Teachers Medical Scheme AON MINET
INPATIENT BENEFIT
This treatment requires admission to a hospital or daycare for surgery/procedure. The benefits (paid net of NHIF rebates) under this cover includes but are not limited to:
• Bed entitlement.
• Doctor’s Fees (Physician, Surgeon & Anesthetist fee).
• ICU/HDU/Critical care and theatre Charges.
• Drugs/Medicines, dressings, and internal surgical appliances.
• Pathology/Laboratory.
• X-ray, ultrasound, ECG, Computerized Tomography Scans (CT Scans) and MRI Scans.
• Radiotherapy and Chemotherapy.
• In-Patient Physiotherapy & Hydrotherapy.
• Occupational therapy.
• Hospital accommodation for accompanying parent and /or guardian for hospitalized children below seven (7) years.
• Medical Emergency Road evacuation services leading to admission.
• Congenital defects/genetic disorders.
• Post- Hospitalisation benefit of up to two (2) weeks for other sicknesses and six (6) weeks for accident cases after the discharge.
• Daycare Surgery for minor surgical treatment that may not require admission.
• In-vitro Fertilisation (IVF).
• Renal dialysis.
• Cancer Treatment and related procedures and tests.
• Medical education.
• Chronic Disease Management.
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OUTPATIENT BENEFIT (Teachers Medical Scheme AON)
This treatment does not require admission or daycare surgery in a hospital. The outpatient cover caters for all routine outpatient services, which include but are not limited to:
• Routine outpatient consultations.
• Prescribed Diagnostic Laboratory and Radiology services (X-ray,
ultrasound, MRI, and CT Scans).
• Prescribed physiotherapy.
• Prescribed drugs and dressing.
• Referral Outpatient to specialists.
• HIV/AIDS-related conditions and prescribed ARV’s to the full cover limit per family per annum.
• Routine Immunizations: KEPI Vaccinations, Baby-Friendly Vaccines.
• Newly diagnosed chronic conditions.
• Pre-existing chronic conditions (including cancer).
• Pap smear for ladies and PSA for men- (for principal members only).
• Medical Emergency Road ambulance evacuation services.
• Rehabilitation services as per limits.
• Preventive care: free Medical camps, Mobile Clinics for events,
counseling on lifestyle and wellness.
• Prescribed preventive and curative drugs/care (Including pressure stockings and clinical corset belt).
MATERNITY BENEFIT
The benefits under this cover include but are not limited to:
• Routine antenatal check-up.
• Delivery/ Doctors Fees.
• Postnatal care up to six (6) weeks post-delivery.
• Routine Immunisations (KEPI) and Baby-Friendly Vaccines.
• 1st emergency ceasarrean section, subsequent elective CS, and normal delivery.
• Pre-maturity/Pre-term up to 37 weeks.
• Congenital conditions.
NB: The maternity benefit is available to principal members and/or their spouse
only.
DENTAL BENEFIT
The benefits under this cover include but are not limited to:
• Dental Consultation and Anaesthetist’s fees.
• Dental X-rays and Root canal treatment.
• Tooth Extraction.
• Deformation surgery.
• Scaling necessitated by a prevailing medical condition and prescribed by a dentist.
• Dentures necessitated by an accident/ injury.
OPTICAL BENEFIT
This benefit caters for expenses related to eye treatment which
includes but not limited to:
• Cost of frames – members who have obtained frames will not be entitled to a replacement within one year.
• Cost of lenses – Not entitled to a replacement within one year unless necessitated by a medical condition or change in prescription by an ophthalmologist.
• Prescription for ophthalmic treatment and eye lenses.
• Ophthalmic ultrasound if prescribed by the Ophthalmologist.
CO-PAY
There shall be a co-pay chargeable of Kenya Shillings Fifty (Kshs 50)
per outpatient visit per individual for dental, optical, and outpatient
doctor consultation services.
The co-pay shall not be charged in the following cases:
• Repeat visit for above services within 7 days from date of previous visit.
• When picking medication for chronic conditions which do not require consultation with the doctor.
MEDICAL EMERGENCY: ROAD AND AIR EVACUATION
This benefit is for emergency transportation and transfer of sick or injured members or dependants from a place of incident or facility with inadequate care to the appropriate facility using road ambulance, fix-wing, or helicopter services within East Africa (Kenya, Uganda, Rwanda, and Tanzania).
Air evacuation will be limited to two (2) per family per annum within the policy period.
INTERNATIONAL REFERRAL & TRAVEL ALLOCATIONS
BENEFIT
This is a payment that shall be made exclusively for members and the person accompanying the patient.
This will be paid out when authorization has been granted for the member to travel to another country for specialized treatment unavailable locally.
A medical referral report shall be required to facilitate overseas treatment.
*All requests for specialized treatment outside Kenya shall require approval from the Director, Medical Services in the Ministry of Health.
GROUP LIFE BENEFIT
This benefit is payable to the next of kin upon the demise of a
principal member. To access the group life benefit, the following
information should be availed to Minet at the earliest possible
convenience:
• The death certificate- original or a certified copy.
• The burial permit- original or a certified copy.
• Surrender of ID form (original or a certified copy) / ID copy of the deceased.
• A copy of the Next of Kin’s ID.
• A copy of the ATM card or bank statement of the claimant (Next of Kin)
indicating the account number, the account name, the bank, and the branch where the account was opened.
NB: *Payment will be made to a valid account number held in a registered commercial
bank.
LAST EXPENSE BENEFIT
This benefit is payable to the next of kin upon the demise of a
principal member mainly to cater for funeral expenses. It is payable
within 48 hours subject to confirmation of the Next of Kin and upon
provision of the following documents:
• The full name of the deceased.
