Does SHA Cover Optical and Glasses? What You Need to Know
"Does SHA cover glasses?"
I get this question every week.
Short answer: Yes, but with limits.
Long answer: It depends on your eye condition, the type of glasses, and where you go.
Let me explain exactly what SHA covers for optical care — and what you'll have to pay out of pocket.
Table of Contents
- What SHA Covers for Optical Care
- The Coverage Limits
- How to Get Glasses with SHA
- What's the Real-World Experience?
- Children's Optical Coverage
- Where to Go for Optical Care in Nairobi
- Eye Conditions SHA Covers
- Tips to Maximize Your Optical Benefits
- What If You Need Contact Lenses?
- Private Insurance for Better Optical
- The Bottom Line
- Next Steps
- Sha-optical-care-coverage-eye-exam-kenya
- The Coverage Limits
- How to Get Glasses with SHA
- What's the Real-World Experience?
- Children's Optical Coverage
- Where to Go for Optical Care in Nairobi
- Eye Conditions SHA Covers
- Tips to Maximize Your Optical Benefits
- What If You Need Contact Lenses?
- Private Insurance for Better Optical
- The Bottom Line
- Next Steps
What SHA Covers for Optical Care
Under SHIF (the health fund managed by SHA), optical services are part of outpatient benefits.
Covered:
- Eye examinations
- Basic prescription glasses
- Referrals to ophthalmologists
- Treatment for eye infections and conditions
- Glaucoma screening and management
- Diabetic eye screening
Not Covered:
- Designer frames
- Contact lenses (unless medically necessary)
- Cosmetic procedures (LASIK, etc.)
- Sunglasses
- Lens upgrades (anti-glare, photochromic) beyond basic prescription
The Coverage Limits
Here's where it gets specific:
| Service | SHA Coverage | Your Limit |
|---|---|---|
| Eye exam | Fully covered | Once per year |
| Basic frames | Partial | KES 3,000-5,000 |
| Single vision lenses | Partial | KES 2,000-4,000 |
| Bifocal lenses | Partial | KES 4,000-6,000 |
| Eye treatment | Case-by-case | Depends on condition |
Important: These limits are per year. If you need new glasses more than once a year, you pay the second pair yourself.
How to Get Glasses with SHA
Step 1: Get a Referral
Start at an SHA-accredited outpatient clinic.
- Tell them you need an eye exam
- They'll examine you and give a prescription
- They'll refer you to an accredited optical shop
Step 2: Choose an Accredited Optical Provider
Not all optical shops take SHA. Look for:
- Optica (most branches accredited)
- Eye Care Kenya
- Lions SightFirst Eye Hospital
- Kenyatta National Hospital Eye Unit
- Accredited opticians at major hospitals
Step 3: Claim Your Benefit
- Present your ID or SHA card
- Present your prescription/referral
- Choose frames within the covered amount
- Pay any excess if you want premium frames
What's the Real-World Experience?
Let me be honest.
The good:
- Basic glasses are genuinely covered
- Eye exams at public facilities are free
- Children's optical care is prioritized
The not-so-good:
- The KES 3,000-5,000 frame limit gets you very basic options
- Most optical shops push you toward out-of-pocket upgrades
- Wait times at public eye clinics can be long
- The process requires referrals (not direct access)
If you want nice frames or progressive lenses, expect to top up KES 5,000-15,000 out of pocket.
Children's Optical Coverage
Good news for parents:
SHA has enhanced optical coverage for children under 18:
- School eye screening covered
- Pediatric eye exams fully covered
- Children's glasses covered up to higher limits
- Special conditions (lazy eye, squint) covered
If your child needs glasses, start with a school health screening or visit any SHA-accredited facility.
Where to Go for Optical Care in Nairobi
Public Options (Lower Cost, Longer Wait):
- Kenyatta National Hospital Eye Unit
- Mbagathi Hospital Eye Clinic
- Mama Lucy Kibaki Hospital
Private Options (Faster, May Require Top-Up):
- Optica (multiple locations)
- Lens Crafters
- Eye Care Kenya
- Sarit Eye Centre
- Lions SightFirst Eye Hospital (Loresho)
Call ahead to confirm SHA acceptance and available services.
Eye Conditions SHA Covers
Beyond glasses, SHA covers treatment for:
| Condition | Coverage |
|---|---|
| Cataracts | Surgery covered at accredited hospitals |
| Glaucoma | Screening, medication, and surgery |
| Diabetic retinopathy | Screening and treatment |
| Eye infections | Fully covered outpatient |
| Corneal injuries | Emergency and follow-up care |
| Refractive errors | Glasses, not LASIK |
For serious conditions, you'll be referred to an ophthalmologist at a level 4 or 5 facility.
Tips to Maximize Your Optical Benefits
1. Time your exams Get your annual eye exam early in the year. If your prescription changes, you can get new glasses and still be covered.
2. Go public for exams, private for glasses Get your prescription at a public hospital (free). Then buy glasses at a private optical shop with better selection.
3. Keep your receipts If you pay out of pocket, keep receipts. Some expenses may be claimable under the chronic or outpatient fund.
4. Ask about children's benefits Children's optical has higher limits. Don't assume adult limits apply.
5. Check for employer top-up Many employers add optical coverage on top of SHA. Ask your HR.
What If You Need Contact Lenses?
SHA typically does not cover contact lenses.
Exception: Medical necessity
If contacts are medically required (not cosmetic), you may get coverage for:
- Keratoconus patients
- Post-surgery patients
- Severe refractive errors not correctable with glasses
You'll need a specialist recommendation and SHA approval.
Private Insurance for Better Optical
If optical care matters to you, consider private top-up insurance.
