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Teachers get Sh14b medical cover

 All teachers in active service aged 18 years to 65 years will benefit from the cover. [istockphoto]

Teachers have been given an early Christmas gift as the employer awarded them a multibillion shilling medical scheme that will see them get up to Sh3 million cover.

All the 347, 446 teachers will be able to visit hospitals anytime and get treatment after the employer struck out the contentious seven-day rule.

This rule made it difficult for teachers to get full medical benefits if they went back to the hospital within seven days of the first visit for the same ailment.

This is because hospitals wanted to charge them for repeat visits for the same conditions which would otherwise not be billed.

Several teachers were denied treatment in hospitals sparking an outcry from their unions. In the new scheme awarded to Minet Kenya, this limitation has been struck out.

"Teachers should be happy that the scheme is significantly improved in terms of benefit limits and scope of cover and should expect much improved services," said Sammy Muthui, Minet Kenya chief executive.

The enhanced medical scheme has also reduced the pre-authorisation time to 10 minutes from one hour.

All illnesses resulting from alcohol intoxication, including liver sclerosis, and toxic encephalopathy are also covered under the scheme. All sexually transmitted infections and all pandemics (including Covid-19) will also be covered.

Under the enhanced cover, teachers will benefit from worldwide medical cover with no geographical limits while on official duty. This means that teachers will now be able to get treatment anywhere across the world.

Also, all strikes, riots, naval, military, air force and other security-related operations, War, invasion and civil war risk, civil commotions and Acts of terrorism are covered under the cover. Another boost is that there will be unlimited cover for teachers who will seek health services from government hospitals and faith-based facilities.

"Unlimited benefits for both Inpatient and Outpatient for Job Group B5 - C3 shall apply to Government Hospitals, Faith Based Hospitals (Missionary Hospitals), and private hospitals owned by the Capitation Provider. Teachers in this category who wish to seek medical services from alternative empanelled hospitals shall be free to do so under the above limits," reads the document.

Starting this month, the 1.2 million-odd beneficiaries of the Sh14 billion cover will get an inpatient cover of between Sh1 million and Sh3 million.

This is a major improvement from Sh750,000 to Sh2.5 million under the previous cover. Teachers and their dependents' outpatient cover is now between Sh150,000 and Sh450,000. Previously, they had an outpatient cover of between Sh100,000 and Sh375,000.

Optical and dental cover will now be a flat rate of sh60,000 and Sh45,000 respectively, for all teachers and their dependents. Previously, these covers were pegged at Sh45,000 and Sh35,000 respectively.

Maternity cover will now range from Sh120,000 to Sh300,000. Previously, this cover ranged between Sh100,000 and Sh375,000.

The details are contained in a circular dated December 15 and sent to all teachers. Teachers Service Commission chief executive Dr Nancy Macharia said the medical cover includes inpatient, outpatient, dental, optical, maternity, and funeral expenses.

The funeral expenses will include mortuary fees, a hearse, a coffin, a wreath and transport for immediate family. This will cover a maximum of 10 people.

Also covered are air evacuation allocation (use of fixed wing and helicopter) and also international travel and referrals allocations.

All teachers in active service and who are aged 18 years to 65 years will benefit from the cover. However, only one legal spouse will be covered under the scheme that will also take care of four dependents, biological or legally adopted.

Their children will be covered under the scheme until they turn 18 years old or 25 years old for those who will still be enrolled in recognised post-secondary institutions. "No maximum age limit shall apply to child dependents with proven disability status," reads the circular.

Overall, teachers will only be required to part with Sh100 co-pay per outpatient visit. This shall apply to dental, optical and specialised doctor consultation services.

"The co-pay shall not be charged on repeat visits services within 14 days from the date of the previous visit and when picking medication for chronic conditions which does not require consultation with the doctor after 90 days from the last visit," said Dr Macharia.

Inpatient benefits will help those searching for services in cancer treatment and related procedures and tests, MRI scans, radiotherapy and chemotherapy physician, kidney failure, hypertension, arthritis, diabetes, domestic violence, depression, surgeon and anaesthetist, ICU/HDU/ critical care and theatre, medicines, dressings and internal surgical appliances.

Others include pathology/ laboratory, X-ray, ultrasound, ECG and computerised tomography, in-patient physiotherapy, hydrotherapy, and hospital accommodation for accompanying patients and or guardian for hospitalised children below seven years.

Also covered are medical education and wellness programme for members with pre-existing and chronic conditions, medical emergency road evacuation services, post hospitalisation benefit of two weeks for other diseases and six weeks for accidents.

Occupational therapy and congenital defects/ genetic disorders, in-vitro fertilisation and renal dialysis are also covered.

Also covered are HIV and AIDS-related conditions and prescribed ARVs to the full cover limit per family per annum and newly diagnosed chronic conditions. Others are pap-smear for ladies and PSA for men, medical emergency road ambulance evacuation services.

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