• The TSC Number.
• The Burial Permit indicating the date of death.
• The next of kin details (Name, Relationship to Deceased, Phone Number).
• A copy of the ATM card or bank statement (of Next of Kin) indicating the account number, the account name, the bank, and the branch where the account was opened.
Chief’s letter in case the deceased had not declared their next of kin.
NB: * Submission of Group Life and Last Expense Claims must be done within 12
months after which it will not be payable.
Psychiatric and Counselling Services
Provision of Psycho-social support programs for employees for
conditions such as chemical dependency, stress, post-traumatic
counselling, relationship difficulties, anxiety, and depression,
parenting, legal or financial distress, etc. services will include but not
limited to:
• Psychiatric and tele-counselling through the Minet toll-free line
0800720029 available 24 hours a day, 7 days a week.
• Onsite counselling services in some special instances.
• Referrals to face to face counselling by a specialist in some special
instances.
SCHEME EXCLUSIONS
Expenses for the following will not be covered under the scheme:
• Massages (except where certified as medically necessary).
• Cosmetic treatment unless relating to an accident.
• Treatment is other than that done by a registered medical practitioner.
• Injuries as a result of active participation in war, invasion, riots, or terrorism.
• Nutritional supplements unless prescribed by a doctor as part of the treatment of a deficiency.
• Maternity cover for dependent children.
• Medical expenses following an attempted suicide.
• Self-prescribed drugs.
• Infertility investigations and family planning procedures and expenses.
• Outpatient, dental and optical co-pay of Ksh. 50/= on each visit.
• Cosmetic dental care – cosmetic crowns, caps, bridges, orthodontics
& dentures, self-prescribed teeth cleaning and whitening, unless necessitated by accidental injury.
• Replacement and repair of old dentures, bridges, and plates unless damage to dentures, bridges, and plates becomes necessary as a result of an accident.
• Replacement of spectacle frames within the same year of cover.
• Reimbursement of costs incurred outside the appointed panel of providers unless for emergency cases, accident cases, and only cases that have been pre-authorized by Minet.
• Private vaccines and travel vaccines.
• Alcohol-related rehabilitation.
• Photochromatic and/or antiglare lenses are excluded unless they form part of the prescription lenses.
• Treatment otherwise covered by NHIF.
ELIGIBILITY
• All teachers employed by TSC and actively in service from eighteen (18) years to the mandatory retirement age.
• One (1) legal spouse to the teacher.
• Four (4) dependent children (biological/legally adopted) from birth till the age of eighteen (18) years or to the age of 25 ( twenty-five) years if residing with their parents and are enrolled in a post-secondary institution.
• No age limit applies to child dependants with a disability.
REGISTRATION
Unstructured Supplementary Service Data (USSD) registration Ensure you have the below mandatory details:
• Principal Member – TSC Number & ID Number.
• Spouse – ID Number Marriage Certificate/ Kadhi’s Certificate Affidavit from the Magistrate or Commissioner of Oaths.
• Children – 6 months & below: Birth notification and/or legal adoption papers
– 7 months -18 yrs: Birth Certificate and/or legal adoption paper
– 19 yrs-25 yrs: Proof of schooling such as a School ID or Principal’s letter from a recognized post-secondary institution
– Disability card (dependants with a disability).
PRINCIPAL REGISTRATION
Step 1: Dial *865# from your Safaricom or Airtel mobile phone number.
Step 2: Key in your TSC and National ID Numbers when prompted. The details will be verified against our database.
Step 3: If successful, you will be prompted to enter your name (surname and another name), role, and gender.
*Once done, you will receive a message confirming your successful registration onto the scheme and a prompt to register dependents.
DEPENDANT REGISTRATION – Teachers Medical Scheme AON MINET
Step 1: Dial *865# from your Safaricom or Airtel mobile phone number
Step 2: Select the dependant you wish to register i.e spouse or child
Step 3: Enter Relation, full names, Disability status, Date of birth, ID number if you are over 18 years.
After successful registration, the member will receive a link to complete the registration process: https://collaborationkenya.minet.com/TSC If not successful, kindly contact us on our call center hotline number 1528 for further assistance.
Procedure for access to medical cover under the scheme
Members of the Teachers’ Medical Scheme can access any of the service providers on our panel countrywide. This list is accessible via USSD code
*340# or Minet/TSC Website.
Step 1: Present yourself at the service provider on our active panel.
Step 2: Identify yourself or your dependant with the TSC number
Step 3: The service provider will generate an SMS that contains a One Time-Pin (OTP), sent to the principal member’s registered mobile number.
Step 4: You will present this OTP to the service provider representative to register the fingerprints.
Step 5: You will be requested to place a finger on the biometric device and the impressions will be saved against your membership record.
On successful registration, the member or dependant can access medical services.
NB: Children under 5 years of age will be registered under either the parent or an appointed guardian.
Medical Facilities – Teachers Medical Scheme AON MINET
Direct facilities
These are primary care facilities that members can access directly
without the need for a referral letter.
Referral facilities
These are facilities that offer medical services for cases that require specialized treatment. A Referral letter from a direct facility is required to access medical services in these facilities.
MEMBER EDUCATION
Scheme member education is a continuous process to sensitize members
on the operation of the medical scheme.
We encourage that you keep this document safe and refer to it often.
To learn more about the Teachers’ Medical Scheme, you are encouraged to get in touch with us through the channels below:
Telephone: 0730 604 000
Hotline: 1528
Email: [email protected]
Website: www.minet.com/kenya
Twitter: @Minet_Kenya
Facebook: MinetKe
Telegram: Teachers’ Medical Scheme
