TSC gives details, list of hospitals for teachers in new health cover

The Teachers Service Commission (TSC) has officially notified all 288,000 teachers that they will not get their medical allowances starting July 1.

The money shall be pooled to create a solid financial base to roll out the new Sh5.9 billion medical scheme.

Teachers get between Sh900 and Sh4,000 a month as medical allowance. AON Minet, the insurance agency contracted by the teachers’ employer to manage the scheme, has also released a list of proposed hospitals that all teachers and their dependents will visit to access medical services starting July.

In a circular dated May 22, TSC Secretary Gabriel Lengoiboni said the scheme will be implemented starting July 1, and will apply to all teachers employed by the commission.

Through conversion

“The comprehensive medical scheme will be funded through conversion of the current medical allowance into a medical fund. The entire medical allowance will therefore be withdrawn from your earnings to fund the medical scheme with effect from July 1 2015,” said Mr Lengoiboni.

The circular is copied to all TSC county directors of education, principals of national polytechnics, training institutes, diploma teachers colleges, primary teachers training colleges and director of the Kenya Institute of Special Education.

Another statement released by AON, reveals a long list of facilities from sub-county level, referrals and facilities in the other East Africa countries.

Some 30 hospitals have been identified in Kampala, Jinja, Tororo, Iganga Mbale, Mukono, Lugazi, Busembatia, Kamuli, Fort Portal, Hima, Masindi and Mbarara towns of Uganda.

In Tanzania, some medical facilities have been identified in Dar es Salam, Arusha and Mwanza. Other facilities have been identified in Rwanda.

AON Chief Operations Officer Sammy Muthui yesterday said they are working round the clock to set up these facilities ahead of July 1.

“Our primary concern is accessibility of medical services by all teachers. We are taking these services where they are and that is why our list of proposed facilities is unparalleled,” said Mr Muthui.

Sets of 25 hospitals have been identified for referral purposes in Mombasa, Nairobi, Kisumu, Eldoret, Nakuru, Nyeri and Machakos. TSC yesterday listed a raft of medical services that teachers stand to benefit under the cover.

The circular says under inpatient care, the scheme shall cover hospital accommodation, doctor’s (physician, surgeon & anesthetist) fee, theatre charges, drugs or medicines, dressings and internal surgical appliance.

Also to be covered are pathology, X-ray, ultrasound, ECG and computerised tomography, MRI scans, radiotherapy and chemotherapy.

No age limit

Emergency road and air evacuation within East Africa leading to admission, overseas evacuations where treatment is not locally available and day care surgery for minor surgical treatment that may not require admission shall also be covered.

Post-hospitalisation benefit, congenital defects or genetic disorders, pre-existing and chronic conditions (including cancer), rehabilitation services, in-patient optical and dental surgeries shall also be covered. Another raft of services have been listed under outpatient care. “All teachers actively in service from 18 years to mandatory retirement date are eligible for cover,” reads the circular.

TSC says only one legal spouse per teacher, four dependent children (biological/legally adopted) will be eligible for the cover.

The children will benefit from time of birth until the age of 18 or to 20 years provided they are residing with their parents and also enrolled in a recognised post-secondary institution.

“No age limit shall apply to child dependants with disability,” reads the circular. Overall, all beneficiaries will have an inpatient cover of between Sh300,000 to Sh1 million annually.

Outpatient cover will range from Sh20,000 to Sh25,000. Maternity cover has been pegged at a flat rate of Sh75,000. Group Life Cover ranges from Sh300,000 to Sh700,000. Last expense cover has been fixed at Sh100,000.