Previously a couple that are both teachers were allowed a maximum of four children in the scheme.
At least 360,000 of the 406,000 teachers employed by the Teachers Service Commission (TSC) have a reason to smile in a new enhanced multibillion medical scheme by Minet- Kenya, an Insurance and risk management solutions provider, which will see them enroll up to eight children in the cover.
The enhanced cover was revealed by Minet- Kenya Managing Director Mr Sammy Muthui and includes inpatient and outpatient benefits, overseas treatment, dental and optical for the public sector teachers in job groups B5 to D5.
Also enhanced is the maternity and last expense benefits for the teachers with group life benefits maintained.
Mr Muthui says that the new development is part of a raft of changes the medical scheme provider has instituted to cushion the teachers “so as to make them focus more in imparting knowledge to learners.”
The teachers were accessible to all medical specialists on referral but enhanced cover guarantees them free access.
In the current limits under Capitation Model, Unlimited benefits for both Inpatient and Outpatient for Job Group B5- C3 shall apply on government hospitals, faith-based hospitals- missionary hospitals and private hospitals owned by the Capitation Provider.
Data from Minet held at the TSC show that 1.3 million are covered by the insurance provider, which includes all the teachers under the TSC payroll, who have 230,000 spouses and at least 677,000 children.
The cover benefits also allows a couple, who are both teachers employed by TSC, to insure up to eight children in the scheme compared to the previous arrangement that limited a maximum of four children.
“Spouses who are both teachers will agree among themselves on the children they want to insure up to eight in cases where they have more children,” said Mr Muthui.
He added; “teachers in this category who wish to seek medical services from alternative empaneled hospitals shall be free to do so under the above limits.” Copay previously charged at Sh50 for outpatient visits has been removed.
“There was so much confusion and pain around this, so we decided to remove co-pay so that the pain is no longer felt,” the Minet boss said.
The inpatient benefits range from Sh1 million for teachers in job group B5 to Sh3 million for those in job group D5.
Previously inpatient cover for the job group B5 were limited to Sh750,000 with teachers in job group D5 allowed a maximum of Sh2.5 million.
The outpatient benefit for the teachers in job group B5 has been increased to Sh150,000 from Sh100,000 with those in job group D5 up to Sh450,000 from Sh375,000.
The enhanced benefits for dental and optical covers have been increased uniformly across the job groups.
The current dental benefits for the teachers is Sh45,000 across the job group from Sh35,000 with optical increasing to Sh60,000 from Sh45,000 across the job groups.
The maternity benefit for teachers in job groups B5, C1, C2 and C3 has been increased to Sh120,000 from Sh100,000.
Teachers in job groups B5, C1, C2, C3, C4, C5 have last expense benefits increased from Sh200,000 to Sh300,000.
The other benefits include the inpatient post hospitalization from the two weeks to five weeks, post hospitalization attendant therapy that was not covered for up to three months.
Laser surgery was previously not covered but is now part of the enhanced inpatient cover.
The overseas treatment has a standalone cover of Sh2 million from Sh1 million and Sh200,000 in air ticket and accommodation for the caregiver, which remains unchanged.
All pandemics including Covid-19, were not explicit in the previous cover but now enjoy full limit cover.
The worldwide medical cover with no geographical limits while on official duty, home based care for critically ill individuals, which involves supplementary oxygen and nursing care were not provided previously but are now provided for within the inpatient package.
The E-health- e-consultation, e-pharmacy was not covered before but now provided within the outpatient cover.
All sexually transmitted infections (STIs), illnesses resulting from alcohol intoxication including liver sclerosis, toxic encephalopathy were not covered previously but now provided within the inpatient package.
Annual health check and well woman and well man services for the principal and spouse are part of the outpatient package.
PSA tests, one Pap smear test and a mammogram were previously for principal members only but are now accessible to employees and spouses.
The naval, military, air force and other security related operations, war, invasion and civil war risk, riots, strikes, civil commotions and acts of terrorism were not explicit previously but are now provided within inpatient.
Prosthetic devices needed as part of treatment which includes external artificial body parts such as prosthetic limb or prosthetic ear were not covered before but are currently provided within inpatient but applied for job group TSC 11 to 15 with a standard private room with a sink for principal members and dependents.
Hospital bed entitlement net of NHIF rebates applies for job groups B5 to C5 with a standard ward bed at disposal of principal members and dependents.
Routine immunization is currently limited to KEPI vaccinations that include baby friendly vaccines that are comprehensive vaccines with no exclusion.
Immunization against Covid-19, family planning and fertility tests, impotence drugs, diagnostic equipment- glucometers, BP machines and hearing aids; recommended travel vaccines- yellow fever and polio; alternative treatment- acupuncture and chiropractor on referral were not covered but are currently part of the outpatient benefit.
Vaccination for diseases such as Hepatitis B were not covered before but now part of the cover for staff only.
The overseas travel cover was not available previously but now applies while staff are on official duty.
The travel insurance cover for principal members while on official duty is limited to eight weeks. Previously it was not covered.
Prescribed preventive and curative drugs or care including pressure stockings and clinical corset belt; drug and substance abuse including alcoholism and associated rehabilitation; domestic violence including gender based violence and trauma are part of the outpatient package. Previously they were not covered.
The dental benefits include dental crowns that are presently within dental limit. Previously the cover for this was unavailable.
International treatment within East Africa and other countries mainly India, South Africa and any one country in or outside Africa is limited to recommendation by a medical doctor and approved by Director Medical Services (DMS).
Before, the international treatment was limited to India only.