Teachers to enjoy more medical scheme benefits

Kaaga primary school head teacher Mrs Eva Ngichoro,instructs her class one pupils,on how to use a tablet. More than 200,000 teachers are set to reap more benefits from the Sh5.3 billion medical scheme starting from July. (PHOTO: PETER MUTHOMI/ STANDARD)

More than 200,000 teachers are set to reap more benefits from the Sh5.3 billion medical scheme starting from July.

The proposed improved medical insurance package extends the cover to all spouses of members and their children. Presently, the number of beneficiaries is limited to one legal spouse and four children – biological or legally adopted.

In-patient cover that currently stands at between Sh300,000 and Sh1 million a year is also set to go up by half.

In addition, teachers shall still enjoy the insurance cover even after they retire from service, if the new scheme is implemented.

"The scheme shall buy a medical cover for all retired teachers under an agreed arrangement of gradual contribution by members while still in service," reads the brief exclusively seen by The Standard.

The Teachers Service Commission (TSC) contracted AON Kenya in July last year to roll out the medical scheme for all the 288,000 teachers for one year.

Once the cover expires in a month, it is expected that the insurance provider will present to TSC the proposal for renewal.

The document reveals that 233,910 teachers enlisted for the scheme, even as unions moved to court to stop implementation of the cover.

The latest information shows that since inception, a total of 657,457 members have benefited from the scheme.

The comprehensive medical scheme is being funded through conversion of the current teachers' medical allowances into a medical fund. Teachers get between Sh900 and Sh4,000 monthly in medical allowances.

A breakdown per county of principal members shows that Kakamega County has registered 11,476 teachers, the highest under the scheme.

Kiambu County is second with 10,852 followed by 9,946 for Meru County and 9,753 of Nakuru County.

Kisii has 9,093 teachers while Machakos (8,835) and Kitui (8,597) followed in that order.

Tana River has the lowest registration of teachers at only 855.

According to the document, the most reported incidents for in-patient are orthopedic cases followed by malaria, uterine fibroids and cancer.

Hypertension, pneumonia, anaemia, hernia, meningitis and kidney diseases followed in that order.

With barely one month to the expiry of the one-year contract, the medical cover scheme lists improved health for teachers and their families and decreased death rates as its major successes.

Details show that 517 deaths have been recorded so far since the cover was rolled out, compared to 1,200 deaths the prior year.

Some 93,652 spectacles have been given to teachers since July last year. Optical and dental cover ranges from Sh20,000 to Sh25,000.

The enhanced package says teachers and their beneficiaries shall, starting July, have high cost hospitals open to them.

"We hope to negotiate and allow more access to high cost hospitals especially for referral cases," reads the brief.

The confidential document, however, lists a number of challenges that the scheme is experiencing, with fraud, misuse and overdose among members listed top.

Difficult cost control negotiations with some medical service providers, requests for inclusion of higher cost facilities and congestion in certain preferred facilities are also listed among the challenges.

"But even with the challenges, the cover has saved lives through AON emergency international evacuations and local air ambulance evacuations and hospital transfers," reads the brief.

Air evacuations

A total of 18,058 in-patient visits have been recorded since last July and some 56 overseas evacuations carried out.

About 100 road and air evacuations have been conducted locally, according to the data.

"The scheme has prevented poverty, dependency and destitution among teachers and their families, especially for expensive medical bills and following death of the bread-winingteacher," reads the brief.

A TSC circular dated May 22, 2015, says the medical scheme was expected to benefit all commission teachers.

The circular, sent out to all TSC County Directors of Education, says outpatient services will have no limit. Maternity cover has been pegged at a flat rate of Sh75,000. Group Life Cover ranges between Sh300,000 and Sh700,000, while Last Expense Cover is fixed at a flat rate of Sh100,000.

Other benefits on teachers' wellness will include health education, 24-hour psychosocial tele-counselling, where teachers call in.

Under inpatient, the scheme covers hospital accommodation, doctor's (physician, surgeon and anesthetist) fee, theatre charges, drugs or medicines, dressings and internal surgical appliance.

Also covered are pathology, X-ray, ultrasound, ECG and Computerised tomography, MRI scans, radiotherapy and chemotherapy.

Emergency road and air evacuation within East Africa leading to admission, overseas evacuations where treatment is not locally available and day care surgery for minor surgical treatment that may not require admission shall also be covered, among other benefits.