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Teachers’ Medical Scheme Eliminates Co-Payment for Hospital Visits

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Teachers’ Medical Scheme Eliminates Co-Payment for Hospital Visits

As part of a comprehensive strategy to support teachers, the medical scheme provider has implemented various changes, with the primary objective being the prudent utilization of public funds.

A significant modification involves the elimination of the controversial co-payment requirement for teachers during hospital visits, specifically the previous obligation for a Sh50 top-up for outpatient consultations.

Muthui emphasized that this adjustment was made in response to public feedback and is aimed at reducing confusion and discomfort surrounding this aspect.

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ALSO READ: Teachers to Enroll Up To Eight Children in Multi-Billion Medical Scheme

Explaining the rationale behind co-payment, Muthui pointed out that insurers typically adopt this approach to mitigate the risk of excessive usage within a medical coverage.

Under this system, a portion of the outpatient consultancy fee is charged to the scheme member, while the remaining balance is covered by the scheme. The intention is to encourage individuals to seek medical attention only when necessary.

Muthui clarified, “There is so much confusion and pain around this so we decided to remove it so that the pain is no longer felt.”

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Additionally, the medical scheme has worked on improving the efficiency of pre-authorisation processes for in-patient cases, reducing the turnaround time and ensuring quicker responses to such requests. These changes collectively aim to enhance the overall experience and support provided to teachers through the medical scheme.

ALSO READ: TSC AON Minet Insurance Health Facilities in Baringo County

The scheme’s requirement for pre-authorisation has been a source of contention, involving the insurer’s verification of an in-patient request before treatment. Muthui, a representative, highlighted the reduction of the turnaround time to 10 minutes, addressing delays from previous incidents.

This step, while instrumental in dealing with fraud cases, is considered crucial for the scheme’s sustainability, both financially and infrastructure-wise.

Health insurance is susceptible to fraud, with the Insurance Regulatory Authority (IRA) estimating that up to 30% of medical insurance claims are fraudulent. Muthui emphasized the scheme’s diligence in duty of care as a key factor in its sustainability.

Despite recording an average of 7,000 daily outpatient visits and 300 hospitalizations, the scheme has demonstrated improved mortality rates. Muthui explained a significant decline in mortality among teachers and their dependents, noting a reduction of mortality rates by 50%.

ALSO READ: TSC AON Minet Insurance Health Facilities in Bomet County

Teachers’ Medical Scheme Eliminates Co-Payment for Hospital Visits

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