Teachers get better health cover

The Teachers Service Commission has awarded a Sh9 billion medical cover with enhanced insurance packages for 318,000 employees.

The Standard has established that AON Minet, which has run the teachers' health scheme for the last four years, has been awarded a new three-year contract to implement the expanded benefits for tutors.

Details from the new contract reveal that in the second year of its implementation, the cover will cost Sh12 billion. In its third and final year, the cover will cost Sh14 billion.

The Teachers Medical Scheme is designed around pooling of medical allowances from teachers into a consolidated fund to provide a comprehensive medical cover for eligible teachers and dependants, including group life (death in service cover) and last expense cover in case of demise of the principal member.

Details seen by The Standard show that all teachers and their dependants will now enjoy enhanced inpatient, maternity, dental, optical, group life and last expense (funeral) covers.

The award means that all teachers will immediately have their inpatient medical benefits raised to Sh750,000 for those under the lowest job group G (or B5) to a maximum of Sh2.5 million for highest paid staff under job group R (or D4).

Inpatient cover

Under the previous cover, teachers enjoyed inpatient cover of Sh500,000 to Sh1.5 million  across the various job groups. Outpatient cover will, however, be capped at between Sh100,000 and  Sh375,000. The cover was previously unlimited.

Teachers will only be required to pay Sh50 as co-pay for dental, optical and outpatient doctor consultation services.

This will, however, not apply on repeat visits for the above services within seven days from date of previous visit or when picking medication for chronic conditions.

Overall, some 1,006,673 beneficiaries are registered under the scheme. Of these are about 313,333 principal members and 178,272 listed as spouses.

A total 515,068 children have also been listed as beneficiaries under the scheme.

Members will get medical treatment while in Kenya, Uganda, Rwanda or Tanzania. There will, however, be a provision for international evacuation for cases where treatment is not available locally.

International referrals rates have been pegged at a flat rate of Sh1 million across all job groups.

Finer details under the new package show that teachers will enjoy optical and dental covers increased to a flat rate of Sh45,000 and Sh35,000 respectively.

Previous optical and dental covers were pegged at between Sh10,000 and Sh25,000 respectively.

Dental benefits will include consultation and anaesthetists fees, dental X-rays and root canal treatment, tooth extraction, scaling, dentures necessitated by an accident/injury and deformation surgery.

Optical cover will include cost of lenses and frames, prescription for ophthalmic treatment and eye lenses and ophthalmic ultrasound.

The new deal also increases the group life covers to between Sh450,000 and Sh1,050,000 from a previous rate of between Sh300,000 and Sh700,000.

Maternity cover has also been enhanced to between Sh100,000 and Sh200,000, from a flat rate of 75,000.

Mothers will enjoy routine antenatal check-up, delivery/doctor’s fees, postnatal care up to six weeks post-delivery, routine immunisations and baby-friendly vaccines.

The cover will also support first emergency caesarean section (CS), subsequent elective CS and normal delivery, pre-maturity/pre-term and congenital conditions.?

And for the last expense cover, TSC has increased the rates to between Sh200,000 and Sh600,000 from the previous flat rate of Sh100,000.

The revised deal for teachers will push facilities to come with enhanced services for members and their dependents.

No outpatient pre-authorisation will be required for outpatient services and a huge demand placed on improved and faster inpatient admission and discharge process.

Teachers will also benefit from better service provider engagement and faster pre-authorisation response for inpatient cases.