A section of teachers took to social media to criticize the Teachers Service Commission (TSC) after it emerged that some of their colleagues cannot access medical services under NHIF insurance cover because their employer has not been remitting NHIF dues despite making monthly deductions on teachers salaries.
Teachers and other TSC employees enjoy two insurance covers, AON Minet which is the primary health insurance cover and NHIF and which they pay through monthly deductions on their payslips.
Teachers pay for AON cover through their medical allowance and NHIF through an amount determined by the health insurance.
However things seems to have gone haywire for teachers who are fond of using NHIF to get treated or to seek treatment for their dependants.
Some teachers were turned away by hospitals which said their NHIF accounts have not been credited and that there contributions are in arrears.
TSC is yet to respond on this development and teachers who are now relying on NHIF for medical services are now at crossroads.
Teachers have a choice to use AON Minet or NHIF and mostly NHIF is more useful especially if a TSC teachers benefits limit is reached under AON Minet.
TSC defends AON Minet cover
Early last month TSC defended the medical scheme of its employees, saying it is the best of its kind in the region, terming allegations that they are being humiliated by service providers baseless.
TSC chief executive Nancy Macharia said claims of teachers being humiliated when seeking services are untrue.
She added that AON Minet Insurance does not have a daily limit on outpatient services.
“The only capping for the outpatient component is the member’s annual allocation,” Mrs Macharia told the Senate Committee on Education chaired by Dr Alice Milgo in November.
She said an analysis of the benefits shows that the teacher’s medical scheme is better than what is enjoyed by most public workers in Kenya and the region.
Mrs Macharia said the scheme covers a wide range of services and that the annual allocations for evry component are enough to cover the principal member and five dependants.
“It is one of the most comprehensive medical schemes,” she said.
The commission boss added that the scheme provides accessible health services to teachers in the 47 counties.
She was responding to a statement sought by Senator Rose Nyamunga who said teachers are being humiliated under AON Minet Insurance Scheme.
Ms Nyamunga said teachers are complaining that the money for outpatient services is capped at Sh900, inclusive of doctor consultation, tests and medicine.
The lawmaker added that teachers are being restricted on where to seek treatment.
She said some of the hospitals taking the teachers are poorly equipped and lack qualified staff.
“There are delays in approval, which can sometimes take up to a month,” Ms Nyamunga said.
Other challenges the teachers and their dependants face, she said, include limited access due to rigid operating hours at some hospitals and limited dental services. AON Minet only carters for tooth extraction.
Senator Nyamunga said teachers face huge problems lodging claims with the insurance firm.
TSC, however, said the scheme has more than 500 providers offering a wide range of services, including inpatient, outpatient, dental, optical, maternity, medical emergency evacuation and specialised referrals locally and internationally, group excess of loss cover, group life and last expense cover.
The medical scheme covers more than 1,036,000 lives, with 332,000 registered teachers and their dependants accessing any hospital on the list of service, the commission said.
“Based on the feedback at consultative forums on the administration of the scheme and monthly meetings, additional 32 medical service providers ranging from private facilities, faith-based institutions as well as some country referral hospitals were added to the list of medical providers,” Mrs Macharia said.
She added that TSC has ensured hospitals are accredited by National Health Insurance Fund (NHIF).
The TSC chief said the claim that some hospitals on the list lack qualified personnel “is not entirely true”.
“To address such a sensitive issue, the commission requires specific details,” she said.
The Kenya National Union of Teachers (Knut) and the Kenya Union of Post-Primary Education Teachers (Kuppet) had asked the government to increase funds and help improve the medical cover.
Kuppet Secretary-General Akelo Misori urged teachers facing problems while using the medical scheme not shy away from informing the union and TSC.
“It is important to know the hospitals lacking facilities and qualified workers. That will help us raise the matter with the service providers,” Mr Misori said.
Knut Secretary-General Wilson Sossion said teachers contribute to NHIF besides the medical scheme.
“To be fair to service providers, we request to be given specifics so that our representatives can follow up and provide feedback,” he said.
Mr Sossion said some hospitals could be offering poor services to sabotage the scheme.