Teachers now want their medical cover enhanced to Sh17 billion to cushion them from economic hardships caused by Covid-19.
Kenya National Union of Teachers (Knut) Secretary-General Wilson Sossion said the amount should be factored in the next Collective Bargaining Agreement up from the current Sh9 billion if the scheme is to run better and independently.
Having seen the benefits of the scheme, Sossion said teachers also want to be allowed to have additional dependants enlisted, including those over 21 years who are jobless or not in school.
“We have initiated a process with Minet Insurance to review the current rates to ensure come year 2021-22 , the effects of the economic hardships being globally and locally experienced due to the impact of Covid-19 and the surge in cases is captured in the capitation,” said Sossion, during a virtual presentation to the Senate Education Committee on Wednesday.
Sossion also said that besides the medical scheme, all teachers contribute the mandatory National Hospital Insurance Fund (NHIF) deductions.
However, he observed that service providers have indicated that the universal benefits all contributors are entitled to are being rejected by NHIF at hospitals where teachers seek services.
Knut has since urged Teachers Service Commission (TSC) to address the matter immediately, with Sossion saying the scheme would be more affordable as they would have two streams of payments.
“I bring to you this issue because it is something that we believe needs to be addressed so that if NHIF is not willing to provide services, then through policy, remedial action is taken,” Sossion urged the committee.
Sossion also lamented that some facilities are ill-equipped and lack qualified professionals.
He noted that there has been delays in approvals, which he said, can take up to a month in some cases.
However, he observed that it was agreed that the scheme administrator works on an online mechanism for pre-authorisation of referral to other hospitals in order to reduce time for accessing services.
Knut also said that in some instances, there have been denied service, which is a breach of contractual agreements by empanelled service providers.
“We have had cases reported and on investigation, we established that some of the service providers were doing this to sabotage the scheme with the hope that they would be given more capitation amount,” Sossion stated.
But in a rejoinder, TSC Secretary Dr Nancy Macharia said the commission approached NHIF in July last year for provision of medical insurance for all teachers under their roll.
She told the committee that NHIF later submitted a proposed medical premium cover for 318,000 teachers at an annual contract price of Sh15 billion.
Similarly, TSC requested National Treasury to provide an annual budget allocation of Sh15 billion for teachers medical scheme for three years, 2019-22.
But due to the economic situation, she said Treasury said it would not be able to fund the Sh15 billion annual amount.
“Due to lack in budgetary provisions to have a fully-fledged medical insurance cover for teachers based on the response from NHIF and National Treasury, the commission settled for hybrid insurance model comprising capitation financing model and fully insured components to bridge the budgetary gaps,” explained Macharia.