TSC issues guide for teachers' medical cover
What you need to know:
Services offered include inpatient, outpatient, dental, optical, maternity and local and international medical emergency evacuation.
The maternity benefits are available to principal members and/or their spouses only.
Group life cover will be between Sh450,000 and Sh1,000,050, last expense Sh200,000 to Sh600,000.
The Teachers Service Commission (TSC) has issued guidelines on the Sh9 billion medical scheme for 318,000 teachers across the country.
In a March 12 circular, TSC chief executive officer Nancy Macharia said only those aged between 18 and 65 years, are in active service and one legal spouse are eligible.
“Four dependent biological or legally adopted children are eligible for the cover until they are 18 or 25 if still living with their parent(s) and enrolled in a recognised post-secondary institution,” the circular said.
In November, Minet Kenya Insurance Brokers won the contract to provide medical cover to teachers and their dependants.
She said that a beneficiary would pay Sh50 per visit for outpatient, dental and optical doctor consultation services.
“However, the co-pay shall not be charged for maternity and related conditions and in repeat visits for the mentioned services within seven days from first visit,” she said.
The services offered include inpatient, outpatient, dental, optical, maternity and local and international medical emergency evacuation.
The maternity benefits are available to principal members and/or their spouses only.
“Medical emergency air and road evacuation allows for emergency transport and transfer of sick or injured members or dependants from the place of incident or facility with inadequate care to the appropriate facility using road ambulance, fixed-wing plane and helicopter within East Africa. Air evacuation is limited to two per family per annum within the policy period,” Mrs Macharia said.
Last expense cover will provide a fixed amount graduated per grade and payable only in the event of death of principal member to cater for funeral expenses. Group life benefit will be graduated according to grade. The teachers and their dependants are required to access medical care services from an approved panel of service providers on the TSC and Minet website.
In the new scheme, the TSC has increased inpatient cover to between Sh750,000 and Sh2.5 million from the current Sh500,000 to Sh1.5 million.
Optical services will be Sh45,000, dental (Sh35,000) while maternity will be between Sh100,000 and Sh200, 000.
Group life cover will be between Sh450,000 and Sh1,000,050 while the last expense will be between Sh200,000 and Sh600,000.
Overseas evacuation has been given an extra Sh1 million while Sh200,000 will be provided to a relative accompanying the patient.
