Teachers will no longer have to endure long waits at health facilities to receive treatment under their Sh5.6 billion medical scheme.
Their insurer, Minet Kenya Insurance Brokers, has scrapped a pre-authorisation rule that required that the firm approve treatment for members.
The approved health facilities will now be required to treat the nearly one million teachers and their dependents and resolve the payment modalities with the insurer.
"Due to the issues that have been raised with regard to delays and inconvenience caused by the outpatient pre-authorisation process, Minet embarked on an effort to socialise the providers to a fixed rate per visit model of service provision,” read a statement from the insurer.
Minet yesterday said the pre-authorisation process had been implemented countrywide, with only five per cent of the providers yet to comply.
“This means that a teacher can walk in and out of the facility without having to wait for consultation between the service provider and Minet for primary and chronic care services,” said Sammy Muthui, the Minet managing director.
Teachers had complained that they had to wait for long at health facilities to get treated.
The Teachers Service Commission (TSC) contracted Minet on July 1, 2015 to manage the multi-billion shilling medical scheme.
The three-year contract is subject to renewal annually based on service delivery and efficiency.
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A report from the insurer said malaria was ranked first among the top 15 ailments that took teachers to hospitals. It was closely followed by gastric disorders, pneumonia, respiratory tract infections and fractures.
Hypertension, ulcers, septicaemia, cancer and urinary tract infections were the next five ailments for which teachers seek medication.
Closing out the list of the top 15 are typhoid, anaemia, diabetes, gastritis and dermatitis respectively. Nearly 5,000 teachers are admitted to hospital every month.
The list of approved health facilities is also expected to be expanded to include more private, mission and county referral hospitals. Sources said talks on costs were underway to allow teachers to get access to more hospitals within their medical limit range.
Sources said some of the hospitals to be included in the panel were recommendations made by individual teachers, unions or the TSC.
“Provider accreditation and empanelment is an ongoing process driven by client request, types of services available with the existing providers, administrative considerations and client satisfaction,” read the brief.
Some of the facilities that have been criticism by teachers will be dropped and others picked in order to improve the cover.
“The goal is to ensure teachers and/or their dependents can access basic medical care with ease within their locality or at the provider of their choice anywhere within the country,” said Mr Muthui.
The details emerged after a November 7 meeting between Minet, TSC, and Kenya Union of Post Primary Education Teachers (Kuppet) officials.
The meeting was called to enhance stakeholder engagement after complaints that some service providers were turning away teachers while others offered poor services.
“This is a result of intensive lobbying. It is a major win for teachers and we hope that our members will get unparalleled services moving forward,” said Kuppet Secretary General Akelo Misori.
Dental and optical
Further details revealed that teachers would benefit from a review of dental and optical services.
“These are spread throughout the country. In areas where this service is not available, Minet encourages service providers currently not offering these services to consider doing so for ease of access to its members,” read the statement.
The scheme offers members and their dependents both dental and optical benefits pegged at a flat rate of Sh25,000 a year.
The comprehensive medical scheme is funded through conversion of teachers’ medical allowance into a medical fund.
Teachers earned between Sh900 and Sh4,400 monthly medical allowances.
This meant that the lowest paid teacher contributed Sh11,448 a year to the scheme while the highest paid contributed Sh52,944.