New medical scheme for teachers

Teachers are to contribute half of their current medical allowances towards a new health scheme in new proposals to be unveiled on Wednesday.

Delegates at the 54th annual delegates conference in Nairobi’s Kasarani grounds will be urged to endorse the new scheme that will see teachers pay up to Sh2,000 towards the planned scheme.

Currently, the lowest paid teacher receives a monthly medical allowance of Sh767. The highest paid teacher, a chief principal, earns Sh4,412 per month.

But the new scheme negotiated by officials of the Kenya National Union of Teachers (Knut) and the Kenya Hospital Insurance Fund (NHIF) proposes that they surrender half of the medical earnings to fund the scheme.

Currently, each teacher pays a standard Sh320 towards NHIF for health insurance.

Under the current arrangement, they will surrender half of their medical allowance to the new scheme to top up their current contributions.

That means a teacher earning a medical allowance of Sh900 will surrender Sh450 to the new scheme, bringing the total amount to Sh770.

The changes will increase the total contribution by teachers to NHIF from the current Sh1 billion to Sh3.4 billion.

There are 240,000 teachers in public primary and secondary schools, although some belong to the rival Kenya Union of Post-Primary Union.

The Nation obtained a document containing details of the new scheme showing that the teachers had given a wide berth to initial proposals by Public Service minister Dalmas Otieno requiring them to surrender all their allowances to the new scheme.

According to Mr Otieno, the scheme was to be ran by private insurance companies.

Mr Otieno has already advertised for the tenders to provide the medical cover to public servants, a move that had been opposed by his Medical Services colleague Anyang’ Nyong’o and the teachers.

According to the document to be tabled before the delegates on Wednesday, the medical cover will provide for medical and surgical expenses reasonably incurred by the insured members as a direct result of their sustaining accidental bodily injury.

All staff employed by the Teachers Service Commission (TSC) will be eligible for the cover.

Their contributions will be deducted through a check-off system as are other contributions like union dues.

Also to benefit will be dependants of the staff, aged below 18.

There will be a provision for the children to enjoy the scheme to the age of 23 years if they are not in employment and are still living with their parents.

But they must be enrolled in full-time study at recognised colleges.

According to the proposals, in-patient cover will take care of hospital bed charges, doctors’ bills, operating theatre fees and pharmacy, laboratory and investigations fees.

It will also cover dental and optical conditions resulting from illness or accidents.

The members will be covered for 180 hospitalisation days per year. In case of out-patient, all laboratory tests, x-rays and other outpatient services will be covered.

Aids related ailments

To sweeten the cover, HIV/Aids related ailments, chronic illness, congenital conditions and pre-existing conditions will be covered. Some of these had been excluded under the cover proposed by the Public Service ministry.

The teachers will be allowed to choose medical centres and hospitals from where they receive their services, with an option of changing after every three months.

They will start benefiting from the services 30 days after registration and payment of full monthly premium.

According to the deal, a member will be allowed to add a spouse at an additional premium of Sh21 per month.

“Only accidental reconstruction surgery is covered,” the document said, adding that “cosmetic and beauty treatment surgeries are not covered”.

But beneficiaries will pay Sh200 as co-payment every time they visit private and mission hospitals covered under the scheme.

Those visiting government hospitals will only be required to pay Sh100.

A technical team comprising not more than 12 members will be formed to monitor the implementation of the scheme.

Six each will be picked from Knut and NHIF.

The scheme will also benefit retirees so long as they were members when they were in service.

Only the principal members and one declared spouse will be entitled to the retirement package.

“It is expected that to provide this medical cover, the contributions for the scheme would be 50 per cent of (current) medical allowance,” the said.

The teachers’ move to ignore Mr Otieno’s scheme now means only core civil servants may remain covered by private insurance providers.

Recently, it emerged that only about 215,000 junior civil servants in Job Group A to M will have their out-patient medical bills paid by the NHIF in a new deal struck with 10 insurers.

But 6,500 top officers in Job Group N to T will enjoy superior and unlimited services offered by private hospitals.

This came up even though the NHIF did not participate in the tender for the business.

It was only brought in by the insurance companies in a partnership that was likely to shift most of the risk of providing medical insurance to the public institution.

Under the deal, the NHIF will receive a premium of Sh2.5 billion, while the insurance companies will share Sh1.3 billion in premiums.

Actuarists and analysts in the industry have warned the premium was insufficient to cover the civil servants and three dependants each.

When the government floated the first tender for the business in early June, the insurance companies quoted Sh12 billion.