Aon Minet gives teachers option to change dependants by 31st Oct

Aon Minet gives teachers option to change dependants by 31st Oct

TSC teachers have been given till October 31, 2021 to make changes to their dependants list if they so wish.

AON Minet is one of the largest insurance providers in the country. TSC has in its workforce 340,000 teachers in 30,000 public primary and post-primary schools who are covered by AON Minet.

However the insurer said changes made on the dependants list will take effect in December.

AON Minet only allows teachers to make changes on their dependants list during the end of a policy year.

“Dear Mwalimu, you have until October 31, 2021 to make changes to your dependants list. Select changes of dependants from the main menu at https://collaborationkenya.minet.com/tsc and follow the process. All changes will take effect in the month of December. For any clarification call 1528,” read a message sent to a teacher by MinetKenya.

The teachers pay for the medical cover through their payslip deductions. TSC teachers don’t get their medical allowance which is channeled towards the cover.

The cover cost TSC Sh9 billion in 2019, Sh12 billion in 2020 and Sh14 billion this year.

Teachers will be required to upload a birth certificate for children below eighteen years or a birth notification for children born recently.

For married teachers they will upload a marriage certificate or a sworn affidavit. They will also be required to upload their spouses ID cards.

Teachers with children in college or university or high school who are adults with eighteen years and above are required to upload there original ID cards or school ID card as prove. For those with disabled children a disability card is required.

  Job Group  Outpatient  Inpatient  Dental  Optical  Maternity  Group life  Last Expense  International Referral  International Travel
  B5  100,000  750,000  35,000  45,000  100,000  450,000  200,000  1,000,000  200,000
  C1  100,000  750,000  35,000  45,000  100,000  450,000  200,000  1,000,000  200,000
  C2  100,000  750,000  35,000  45,000  100,000  450,000  200,000  1,000,000  200,000
  C3  100,000  850,000  35,000  45,000  100,000  550,000  200,000  1,000,000  200,000
  C4  150,000  1,000,000  35,000  45,000  100,000  550,000  200,000  1,000,000  200,000
  C5  175,000  1,250,000  35,000  45,000  100,000  650,000  200,000  1,000,000  200,000
  D1  225,000  1,500,000  35,000  45,000  150,000  650,000  300,000  1,000,000  200,000
  D2  250,000  1,800,000  35,000  45,000  150,000  1,050,000  400,000  1,000,000  200,000
  D3  275,000  2,000,000  35,000  45,000  200,000  1,050,000  500,000  1,000,000  200,000
  D4  375,000  2,500,000  35,000  45,000  200,000  1,050,000  600,000  1,000,000  200,000
  D5  375,000  2,500,000  35,000  45,000  200,000  1,050,000  600,000  1,000,000  200,000

INPATIENT BENEFIT

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.

•  Pathology/Laboratory.

•  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.

OUTPATIENT BENEFIT

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).

MATERNITY BENEFIT

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.

DENTAL BENEFIT

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.

OPTICAL BENEFIT

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.

SCHEME EXCLUSIONS

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.

PRINCIPAL REGISTRATION

Step 1:

Dial *865# from your Safaricom or Airtel mobile phone number.

Step 2:

Key in your TSC and National ID Numbers when prompted. The details will be verified against our database.

Step 3:

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.

DEPENDANT REGISTRATION

Step 1:

Dial *865# from your Safaricom or Airtel mobile phone number

Step 2:

Select the dependant you wish to register i.e spouse  or child

Step 3:

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.

Step 1:

Present yourself at the service provider on our active panel.

Step 2:

Identify yourself or your dependant with the TSC number

Step 3:

The service provider will generate an SMS that contains a One-Time-Pin (OTP), sent to the principal member’s registered mobile number.

Step 4:

You will present this OTP to the service provider representative to register the fingerprints.

Step 5:

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.

Medical Facilities

Direct facilities

These are primary care facilities that members can access directly without the need of a referral letter.

Referral facilities

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.

MEMBER EDUCATION

Scheme member education is a continuous process to sensitise members on the operation of the medical scheme.

We encourage that you keep this document safe and refer to it often.

To learn more about the Teachers’ Medical Scheme, you are encouraged to get in touch with us through the channels below:

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