Crisis hits police and teacher medical schemes

More than 150,000 police officers may soon start paying more for medical cover to enable them to access medical loans.

An internal memo seen by The Standard says the Utumishi Fund, which was established in 1995 and loans police officers up to Sh50,000, is no longer enough to cater for the rising medical bills.

The memo says the crisis has been occasioned by the implementation of the AON medical cover that puts a cap on the amount a member can spend, leaving many officers with huge bills after exhausting their annual allocations.

The communication sent from the national police headquarters says that currently, the fund only allows police officers to borrow enough money to pay up to half of the accrued medical bills but that the amount should not exceed Sh50,000.

Billions of shillings

“In the advent of the AON cover, requests have suddenly shot up because the cover has limits and many officers have exhausted their cover and are still undergoing treatment, meaning they are accruing bills running into millions of shillings,” reads the memo by the deputy inspector general of police and signed by a John Kamau.

A consortium of three insurers – AAR, Jubilee, and UAP – jointly provides teachers and police officers health cover.

AON is the intermediary between the insurers and the beneficiaries. It runs the day-to-day activities of the schemes.

About 85 per cent of police officers and teachers are covered under the scheme.

Low cadre police officers have an in patient cover of Sh1.5 million and an out patient cover of Sh150,000. Optical cover is at a flat rate of Sh50,000, maternity cover is Sh125,000, and last expense benefit of Sh50,000.

Officers in the highest job group have an in-patient cover of Sh2.5 million and an out-patient cover of Sh400,000. They also enjoy a flat rate optical cover of Sh50,000, maternity cover of Sh125,000 and last expense benefit of Sh50,000.

The document dated May 22 says that despite the mounting debts, police officers cannot be given money beyond the limits stated under the Utumishi Fund.

“Assisting them means we will be in contravention of the policy, which had a ceiling of Sh50,000. The DIG has suggested that we increase contributions,” reads the memo.

Currently, each police officer contributes Sh50 a month to the kitty.

Two proposals have been made to enable officers to enjoy up to Sh5 million medical cover.

“A proposal of Sh500 monthly contribution with maximum assistance being raised from Sh50,000 to Sh2.5 million has been suggested,” it says.

The second proposal is to have the officers pay Sh1,000 a month to enjoy Sh5 million assistance.

“The purpose of this signal is to seek your indulgence on the issue so that you can come up with proposals for consideration,” it said.

Junior police

The initiative will largely benefit junior police officers. The memo says that before AON, the demand for financial assistance among junior officers was minimal as the National Hospital Insurance Fund (NHIF) cover was limitless.

Just last week, AON defended growing complaints among teachers and police officers, saying fraud perpetrated by hospitals was making the government-sponsored medical scheme difficult to administer and unrewarding to its beneficiaries.

AON Kenya General Manager Edwin Kegonde said the corruption is perpetrated by health providers through double billing and unwarranted admissions. He also cited hospitals that exaggerate costs through unnecessary tests.

AON has also blamed some beneficiaries for shunning low-priced hospitals and going to high-cost facilities, pushing up costs.

“Some of the police officers and teachers complain that when they attend some hospitals that we have listed, they are denied health care. This is not true. The expensive hospitals we have listed are to be approached only for referral cases, not primary health care,” Kegonde said.