Medical insurers are set for a heated race for the multibillion-shilling contract to provide healthcare cover for 341,837 teachers.
The Teachers Service Commission (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 is currently provided by AON Minet, which 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.