TSC teachers can now make changes to their dependants list. AON Minet has given till October 31, 2022 for those who want to review their dependants.
AON Minet is one of the largest insurance providers in the country. TSC has in its workforce 341,837 teachers in 30,000 public primary and post-primary schools who are covered by AON Minet.
However the insurer says 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.
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 last 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.
Medical insurers in race to replace AON Minet
Medical insurers are set for a heated race for the multibillion-shilling contract to provide healthcare cover for 341,837 teachers.
TSC is seeking a consortium of insurers to offer comprehensive medical cover for its teachers and their dependants.
The commission, in a call for bids, said the consortium would be required to cover outpatient, maternity, dental, optical and emergency air and road evacuation services, as well funeral expenses for a three-year period.
“While it is appreciated that medical schemes come with inherent controls and procedures, TSC expects that the successful consortium will look at the possibilities of ensuring that any controls and procedures are not unnecessarily bureaucratic and cumbersome to curtail the rights of scheme members to access quality cover as prescribed in the schedule of requirements and description of services” the teachers’ employer added.
The teachers’ medical scheme AON Minet has repeatedly come under criticism by the tutors for alleged poor services.
In January this year, the Kenya National Teachers Pressure Group – a lobby comprising teachers in primary and secondary schools and teacher training colleges – petitioned TSC to revoke the contract with AON Minet on claims of poor services.
The teachers claimed that they face challenges while lodging claims and that there is limited access due to rigid operating hours in some health facilities.
There have also been instances where hospitals have turned away teachers insured by AON Minet because of the challenges they face while lodging claims with the company.
The current scheme, which was projected to cost TSC about Sh14 billion in 2021, covers more than one million people, including registered teachers and their dependants.
It covers inpatient, outpatient, optical, dental, maternity, group life, and last expense (funeral).
In an attempt to address the concerns over service quality, TSC is now seeking a consortium of insurers.
TSC said the new scheme would come with in-patient benefits including; hospitalisation and full diagnosis tests and treatment, post-hospitalisation benefits up to a maximum of 35 days, and accommodation and meals for a caretaker, parent, or guardian accompanying a child of 12 years and below.
The new scheme will also cater for dental and optical hospitalisation resulting from an accident or other dental and optical illnesses requiring hospitalisation. Both expenses will be covered within the in-patient limit.
“The inpatient scheme shall encompass the following benefits: specialists fees including physician, surgeons, anaesthetic, etc.; surgical fees including theatre, anaesthetist’s fees and other associated charges; pre-existing and chronic recurrent conditions including hypertension, asthma, diabetes, cancer-related illness, arthritis, and pre-existing surgical conditions,” TSC stated.
The commission further said the new cover will also cater for treatment of congenital conditions and neonatal expenses including defects/genetic disorders, and medical appliances such as hearing aids, glucometer and insulin delivery devices and urine catheters, among others.
In the new scheme, prescribed overseas treatment for a member will be covered up to Sh2 million and will include a Sh200,000 air ticket and accommodation for the spouse.
“The cover shall also care for injuries that result from illnesses resulting from alcohol intoxication, including liver sclerosis, toxic and encephalopathy,” TSC said.
| 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: