TSC set to award Sh9bn medical cover tender

The Teachers Service Commission (TSC) is set to award a multibillion shilling medical scheme tender that will cater for its 318,000 tutors over the next three years.

In August, TSC issued a Sh9 billion tender for the provision of medical insurance for teachers up to 2022. The tender was advertised in local dailies and bidders were required to submit their proposals by August 29.

The lucrative contract has attracted several local insurance firms and health service providers who have formed consortiums.

Apart from having an established medical insurance firm, it is expected that the winning consortium will have a medical provider with the capacity to serve the huge TSC membership, including an extensive network of public and private hospitals.

The TSC has opted for four options with bidders expected to choose the option that fits them and TSC making the final decision.

As per the tender document seen by the Nation, the four are: Fully Insured Scheme, Hybrid Financing Model (inpatient, self-fund), Hybrid Financing Model (inpatient, fully insured) and Capitation Financing Model.

The Fully Insured Scheme stipulates a 100 per cent cover and the benefits and limits do not require co-payments between the patient and the client.

With the Hybrid Financing Model (inpatient, self-fund), a combination of insurance and funded schemes is involved. It could be 50 per cent insurance or 50 per cent cash cover. This means a client pays for the inpatient and outpatient is insured.

The third option — Hybrid Financing Model (inpatient, fully insured) — means that outpatient costs are self-paid while inpatient costs are covered.

Capitation Financing Model is the most controversial and means that a certain amount is given by TSC to the hospital for a period for unlimited number of patients treatment.

The fourth option, which insiders say is prone to abuse as it lacks checks and balances, means that one insurance company can collude with a company that owns hospitals countrywide therefore there is limited access for teachers in terms of the hospitals they can visit.

Evacuation cover for teachers and their families will also be separate from inpatient cover. Teachers have been pushing for better medical cover.