Most private plans offer:
- KES 15,000-30,000 optical limit
- Designer frames covered
- Contact lenses covered
- Progressive lenses covered
- No referral required
That's significantly better than SHA's KES 3,000-5,000 limit.
The Bottom Line
SHA covers optical care.
But it's basic:
- One eye exam per year
- Simple frames (KES 3,000-5,000 limit)
- Basic lenses
- Treatment for eye conditions
If you want better frames or contact lenses, you'll pay the difference or get private insurance.
For most people, SHA optical is enough for functional glasses. Just don't expect fashion eyewear.
Next Steps
- Schedule your annual eye exam at an SHA facility
- Check the accredited optical providers near you
- Know your limits before you shop
- Consider private top-up if optical matters to you
Have more questions about SHA benefits? Read my complete SHA guide.
Sha-optical-care-coverage-eye-exam-kenya
The Coverage Limits
Here's where it gets specific:
| Service | SHA Coverage | Your Limit |
|---|---|---|
| Eye exam | Fully covered | Once per year |
| Basic frames | Partial | KES 3,000-5,000 |
| Single vision lenses | Partial | KES 2,000-4,000 |
| Bifocal lenses | Partial | KES 4,000-6,000 |
| Eye treatment | Case-by-case | Depends on condition |
Important: These limits are per year. If you need new glasses more than once a year, you pay the second pair yourself.
How to Get Glasses with SHA
Step 1: Get a Referral
Start at an SHA-accredited outpatient clinic.
- Tell them you need an eye exam
- They'll examine you and give a prescription
- They'll refer you to an accredited optical shop
Step 2: Choose an Accredited Optical Provider
Not all optical shops take SHA. Look for:
- Optica (most branches accredited)
- Eye Care Kenya
- Lions SightFirst Eye Hospital
- Kenyatta National Hospital Eye Unit
- Accredited opticians at major hospitals
Step 3: Claim Your Benefit
- Present your ID or SHA card
- Present your prescription/referral
- Choose frames within the covered amount
- Pay any excess if you want premium frames
What's the Real-World Experience?
Let me be honest.
The good:
- Basic glasses are genuinely covered
- Eye exams at public facilities are free
- Children's optical care is prioritized
The not-so-good:
- The KES 3,000-5,000 frame limit gets you very basic options
- Most optical shops push you toward out-of-pocket upgrades
- Wait times at public eye clinics can be long
- The process requires referrals (not direct access)
If you want nice frames or progressive lenses, expect to top up KES 5,000-15,000 out of pocket.
Children's Optical Coverage
Good news for parents:
SHA has enhanced optical coverage for children under 18:
- School eye screening covered
- Pediatric eye exams fully covered
- Children's glasses covered up to higher limits
- Special conditions (lazy eye, squint) covered
If your child needs glasses, start with a school health screening or visit any SHA-accredited facility.
Where to Go for Optical Care in Nairobi
Public Options (Lower Cost, Longer Wait):
- Kenyatta National Hospital Eye Unit
- Mbagathi Hospital Eye Clinic
- Mama Lucy Kibaki Hospital
Private Options (Faster, May Require Top-Up):
- Optica (multiple locations)
- Lens Crafters
- Eye Care Kenya
- Sarit Eye Centre
- Lions SightFirst Eye Hospital (Loresho)
Call ahead to confirm SHA acceptance and available services.
Eye Conditions SHA Covers
Beyond glasses, SHA covers treatment for:
| Condition | Coverage |
|---|---|
| Cataracts | Surgery covered at accredited hospitals |
| Glaucoma | Screening, medication, and surgery |
| Diabetic retinopathy | Screening and treatment |
| Eye infections | Fully covered outpatient |
| Corneal injuries | Emergency and follow-up care |
| Refractive errors | Glasses, not LASIK |
For serious conditions, you'll be referred to an ophthalmologist at a level 4 or 5 facility.
Tips to Maximize Your Optical Benefits
1. Time your exams Get your annual eye exam early in the year. If your prescription changes, you can get new glasses and still be covered.
2. Go public for exams, private for glasses Get your prescription at a public hospital (free). Then buy glasses at a private optical shop with better selection.
3. Keep your receipts If you pay out of pocket, keep receipts. Some expenses may be claimable under the chronic or outpatient fund.
4. Ask about children's benefits Children's optical has higher limits. Don't assume adult limits apply.
5. Check for employer top-up Many employers add optical coverage on top of SHA. Ask your HR.
What If You Need Contact Lenses?
SHA typically does not cover contact lenses.
Exception: Medical necessity
If contacts are medically required (not cosmetic), you may get coverage for:
- Keratoconus patients
- Post-surgery patients
- Severe refractive errors not correctable with glasses
You'll need a specialist recommendation and SHA approval.
Private Insurance for Better Optical
If optical care matters to you, consider private top-up insurance.
Most private plans offer:
- KES 15,000-30,000 optical limit
- Designer frames covered
- Contact lenses covered
- Progressive lenses covered
- No referral required
That's significantly better than SHA's KES 3,000-5,000 limit.
The Bottom Line
SHA covers optical care.
But it's basic:
- One eye exam per year
- Simple frames (KES 3,000-5,000 limit)
- Basic lenses
- Treatment for eye conditions
If you want better frames or contact lenses, you'll pay the difference or get private insurance.
For most people, SHA optical is enough for functional glasses. Just don't expect fashion eyewear.
Next Steps
- Schedule your annual eye exam at an SHA facility
- Check the accredited optical providers near you
- Know your limits before you shop
- Consider private top-up if optical matters to you
Have more questions about SHA benefits? Read my complete SHA guide.
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