CIRCULAR NO. 19/2022
TO: All Teachers
COVERAGE FOR MEDICAL CARE FOR TEACHERS AND THEIR DEPENDENTS (INCLUDING LAST EXPENSE)
The Teachers Service Commission has hired Minet Kenya Insurance Brokers Limited, one of the top service providers, to provide medical coverage for all teachers in their employment, along with their dependents, beginning on December 1st, 2022, as part of an initiative to implement the National Policy on Universal Health Care for Citizens.
ELIGIBILITY FOR MEMBERSHIP
eligibility requirements;
all educators working full-time from 18 to 65 years old one (1) teacher’s spouse legally.
From birth until the age of eighteen (18) years, or until the age of twenty-five (25) years if live with their parents and enrolled in a recognized post-secondary institution, four (4) dependent children (biological or legally adopted) are eligible for coverage.
There is no upper age limit for dependent children who have an impairment that has been verified.
The major member and five (5) dependents make up the maximum family size of six (6).
CO-PAY
For dental, optical, and specialty medical consultation services, a co-pay of Kenya shillings one hundred (Ksh. 100) each outpatient visit per person is required.
When choosing medication for chronic disorders that do not require consultation with a doctor after 90 days from the last appointment, and when repeat visits are made within 14 days of the date of the last visit, the co-pay is not charged.
SCHEME BENEFITS STRUCTURE
The Scheme benefits are graduated according to grading as outlined below:
TERMS OF COVERAGE
Inpatient, outpatient, dental, optical, maternity, and burial services are covered under the medical insurance.
(such as funeral expenses, a hearse, a coffin, a wreath, and transportation for the patient’s immediate family, which can number up to 10 people), air evacuation allocations, evacuation allocations-air (fix wing and helicopter), international travel, and referral allocations.
Benefits for Patients
This is a course of treatment that calls for an overnight hospital stay or day surgery/procedure. The benefits under this cover include, but are not limited to: – The following, paid net of NHIF rebates:
Doctor’s (Physician, Surgeon Anesthetist) (Physician, Surgeon Anesthetist) Fee.
Charges for ICU, HDU, critical care, and theater
medications, bandages, and internal surgical equipment
ECG, computerized tomography, ultrasound, and MRI scans are used in pathology and laboratory settings.
chemotherapy and radiation therapy
Hydrotherapy and in-patient physical therapy
Workplace therapy
Hospital accommodations for a parent or guardian who is with a hospitalized child under the age of seven (7)
- Medical education and wellness program for members with pre-existing and chronic conditions
- Medical Emergency Road evacuation services leading to admission
- Congenital defects/genetic disorders
- Post- Hospitalization benefit of up to two (2) weeks for other sicknesses and six (6) weeks for accident cases after discharge.
- Day care Surgery for minor surgical treatment that may not require admission
- In-vitro Fertilization (IVF)
- Renal dialysis
- Cancer Treatment and related procedures and tests.