Tough rules for Sh4b student medical cover

Students who drop out of secondary schools will not benefit from the Sh4 billion medical cover.

Saturday Standard has established that it will cost the Government more money if additional students are admitted midstream to the multi-billion medical scheme.

Finer details of the contract document reveal the pressure that has been put on parents and the Government to ensure all students stay in school.

This also means that school heads will have to track and establish the whereabouts of their students and issue a comprehensive periodic report on enrollment data.

Terms and conditions

The agreement between the Ministry of Education and the National Hospital Insurance Fund (NHIF) expressly states that only students actively undertaking secondary education will benefit from the lucrative cover.

NHIF will administer the comprehensive medical scheme for secondary school children, which will be rolled out through the Ministry of Education.

“The insurance cover will cease in respect of a member who exits from a public secondary school coincident with the annual renewal date of this agreement or otherwise at the next renewal date immediately following the member’s exit,” reads the contract detail.

This means that parents who wish to shed off medical burden must ensure that their children stay in school and actively engage in learning programmes.

The agreement also says that the Ministry of Education will pay additional fees for students who join the scheme mid-way.

“New members will be allowed to join upon notification at any time during the coverage period subject to payment of additional premiums in accordance with the procedure stated in Section III of this contract,” the document says.

The terms of the contract says that under the insurance cover, premiums will be paid annually in advance at the beginning of the cover period.

This also means that the ministry must ensure that all children are in school during the start of the cover and discourage cases of learners dropping out.

The document seen by Saturday Standard reveals that the five-year medical cover will be renewed annually.

“The contract is for an initial period of 10 months from March 1, 2018 to December 31, 2018 both days inclusive and thereafter renewable annually from January 1, 2019 over a period of five years.”

Each annual renewal period after the first 10 months will end on December 31 of the same year. And no other person other than the individual secondary school students enrolled in public schools will benefit from the cover.

“A member as provided shall be eligible to benefit under this contract and this contract shall only cover such member,” reads the document.

Parents and guardians who accompany the student to treatment destination abroad will be taken care of.

“NHIF will cover travel and accommodation costs for a person accompanying a member travelling for treatment abroad provided that such travel has been preauthorised by NHIF,” the contract reads.

The document also states that NHIF will cover lodger fees for a parent or a guardian accompanying a member of age 12 years and below for in-patient treatment and care in accredited facilities within Kenya. To protect the scheme from fraud, the Fund will register and issue students with bio-metric cards for identification and to access services under the medical cover,” NHIF Chief Executive Officer Geoffrey Mwangi said.

Finer details of the health cover show that students’ enhanced package will include out-patient, in-patient, dental, optical, daycare, local road ambulance and emergency air rescue services.

Cases that will require overseas air evacuation, general and specialised services, overseas management for cases not treated in the country, funeral expense and group life are also part of the package.

Speaking during the launch of the cover, Mwangi said it will cater for some three million students at a cost of Sh1,350 per student per year.

He added that the students will access medical cover whether in school or away at home during the holidays.

He said there is high learner risk when the students are involved in school-related activities while in their institution or outside the school compound.

Annual renewal

All children under the Ministry of Education data will get the cover even when their parents are not listed under NHIF.

Additional details show that NHIF will receive and acknowledge claims arising from notifications within 30 days in case of death.

The Last Expense Cover has been pegged at Sh100,000 and will be included within the Group Life Cover, the contract paper says.

“The next of kin will obtain and give NHIF with a duly filled claim form and all other relevant documents and will also provide NHIF with any such additional information and assistance as it may require,” the contract terms say.

The students will however access ward bed facilities for in-patient services in any accredited health facilities. These will include accredited providers, any accredited mission/faith-based health care provider and any accredited private healthcare providers.

High-cost private healthcare providers will however be exempted from the list. HIV and Aids, chronic illness, pre-existing illnesses, rehabilitation and congenital conditions will also be covered.