How Kenyan teachers will share Sh5.6 billion medical scheme

Knut Secretary General Sossion with Chairman Mudzo Nzili during a consultative stakeholders meeting in Nairobi recently. [PHOTO: WILLIS AWANDU/STANDARD]

Three years of negotiations between teachers and their employer have finally paid off.

Starting next month, over 288,000 tutors will access a comprehensive Sh5.6 billion annual medical cover.

Each member of the Kenya Union of Post Primary Education Teachers (Kuppet) and Kenya National Union of Teachers (Knut) will enrol five other beneficiaries - a spouse and four children - for the scheme that covers outpatient, inpatient, dental, maternity, optical and emergency evacuation, among others.

The benefits are graduated based on staff grades with the inpatient cover, for instance, ranging between Sh350,000 for the lowest paid teacher to Sh1 million for the highest paid.

After negotiations with prospective cover providers, it emerged that teachers settled for a “self-funded model” to have direct control over their money.

Under the arrangement, teachers’ monthly allowances will be pooled in an account by the Teachers Service Commission (TSC), but a contracted firm will manage the medical scheme.

The lowest paid teacher is currently deducted Sh950 monthly for medical allowance and the highest paid parts with Sh4,000.

Teachers Service Commission Secretary Gabriel Lengoiboni told the union during last week’s meeting that AoN had been awarded the contract, but noted that “specific details of the cover” were still being worked on.

But The Standard established that the contract details with the firm will be signed “sometime this week.”

Knut Secretary General Wilson Sossion said TSC is mandated to complete talks with AoN.

collective purchase

“We wanted a firm that would only manage the cover because buying premiums was expensive and had many vested interests. AoN manages medical cover for MPs, commercial banks and many corporate institutions,” he said.

“We negotiated strongly to get the firm based on teachers’ collective purchase. Can you now tell TSC to complete this process immediately because teachers are suffering?” said Sossion.

Teachers and their families will be able to seek medical treatment across hospitals in East Africa. However, only one spouse will be covered under the arrangement, and children less than 18 years of age.

Details reveal that teachers and their families will enjoy in and outpatient services, maternity, dental, optical, emergency or rescue evacuation and psychiatric and counseling services. All outpatient services will be free.

“The maximum liability as regards pre-existing and chronic conditions, and HIV and Aids related conditions will be limited to the specified amounts under inpatient limits,” reads a summary of the scope of cover for the 288,060 teachers.

The inpatient cover ranges between Sh350,000 for the lowest paid teachers (job group G and H), and graduates to Sh1 million for those in the highest job group R.

Teachers under job group G and H and their families shall also enjoy optical and dental cover of Sh10,000 each. There are 132,281 teachers in these categories.

“The benefits are graduated based on staff grades and the population,” the document reads.

Teachers in job group J will have an inpatient cover of Sh400,000 and dental and optical cover of Sh10,000 each. Some 21,789 teachers shall benefit under this category.

Teachers in job group K and L and their families will receive Sh500,000 inpatient cover. They will also receive dental and optical cover of Sh15,000 each. There are 93,340 teachers in these two job groups.

Teachers in job group M, N and P will enjoy an inpatient cover of Sh750,000. The annual optical cover for members in these job groups is pegged at Sh20,000 for each medical service.

There are 40,428 teachers under the three job groups.

Groups Q and R will receive inpatient cover of Sh1 million and optical and dental cover of Sh20,000 each. There are 222 teachers in these two job groups.

Maternity services have been pegged at a flat rate of Sh75,000 across all job groups.

“Maternity cover will cater for delivery expenses only,” reads the brief.

But in the event that families exhaust their annual inpatient cover, they will have an additional minimum cover of Sh50,000 called “excess of loss cover” that is graduated across job groups to a maximum of Sh500,000.

This means that, for instance, families under job group G and H with an inpatient cover of Sh350,000 will have a general pool of Sh50,000 to cater for all other medical expenses should they exhaust their inpatient limit before end of the year.

“The minimum inpatient limit must be in place for the excess of loss cover to apply,” reads the document. The overall group limit (for all teachers and their families) under this excess of loss cover is pegged at Sh500 million.

In addition to these, teachers will also have group life cover that ranges between Sh300,000 and Sh700,000, graduated across job groups.

This means that when a teacher or a member their family dies, each family will receive this money depending on the job grade of the principal member.

“This will be a benefit rider under the health care medical scheme,” reads the summary.

The cover also offers a flat rate of Sh100,000 as “last expense cover” (funeral cover) for all teachers.

hasten process

In July, Sossion said teachers were overburdened by huge medical bills and asked TSC to "hasten the process' of implementing the new medical scheme for teachers.

"We are demanding that TSC expedites the process of identifying a medical service provider to bail out teachers from these huge expenses," he said.

Sossion said teachers were disposing of their property at "throw-away prices" to finance their health care needs and those of their families.

"We have agreed on the most effective model that is cost-effective and can give the highest value to the teachers of Kenya. What we now want is a service provider to manage it," he said. 

Teachers also negotiated a medical scheme with the National Hospital Insurance Fund.