup covered?"

No. Routine checkups are considered preventive care and aren't covered under SHA.

Taking Care of Your Teeth

Since SHA dental is limited, prevention saves money:

Daily Care

• Brush twice daily
• Floss once daily
• Use fluoride toothpaste
• Avoid excessive sugar

Regular Checkups

Even though SHA doesn't cover them:

• Visit dentist every 6–12 months
• Catch problems early (cheaper to fix)
• Professional cleaning 1–2 times per year

Cost-Saving Tips

1. University dental schools — Quality care at lower costs
2. Dental camps — Free screenings and basic treatments
3. Early treatment — A filling costs less than a root canal
4. Shop around — Prices vary between dentists

The Bottom Line

SHA dental coverage is basic:

What you can count on:

• Emergency dental care
• Basic extractions
• Simple fillings
• Treatment at government hospitals

What you'll need to pay for:

• Checkups and cleanings
• Root canals (mostly)
• Crowns and bridges
• Orthodontics
• Implants
• Cosmetic work

If dental care is a priority, consider private insurance with dedicated dental benefits alongside SHA.

Next Steps

1. Find SHA-accredited facilities with dental near you
2. Budget for dental care not covered by SHA
3. Consider dental add-on through private insurance
4. Read: Best Private Insurance to Top Up SHA
5. Explore: Complete SHA Benefits Guide