TSC medical for Teachers by AON-Minet in 2019-2022: Latest TSC Circular

The Teachers Service Commission, TSC, has finally released guidelines on the Teachers’ 2019-2022 medical scheme by Minet. The Contract, between TSC and Minet, to offer medical insurance to teachers and their dependents was renewed in November, 2019.

“The Teachers Service Commission procured and awarded Minet Kenya Insurance Brokers the contract for provision of Medical cover for all teachers and their dependants with effect from November 1, 2019,” says the TSC Boss Dr. Nancy Macharia via a circular dated March 12, 2020. The latest guidelines detail the medical scheme benefits for members pegged on their respective job groups (See featured photograph for benefits per job group).

MEMBERSHIP ELIGIBILITY

According to TSC, the following are eligible to benefit from the medical scheme:

All teachers in active service aged 18 years up to 65 years.
One (1) legal spouse of the teacher
Four (4) dependent children (biological/legally adopted) are eligible for cover from birth until the age of eighteen (18) years or to the age of twenty (25) years if residing with their parents and enrolled in a recognized post- secondary institution.
No maximum age limit shall apply to child dependants with disability.

The maximum family size is Six (6), comprising of principal member plus five dependents.

CO-PAY

teachers visiting accredited facilities will have to part with a consultation (Co-pay) fee of Kenya shillings Fifty (Ksh.50) per visit per individual for Outpatient, Dental and Optical doctor consultation services.

The Co-pay shall not, though, be charged for Maternity and related conditions, in repeat visits for these services within seven (7) days from the date of previous visit and when picking medication for chronic conditions that may not require consultation with a doctor.

SCOPE OF COVER

The newly signed medical cover includes inpatient, outpatient, dental Optical, Maternity, Local and International Medical Emergency evacuation.

INPATIENT BENEFITS

This is a treatment which requires admission in and stay in a hospital or day care surgery/ procedure. The benefits (paid after subtracting NHIF rebates) under this cover include but not limited to:

Bed entitlement: Job Group B5 to D2 (Standard ward bed) and Job group D3 to D5 (Standard Private Wing),
Doctor’s (Physician, Surgeon & Anesthetists) Fee.
ICU/HDU/Critical care and theatre Charges
Drugs/Medicines, dressings and internal surgical appliance
Pathology/Laboratory
X-ray, Ultrasound, ECG and Computerized Tomography, MRI Scans
Radiotherapy and Chemotherapy
In-Patient Physiotherapy, Hydrotherapy
Occupational therapy
Hospital accommodation for accompanying parent and /or guardian for hospitalized children below seven (7) years
Medical education and wellness program for members with pre-existing and chronic conditions
Medical Emergency Road evacuation services leading to admission
Congenital defects/genetic disorders
Post- Hospitalization 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 Fertilization (IVF)
Renal dialysis
Cancer Treatment and related procedures and tests

Outpatient Benefits

This is treatment that does not require admission or stay in a hospital or day care. The outpatient benefits include but not limited to: –

Routine outpatient consultations.
Prescribed Diagnostic Laboratory and Radiology services (X- ray, ultrasound, 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.
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 service as per limits
Preventive care: to include 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)
There shall be portability with no restrictions to panel of medical providers. Teachers are free to visit any medical service provider within the Country; within list of selected hospitals.

Maternity Benefits

Benefits under this cover include but not limited to; –

Delivery/ Doctors Fees
Routine Antenatal check-up
Postnatal care up to six (6) weeks post-delivery
Routine Immunizations (KEPI) and Baby Friendly Vaccines
1st emergency caesarean section, subsequent elective CS and normal delivery
Pre-maturity/Pre-term
Congenital conditions

NB. The maternity benefit is available to principal members and/or their spouse only.

