The teachers insurance service provider, AON Minet, has suspended thousands of teachers dependants for lacking required documentation.
Teachers dependants include wife or husband and children. Teachers are allowed to register upto to four children under the cover.
“Dear Mwalimu, kindly note that KELVIN, listed as your dependant has been deactivated from the hospital system, Please contact us on 1528 or 0730604000 to avoid inconveniences while accessing cover. Upload documents via https://collaborationkenya.minet.com/tsc,” reads a text message sent to teacher Jane Wambia in Taveta.
According to AON Minet teachers affected failed to upload required documents that would serve as evidence for their dependants listing.
However the insurance officials say the teachers only need to upload required documents to support their dependants for them to be reinstated in the hospital system.
For spouse a teacher is required to upload the national ID card and a marriage certificate. Those lacking marriage certificate can apply to get a sworn affidavit which they can use instead.
For children recently born a birth notification can be used. Teachers can upload birth certificates for older children. Those with eightenn years and above must be in colleges and universities to be supported and their college or university ID must be uploaded.
Early this month AON Minet issued new terms for its teachers and dependants seeking medical services in various facilities beginning 1st February 2022.
Teachers who want to change their dependants can only do that once a year and only at the end of the policy year.
Among the new rules, AON Minet, which covers more than 300,000 teachers on Teachers Service Commission (TSC) payroll, said it will no longer use code verification in all facilities it listed.
The insurer said it will use biometric verification for teachers and their dependants in its medical service providers to curb unethical practices.
Minet also said referrals will be through TSC offices, Bliss hospitals or referral and teaching hospitals if one needs a specialized check up.
AON Minet sent short messaging services to teachers informing them of the changes it planned to roll out.
“Dear Mwalimu, expect changes to the panel of service providers from 1st Feb 2022. Dial *202*06# or visit the link https://bit.ly/TMServiceProviders to view the updated list for year 2022,” reads SMS sent to teachers.
The medical cover cost TSC Sh9 billion in 2019, Sh12 billion in 2020 and Sh14 billion last year.
Two months ago AON Minet blacklisted at least 20 hospitals for engaging in unethical practices, exposing dubious ways the health facilities use to defraud the multibillion-shilling teachers’ medical scheme.
Teachers and their dependents also came into sharp focus as it was revealed that they collude with hospitals to fleece the TSC of the insurance cover.
The vices ranged from making fake claims, overcharging members, listing fake ailments to impersonation.
A brief by Minet Kenya, the firm contracted by TSC to manage the scheme, listed at least 10 ways that teachers, their dependents and hospitals use to fleece the scheme.
They include impersonation, billing for services not rendered, billing for conditions not covered under the scheme, double billing of medical expenses and falsification of the length of stay of patients in hospitals.
Incorrect reporting of diagnosis or procedures, false and unnecessary prescription of drugs, abnormal utilisation of services, bribery and unethical inducement are also ways used to cheat.
In addition to these, Minet Kenya Chief Executive Sammy Muthui said many facilities have been blacklisted and others presently put under investigations for abusing the seven-day rule.
Under this rule, Muthui said if a patient is treated for a condition and within seven days returns to the hospital to be cared for over the same ailment, they should not be charged.
“The member should never be asked to pay out of pocket. But we have had cases where this rule has been breached and patients asked to pay money or turned away. This is fraud and we take it seriously,” he said.
AON MINET BENEFIT STRUCTURE FOR TEACHERS
Below are benefits teachers get from the AON Minet cover.
|Job Group||Outpatient||Inpatient||Dental||Optical||Maternity||Group life||Last Expense||International Referral||International Travel|
This is treatment which requires admission in a hospital or day care surgery/procedure. The benefits (paid net of NHIF rebates) under this cover include but are not limited to:
• Bed entitlement.
• Doctor’s Fees (Physician, Surgeon & Anesthetist fee).
• ICU/HDU/Critical care and theatre Charges.
• Drugs/Medicines, dressings and internal surgical appliance.
• X-ray, ultrasound, ECG, Computerized Tomography Scans (CT Scans) and MRI Scans.
• Radiotherapy and Chemotherapy.
• In-Patient Physiotherapy & Hydrotherapy.
• Occupational therapy.
• Hospital accommodation for accompanying parent and /or guardian for hospitalised children below seven (7) years.
• Medical Emergency Road evacuation services leading to admission.
• Congenital defects/genetic disorders.
• Post- Hospitalisation 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 Fertilisation (IVF).
• Renal dialysis.
• Cancer Treatment and related procedures and tests.
• Medical education.
• Chronic Disease Management.
This is treatment that does not require admission or daycare surgery in a hospital. The outpatient cover caters for all routine outpatient services which include but are not limited to:
• Routine outpatient consultations.
• Prescribed Diagnostic Laboratory and Radiology services (X- ray, ultra sound, MRI and CT Scans).
• Prescribed physiotherapy.
• Prescribed drugs and dressing.
• Referral Outpatient to specialists.
• HIV/AIDS related conditions and prescribed ARV’s to the full cover limit per family per annum.
• Routine Immunizations: KEPI Vaccinations, Baby Friendly Vaccines.
• Newly diagnosed chronic conditions.
• Pre-existing chronic conditions (including cancer).
• Pap smear for ladies and PSA for men- (for principal members only).
• Medical Emergency Road ambulance evacuation services.
• Rehabilitation services as per limits.
• Preventive care: free Medical camps, Mobile Clinics for events, counselling on lifestyle and wellness.
• Prescribed preventive and curative drugs/care (Including pressure stockings and clinical corset belt).
The benefits under this cover include but are not limited to:
• Routine antenatal check-up.
• Delivery/ Doctors Fees.
