Sh3 billion additional medical cover benefits for 318,000 teachers

Teachers Service Commission (TSC) is proposing Sh3 billion additional medical benefits for 318,000 tutors under a new scheme to be rolled out from October 1.

An inpatient cover increment ranging from Sh250,000 to Sh1 million, a hike of Sh25,000 to Sh125,000 for maternity; Sh45,000 for optical and dental for Sh25,000, are among additional benefits according to bid documents seen by The Standard.

But teachers and their dependents will have to give up a limitless outpatient cover for one pegged at between Sh100,000 and Sh375,000.

Under the proposed scheme, inpatient cover will now range from Sh750,000 for teachers under the lowest job group G (or B5) to a maximum of Sh2.5 million for the highest paid staff under job group R (or D4).

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The current inpatient rates under the existing scheme range between Sh500, 000 to Sh1.5 million across the various job groups.

Teachers under job group G (or B5) to M (or C5) will be entitled to standard ward bed on admission. Those under Job Group N (or D1) to R (or D4) will be entitled to standard private rooms on admission.

Existing one

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Details of the scheme reveal that the new adjustments are likely to expand the cover to up to Sh9 billion to better the existing one.

Finer details of the new medical scheme reveal that optical and dental covers have also been increased to a flat rate of Sh45, 000 and Sh35, 000.

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Teachers currently enjoy optical and dental covers of between Sh10, 000 and Sh25, 000. The optical cover will include cost of lenses and frames, prescription for ophthalmic treatment and eye lenses and ophthalmic ultrasound.

Dental benefits will include consultation and anesthetists fees, dental X-rays and root canal treatment, tooth extraction, scaling, dentures necessitated by an accident/ injury and deformation surgery.

Mothers will also register major medical boost under the new scheme as the TSC proposes to increase maternity cover to between Sh100, 000 and Sh200, 000. Currently, maternity cover is pegged at a flat rate of 75,000.

This benefit will cover routine antenatal check-up, delivery/ doctor’s fees, postnatal care up to six weeks post-delivery, routine immunisations and baby-friendly vaccines.

It will also cover first emergency cesarean section (CS), subsequent elective CS and normal delivery, pre-maturity/pre-term and congenital conditions.

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The teachers’ employer also intends to expand the benefit brackets for Group Life Covers to between Sh450,000 and Sh1,050,000.

The cover currently ranges between Sh300,000 and Sh700,000.

And for the last expense cover, TSC will increase the rates to between Sh200,000 and Sh600,000 up from the current flat rate of Sh100,000.

The details are contained in the bid documents from the TSC. The commission called for fresh bids from interested insurance firms in an open tender to provide medical cover for its teaching staff.

The development came as the contract of the existing provider expires end of September.

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TSC contracted AON Minet in July 1, 2015, to manage the multi-billion shilling medical scheme. The contract has been renewed annually since then.

Data from the TSC shows that some 1,006,673 beneficiaries have been registered under the AON scheme, with 313,333 being teachers, 178, 272 being their spouses and 515,068 being their children.

The revelations come as TSC is set to meet Kenya Union of Post Primary Education Teachers (Kuppet) today to discuss the medical scheme among other issues.

“We have always called for enhanced benefits for teachers and improved choices for outpatient facilities for our members. If these are part of the deal, we will have no problem even under current arrangement,” said Akelo Misori, Kuppet Secretary-General.

Misori said today’s meeting with TSC will bring out the improvements teachers have always yearned for under the existing covers.

“We know where the complaints have always been and this is what we want fixed,” said Misori.

TSC Chief Executive Officer Nancy Macharia listed medical cover discussions among today’s agenda.

Overall, the teachers’ scheme will still cover up to five family members, including the principal member. That is, a teacher will only list one spouse and a maximum of four children.

It will cover children up to 18 years and those between 19 and 25 will produce proof they are still under the care of their parents, including school details.

The scheme’s geographical limit is East Africa (Kenya, Uganda, Rwanda and Tanzania). However, there will be a provision for international evacuation for cases where treatment is not available locally.

International referrals rates have been pegged at a flat rate of Sh1 million across all job groups.

Scheme also suggests a flat rate of Sh200,000 for international travel (patient and one accompanying helper).

International travels and referral allocations will be payments that shall be made over and above the inpatient normal cover limits specified for the members and the person accompanying the patient.

“This will be paid out where authorisation has been granted for the member to travel to another country for specialised treatment which is either not available locally or is reasonably cheaper and better quality than is locally, air ticket for patient and aide and their accommodation,” reads the document.

Proposed cover says that each family will be entitled to air (fix-wing and helicopter) for two per family per year.

Under outpatient cover, the scheme says that teachers will only be required to pay Sh50 as co-pay.

“There shall be a co-pay chargeable of Sh50 per outpatient visit per individual for dental, optical and Outpatient doctor consultation services,” reads the document.

The co-pay shall however not be charged on repeat visits for above services within seven days from date of previous visit or when picking medication for chronic conditions that do not require consultation with the doctor.

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