FOR A COMPLETE GUIDE TO ALL SCHOOLS IN KENYA CLICK ON THE LINK BELOW;

SCHOOLS’ NEWS PORTAL

Here are links to the most important news portals:

Dental Benefits

Benefits under this cover include but not limited to; –

Dental Consultation and Anesthetist’s fees
Dental X-rays and Root canal treatment.
Tooth Extraction
Saling necessitated by a prevailing medical conditions and prescribed by a dentist
Dentures necessitated by an accident/ injury
Deformation surgery

Optical Benefits

Benefits under this cover include but not limited to;

Cost of lenses and frames- members who have obtained frames will not be entitled to a replacement within one year unless necessitated by a medical condition and prescribed by an ophthalmologist.
Prescription for ophthalmic treatment and eye lenses
Ophthalmic ultrasound if prescribed by the Ophthalmologist

Medical Emergency Road and Air Evacuation Benefits

This benefit allows for emergency transportation and transfer of sick or injured members or dependents from a place of incident or facility with inadequate care to the appropriate facility using road ambulance, fix-wing and helicopter services within East Africa (Kenya, Uganda, Rwanda and Tanzania). Air evacuation will be limited to two (2) per family per annum within the policy period.

International Travel and Referral Allocations

This will be paid out where authorization has been granted for the member to travel to another country for specialized treatment which is either not available locally or is reasonably cheaper and better quality than is locally, air ticket for patient and aide and their accommodation. A medical referral report shall be required to facilitate overseas treatment.

All requests for specialized treatments outside Kenya shall be approved by the Director, Medical Services in the Ministry of Health.

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:

Psycho-Social tele-counselling services through Minet Tele-counselling center.
On site counselling services in some special instances
Referral for face to face counselling by specialist.

MEDICAL SCHEME EXCLUSIONS

The medical scheme will not cover the following:

Active participation in war, invasion, riots or terrorism
Cosmetic treatment unless relating to an accident
Massage (except where certified as medically necessary)
Nutritional supplements unless prescribed by a doctor as part of treatment of a deficiency
Maternity cover for dependent children
Self-prescribed drugs
Treatment other than by a registered medical practitioner
Outpatlent, dental and optical co-pay of fifty shillings on each visit
Reimbursement of costs incurred outside the appointed panel of providers unless for emergency cases, accident cases and on pre authorization
Private vaccines and travel vaccines
Alcohol related rehabilitation
Maternity for child dependants
Cost of lenses and frames not prescribed by an Ophthalmologist
Replacement of spectacle frames within the same year of cover.
Photo chromatic and/or antiglare lenses unless prescribed by a doctor
Cosmetic dental care Cosmetic Crowns, Caps, Bridges, Orthodontics & Dentures, self-prescribed teeth cleaning and whitening, unless necessitated by
Infertility investigation and family planning procedure expenses
Replacement or repair of old dentures bridges and plates unless damage to dentures, bridges and plates becomes necessary as a result of accident
Treatment otherwise covered by NHIF

GROUP LIFE AND LAST EXPENSE (FUNERAL) COVER

a) Last Expense Benefits

The Last Expense (Funeral) cover provides a fixed amount graduated per grade and payable only in the event of death of the principal member to defray funeral expenses.

b) Group Life Benefit

A fixed amount to be paid graduated according to grade as per the table of benefits above. This will be a benefit rider under the Health Care Medical Scheme.

SERVICE PROVIDERS

Members may view a full list of medical service providers through: –

TSC and MINET Kenya websites
Use of Mobile phone USSD code – dial *340#

Teachers and their dependants are required to access medical care services only from the approved panel of service providers. The Administrator shall not reimburse costs incurred outside the appointed panel of providers except for emergency cases.

CONTACTS FOR ENQUIRIES

Members may direct their enquiries to Minet Kenya through:

Tel:0730 604000
Hotline:1528
Email: [email protected]
Website: www.minet.com/kenya
Twitter: Minet_Kenya
Facebook: MinetKe
Telegram: Teachers’ Medical Scheme

NB: Fraud and Malpractices:Teachers are strongly advised not to engage in fraudulent activities.

Related Content: