Good news for teachers as State unveils annual medical cover

For the first time ever, up to 288,000 teachers in public schools will be entitled to medical insurance which, in some aspects, is even more generous than what is on offer in the private sector.

The Teachers Service Commission (TSC) announced Thursday that the National Treasury has approved implementation of the Sh5.9 billion annual medical cover that takes effect from July 1.

The medical scheme provides an in-patient cover of between Sh300,000 for the lowest paid teacher and Sh1 million for the highest paid.

It is a relief for teachers because the rollout of the scheme had been delayed after TSC early this year cancelled it, citing procurement irregularities, but the Public Procurement Oversight Authority upheld the award of the tender to AoN Kenya Insurance Brokers Ltd.

However, the medical cover comes with a slight cost as teachers will, from the end of this month, forfeit their monthly medical allowance that ranges from Sh900 to Sh4,000 for the lowest and highest paid teachers respectively.

It is also not clear how implementation of the scheme will relate to the National Hospital Insurance Fund (NHIF) cover as the two teachers unions are locked in a battle with NHIF, protesting the new higher rates.

The new cover to be managed by AoN Kenya Insurance Brokers Ltd will benefit the principal contributor, their spouse and four children. It also provides for dental, optical and maternity cover as well as a “last expense cover” pegged at a flat rate of Sh100,000.

The optical cover is fixed at Sh10,000 annually. Maternity cover has been pegged at Sh75,000 annually with a graduated group life cover of between Sh300,000 for the lower cadre to Sh700,000 for the upper group.

The medical scheme brief says AoN will cater for beneficiaries’ official medical travel within East African countries”... and any families living within the region will be covered where they are,” reads the document.

TSC Secretary Gabriel Lengoiboni Thursday confirmed Treasury has committed to remit funds in good time for the cover’s implementation. “They agreed to the medical scheme and we shall roll it out immediately,” said Mr Lengoiboni.

Lengoiboni said the teachers’ medical allowance shall be pooled together to fund the scheme.

“So teachers will not get their medical allowance on their payslips starting this month,” he said.

The good news for teachers, however, is that all outpatient treatment shall be ‘free’, with members only requited to pay a subsidised fee of Sh50 as co-pay.

TSC negotiated revision of the co-pay amount from the initial rate of Sh100.

“An outpatient co-pay of Sh50 per outpatient visit shall be payable by all members to the outpatient service providers,” reads the brief seen by The Standard.

However, the fee will not apply for dental, optical, maternity and in-patient services.

Teachers will also not pay the fee for outpatient visits for chronic diseases under the “Aon Chronic Disease Management” programme, reads the document.

There will be no co-pay for repeat visits for same conditions, meaning after the first day of an outpatient visit, one will not make any subsequent payments for the remaining two days of their visit.

Beneficiaries of the scheme will also not co-pay for accessing facilities to have their medication replenished.

Further details of the cover reveal a reduction in ‘technological costs by about Sh7 million’.

Life cover

Biometric solutions and mobile phone services, which were previously scheduled to cost Sh542 million, will now cost Sh535 million.

A breakdown of teachers’ categories and benefits reveals the lowest paid teachers, in job groups G and H, will have an inpatient cover of Sh300,000.

A similar amount has been assigned to these job groups for the group life cover. There are 132,281 teachers under this category.

The 21,789 teachers in job group J will enjoy an inpatient cover of Sh400,000. Their group life cover is similar to that of teachers in job groups G and H.

And teachers under job group K and L will enjoy an inpatient cover of Sh50,000 and a group life cover of Sh400,000. There are some 93,340 teachers under these two groups.

Teachers in job groups M, N and P will also enjoy an enhanced in patient cover of Sh750,000. The group life cover is Sh500,000 for job group M and N while those in job group P have been allocated Sh700,000 under same cover.

There are some 40,428 teachers under these three job groups.

And the last two job groups of Q and R will enjoy an inpatient cover of Sh1 million and a group life cover of Sh700,000. There are only 222 teachers under these two categories.