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Unions Pile Pressure on TSC Over Teachers Medical Scheme

Unions Pile Pressure on TSC Over Teachers Medical Scheme

Teachers have to wait a few weeks for their employer to finalize an insurance provider selection approval.

Collins Oyuu, general secretary of the Kenya National Union of Teachers, stated that teachers had previously voiced reservations about the existing provider, Minet.

Oyuu stated that despite the budget shortfall, TSC should be able to provide a good medical plan for teachers.

“Our position still remains that teachers need better than what they have today in terms of medical cover,” Oyuu said.

On Tuesday, the SG said during a media briefing  supported an original demand made by Kuppet on Thursday.

“It is our prayer that treasury appropriates more funds to this course so that teachers will be able to access better facilities and satisfactory medical attention,” he said.

According to Kuppet Secretary Akello Misori, funding constraints could prevent teachers from receiving medical care.

Misori stated that according to TSC, the funding for the teachers’ insurance scheme is fifteen billion shillings.

“We want MPs to hasten the process and approve the amount because NHIF, which is the most preferred cover, wants Sh23.9 billion,” Misori said.

When asked why the unionists want to replace Minet, Oyuu stated that teachers require improved services.

He added that TSC handled complaints regarding bad service differently in the past.

“We want MPs to hasten the process and approve the amount because NHIF, which is the most preferred cover, wants Sh23.9 billion,” Misori said.

In August, TSC advertised for a provider of insurance services for educators.

A TSC advertisement stated that interested providers had until August 22 at 10 a.m. to submit their applications.

The circular states, “The Teachers Service Commission invites sealed bids for the provision of complete teacher’s medical insurance coverage.”

As of November 1, 2019, TSC has solicited and awarded Minet Kenya Insurance Brokers the contract for the provision of medical coverage for all teachers and their dependents.

“Tendering will be conducted under a competitive National Open Tender using a standardised tender document and is open to all qualified and interested,” the advert reads.

To qualify, a provider must possess valid registration certificates from the Insurance Regulatory Authority.

The awarded contract will have a duration of fewer than three years and may be renewed annually based on performance.

Teachers have complained that MINET clinics offer limited medical services and frequently misrepresent services.

They want TSC to reform teacher medical coverage and ensure quality health services.

There have been also calling for parliament to investigate the medical scheme’s tender process and oversee TSC operations for openness.

At least 20 hospitals were blacklisted last year for improper methods that swindle the multibillion-shilling teachers’ medical system.

Teachers and their dependents came under fire for colluding with hospitals to defraud the Teachers Service Commission (TSC) of insurance funds.

The vices included fraudulent claims, overcharging members, and impersonation.

Minet Kenya, the corporation contracted by TSC to oversee the plan, listed 10 ways teachers, their families, and hospitals scam the program.

They included impersonation, charging for treatments not given, billing for conditions not covered by the scheme, double billing medical expenses, and falsifying hospital stays.

Incorrect reporting of diagnoses or procedures, incorrect and needless prescriptions, anomalous service utilization, bribery, and unethical inducement are all ways to cheat.

Sammy Muthui, CEO of Minet Kenya, claimed numerous facilities had been blacklisted for breaching the seven-day limit.

Muthui stated a patient should not be charged if they are treated for an illness and return within seven days for the same ailment.

“The member should never be asked to pay out of pocket. But we have had cases where this rule has been breached and patients asked to pay money or turned away. This is fraud and we take it seriously,” he said.

Per the capitation agreement they signed with the service providers, health facilities must give quality services to all teachers without requiring a return for primary care unless for a different diagnosis or consequence.

Muthui stated just a small fraction of health institutions hired to treat teachers and their dependents committed fraud.

TSC CEO Nancy Macharia claimed teachers’ coverage is 99.9% effective and asked Minet to close gaps.

“It is just a small fraction that gives us sleepless nights. And I can assure you that we are very hard on Minet to ensure teachers are happy,” said Macharia.

Unions Pile Pressure on TSC Over Teachers Medical Scheme


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