Sh14b Improved Teachers Medical Cover; All You Need To Know.
The Teachers Service Commission (TSC) has granted teachers a multibillion-shilling medical scheme that will provide them with up to three million shillings in coverage.
After the employer eliminated the contentious seven-day limit, all 347,446 teachers will be permitted to visit hospitals at any time for treatment.
This policy made it difficult for teachers to receive full medical benefits if they returned to the hospital within seven days of their initial visit for the same condition.
This is because hospitals sought to bill patients for multiple visits for the same disease, which would not have been billed otherwise.
Several teachers were denied treatment at hospitals, causing their unions to protest. This restriction has been removed in the new contract issued to Minet Kenya.
“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.
Additionally, the upgraded medical scheme has decreased pre-authorization time from one hour to ten minutes.
All diseases stemming from alcohol poisoning, including liver sclerosis and toxic encephalopathy, are also covered by the scheme.
All pandemics (including COVID-19) and all sexually transmitted diseases will also be covered.
Under the expanded coverage, teachers on official duty will have access to medical care no matter where they are.
This means that teachers can now receive medical treatment anywhere in the world.
In addition, all strikes, riots, naval, military, and air force activities, war, invasion, civil war risk, civil disturbances, and acts of terrorism are covered.
In addition, coverage would be available for teachers seeking medical care at government hospitals and religious services.
“Unlimited benefits for inpatient and outpatient care 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 alternatively empaneled hospitals shall be free to do so under the above limits,” reads the document.
Beginning this month, the roughly 1.2 million recipients of the Sh14 billion cover would receive between Sh1 million and Sh3 million in inpatient cover.
This significantly increased from Sh750,000 to Sh2.5 million under the prior insurance policy.
Outpatient cover for teachers and their families is now between Sh150,000 and Sh450,000. Previously, their outpatient cover ranged between 100,000 and 375,000 Kenyan shillings.
All teachers and their dependents will now pay a flat sum of sh60,000 for optical coverage and sh45,000 for dental coverage.
These covers were previously priced at Sh45,000 and Sh35,000, respectively.
Now, maternity cover will range between Sh120,000 and Sh300,000. Previously, this cover varied from 100,000 to 375,000 Kenyan shillings.
The information is included in a circular that was sent to all teachers on December 15.
The head of the Teachers Service Commission, Dr. Nancy Macharia, said that the medical coverage includes inpatient, outpatient, dental, optical, maternity, and burial costs.
The funeral costs will include the cost of a mortician, a hearse, a casket, a wreath, and transportation for the immediate family.
This will cover up to ten individuals.
There are also budgets for air evacuation (fixed-wing and helicopter use), travel, and referrals outside the country.
The coverage applies to all active-duty educators between 18 and 65.
But the plan only covers one legal spouse and their four children, whether they were born to them or were legally adopted.
The program will cover their children until they turn 18 or 25 if they are still attending an accredited post-secondary school.
According to the circular, there is no limit on how old a child with a verified disability who needs care can be.
Teachers will only be asked to pay Sh100 for every outpatient visit as a co-payment.
This shall apply to dental, optical, and specialized physician services.
Dr. Macharia stated, “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.”
Inpatient benefits will cover cancer treatment and related procedures and tests, MRI scans, radiotherapy and chemotherapy physician, kidney failure, hypertension, arthritis, diabetes, domestic violence, depression, surgeon and anesthetist, ICU/HDU/critical care and theater, services, dressings, and internal surgical appliances.
Other services include pathology/laboratory, X-ray, ultrasound, ECG, and computerized tomography, inpatient physiotherapy, hydrotherapy, and hospital accommodation for accompanying patients and guardians for hospitalized children younger than seven years of age.
Also included is a medical education and wellness program for members with pre-existing and chronic conditions, medical emergency road evacuation services, a two-week post-hospitalization benefit for other diseases, and a six-week post-hospitalization benefit for accidents.
In addition, occupational therapy, congenital/genetic diseases, in-vitro fertilization, and renal dialysis are covered.
In addition, HIV and AIDS-related diseases and prescribed ARVs are covered up to the annual maximum per family, and newly diagnosed chronic conditions are also covered.
Other services include pap smears for women, PSAs for men, and emergency medical evacuation via road ambulance.
Sh14b Improved Teachers Medical Cover; All You Need To Know.