• Postnatal care up to six (6) weeks post-delivery.
• Routine Immunisations (KEPI) and Baby Friendly Vaccines.
• 1st emergency caesarean section, subsequent elective CS and normal delivery.
• Pre-maturity/Pre-term upto 37 weeks.
• Congenital conditions.
NB: The maternity benefit is available to principal members and/or their spouse only.
The benefits under this cover include but are not limited to:
• Dental Consultation and Anaesthetist’s fees.
• Dental X-rays and Root canal treatment.
• Tooth Extraction.
• Deformation surgery.
• Scaling necessitated by a prevailing medical condition and prescribed by a dentist.
• Dentures necessitated by an accident/ injury.
This benefit caters for expenses related to eye treatment which includes but not limited to:
• Cost of frames – members who have obtained frames will not be entitled to a replacement within one year.
• Cost of lenses – Not entitled to a replacement within one year unless necessitated by a medical condition or change in prescription by an ophthalmologist.
• Prescription for ophthalmic treatment and eye lenses.
• Ophthalmic ultrasound if prescribed by the Ophthalmologist.
GROUP LIFE BENEFIT
This benefit is payable to the next of kin upon the demise of a principal member. To access the group life benefit, the following information should be availed to Minet at the earliest possible convenience:
• The death certificate- original or a certified copy.
• The burial permit- original or a certified copy.
• Surrender of ID form (original or a certified copy) / ID copy of the deceased.
• A copy of the Next of Kin’s ID.
• A copy of the ATM card or bank statement of the claimant (Next of Kin) indicating the account number, the account name, the bank and the branch where the account was opened.
NB: *Payment will be made to a valid account number held in a registered commercial bank.
LAST EXPENSE BENEFIT
This benefit is payable to the next of kin upon the demise of a principal member mainly to cater for funeral expenses. It is payable within 48 hours subject to confirmation of the Next of Kin and upon provision of the following documents:
• The full name of the deceased.
• The TSC Number.
• The Burial Permit indicating date of death.
• The next of kin details (Name, Relationship to Deceased, Phone Number).
• A copy of the ATM card or bank statement (of Next of Kin) indicating the account number, the account name, the bank and the branch where the account was opened.
Chief’s letter in case the deceased had not declared their next of kin.
NB: * Submission of Group Life and Last Expense Claims must be done within 12 months after which it will not be payable.
Psychiatric and Counselling Services
Provision of Psycho-social support programs for employees for conditions such as chemical dependency, stress, post-traumatic counselling, relationship difficulties, anxiety and depression, parenting, legal or financial distress etc. services will include but not limited to:
• Psychiatric and tele-counselling through the Minet toll free line 0800720029 available 24 hours a day, 7 days a week.
• Onsite counselling services in some special instances.
• Referrals to face to face counselling by a specialist in some special instances.
Expenses for the following will not be covered under the scheme:
• Massages (except where certified as medically necessary).
• Cosmetic treatment unless relating to an accident.
• Treatment other than that done by a registered medical practitioner.
• Injuries as a result of active participation in war, invasion, riots or terrorism.
• Nutritional supplements unless prescribed by a doctor as part of the treatment of a deficiency.
• Maternity cover for dependent children.
• Medical expenses following attempted suicide.
• Self-prescribed drugs.
• Infertility investigations and family planning procedures and expenses.
• Outpatient,dental and optical co-pay of Ksh. 50/= on each visit.
• Cosmetic dental care – cosmetic crowns, caps, bridges, orthodontics & dentures, self- prescribed teeth cleaning and whitening, unless necessitated by accidental injury.
• Replacement and repair of old dentures, bridges and plates unless damage to dentures, bridges and plates becomes necessary as a result of an accident .
• Replacement of spectacle frames within the same year of cover.
• Reimbursement of costs incurred outside the appointed panel of providers unless for emergency cases, accident cases and only cases that have been pre-authorised by Minet.
• Private vaccines and travel vaccines.
• Alcohol related rehabilitation.
• Photo chromatic and/or antiglare lenses are excluded unless they form part the prescription lenses.
• Treatment otherwise covered by NHIF.
Dial *865# from your Safaricom or Airtel mobile phone number.
Key in your TSC and National ID Numbers when prompted. The details will be verified against our database.
If successful, you will be prompted to enter your name (surname and other name), role and gender.
*Once done, you will receive a message confirming your successful registration onto the scheme and a prompt to register dependants.
Dial *865# from your Safaricom or Airtel mobile phone number
Select the dependant you wish to register i.e spouse or child
Enter Relation, full names, Disability status, Date of birth, ID number if you are over 18 years.
After successful registration the member will recieve a link to complete the registration process: https://collaborationkenya.minet.com/TSC
If not successful, kindly contact us on our call centre hotline number 1528 for further assistance.
Procedure for access to medical cover under the scheme
Members of the Teachers’ Medical Scheme can access any of the service providers on our panel countrywide. This list is accessible via USSD code *340# or Minet/TSC Website.
Present yourself at the service provider on our active panel.
Identify yourself or your dependant with the TSC number
The service provider will generate an SMS that contains a One-Time-Pin (OTP), sent to the principal member’s registered mobile number.
You will present this OTP to the service provider representative to register the fingerprints.
You will be requested to place a finger on the biometric device and the impressions will be saved against your membership record.
On successful registration the member or dependant can access medical services.
NB: Children under 5 years of age will be registered under either the parent or an appointed guardian.
These are primary care facilities that members can access directly without the need of a referral letter.
These are facilities that offer medical services for cases that require specialised treatment. A Referral letter from a direct facility is required to access medical services in these facilities.
Scheme member education is a continuous process to sensitise members on the operation of the medical scheme.