SHA Urges TSC to Dismiss Minet for New Teachers’ Medical Insurance

The Social Health Authority (SHA) has called on the Teachers Service Commission (TSC) to end its existing medical insurance agreement with Minet Kenya and rather enroll teachers in the Public Officers Medical Scheme Fund.

This significant recommendation surfaces just days after TSC notified the Parliamentary Education Committee that SHA did not have the capability to accommodate over 300,000 teachers nationwide into its healthcare system.

Simultaneously, Parliament is now urging TSC to cancel its contract with Minet Insurance brokers and a group of underwriters for the delivery of medical cover services to teachers, describing the setup as an “amorphous structure. ”

Kibra MP Peter Orero revealed that teachers had raised issues stating that whenever they visited the consortium-approved hospitals, they were not provided with medication and were expected to purchase the drugs on their own.

Orero also noted that a majority of teachers were being denied service at health facilities and informed they had not been enrolled in the medical system.

The efforts of the Commission’s lawyer to clarify that the contract with the consortium would conclude in November this year and a decision regarding the onboarding of teachers to the “enhanced” SHA system would be made then were, nevertheless, met with disapproval and calls to terminate the contract beforehand.

“What sort of insurance cover is this? It is a mix that lacks structure. You are dealing with an insurer, a leading consortium, as an administrator and a capitator. Quite an unusual type of insurance. You need to get out of this arrangement,” remarked Melly.

“We cannot proceed in the same manner and anticipate different outcomes. The consortium is a disorganized structure that fails to provide services,” stated Luanda MP Dick Maungu.

Baringo North MP Joseph Makilap suggested grouping teachers so they can gain access to superior healthcare.

“As TSC ends this contract in the next half year, teachers will face difficulties. I recommend that we split them into groups and secure good insurance covers for them or we aggregate them to SHA and may divine assistance help us all,” Makilap noted.

As per SHA, all teachers and their dependents are qualified for the Social Health Authority (SHA) benefits package, which operates under three primary funds: the Primary Healthcare Fund (PHC), the Social Health Insurance Fund (SHIF), and the Emergency, Critical, and Chronic Illness Fund (ECCIF). However, SHA emphasizes that employers like TSC can provide supplementary insurance for additional advantages via acknowledged private underwriters.

Presently, TSC extends a medical cover through Minet Kenya, a private insurance firm. SHA clarified that it does not oversee the Minet coverage and proposed that the commission reevaluate its arrangement by transitioning to the Public Officers Medical Scheme Fund. With this fund, TSC would be able to provide supplementary benefits based on a government-managed budget rather than depending on private providers.
As it currently stands, more than 21. 6 million Kenyans have registered with SHA, with approximately 50,000 new registrations taking place each day. SHA has also formed partnerships with over 8,000 healthcare facilities across the country to guarantee service availability.

The discussion regarding teachers’ medical insurance is growing more intense as worries about the quality, accessibility, and management of the existing Minet medical scheme continue to arise. Teachers’ unions and education stakeholders have consistently highlighted concerns regarding service delays, medication shortages, and unsatisfactory hospital experiences with the Minet scheme.

Should TSC take SHA’s guidance, teachers may soon experience a notable change in how their health insurance is administered, which could enhance healthcare access while saving the commission millions in insurance expenses each year.

𝐄𝐃𝐔𝐂𝐀𝐓𝐈𝐎𝐍 𝐂𝐎𝐌𝐌𝐈𝐓𝐓𝐄𝐄 𝐏𝐑𝐎𝐁𝐄𝐒 𝐒𝐄𝐑𝐕𝐈𝐂𝐄 𝐏𝐑𝐎𝐕𝐈𝐃𝐄𝐑 𝐎𝐕𝐄𝐑 𝐓𝐄𝐀𝐂𝐇𝐄𝐑𝐒’ 𝐌𝐄𝐃𝐈𝐂𝐀𝐋 𝐈𝐍𝐒𝐔𝐑𝐀𝐍𝐂𝐄 𝐀𝐌𝐈𝐃 𝐂𝐎𝐍𝐂𝐄𝐑𝐍𝐒 𝐎𝐅 𝐏𝐎𝐎𝐑 𝐒𝐄𝐑𝐕𝐈𝐂𝐄 𝐀𝐍𝐃 𝐃𝐄𝐋𝐀𝐘𝐒

The National Assembly Committee on Education has put medical service providers on the spot over persistent challenges in the Teachers’ Medical Insurance Scheme.

Appearing before the Committee were Mr. Parmanand Mishra, Chief Operating Officer of Medical Administrators Kenya Ltd (MAKL), Dr. Felix Wanjala, CEO of Bliss Healthcare, and Mr. James Njuguna, GM Operations at MAKL.

The consortium, led by Minet Kenya, was awarded the tender for the 2022-2025 period under a hybrid model that combines capitation and insurance. Other consortium members include Bliss GVS Healthcare, Medical Administrators Kenya Limited, Old Mutual, CIC, Britam, Pioneer Assurance, and Star Discover

The representatives faced questions from Members of Parliament keen on addressing the plight of teachers particularly the delays in treatment approvals, limited access to quality care in rural areas, and complaints over the use of low-quality medication.

Committee Chair, Hon. Julius Melly raised concerns about the scope of the scheme, which covers over 300,000 teachers and their dependents across Kenya. “As you are aware, the Teachers Service Commission (TSC) in Kenya has partnered with Aon Minet and Bliss Healthcare to offer a comprehensive healthcare package,” said Hon. Melly. “However, over the years, numerous challenges have emerged, affecting access and quality of healthcare for our educators.”

Committee Vice Chair, Hon. Eve Obara questioned the lengthy wait times reported by teachers seeking critical care. “What measures are in place to expedite the approval process for specialized and overseas treatments?” she asked.

In response, Bliss CEO, Dr. Wanjala explained that “all acute outpatient visits are handled directly without pre-authorization, and over 96% of inpatient admissions are approved within 30 to 45 minutes.” He added that emergency cases are attended to immediately and that providers are regularly trained to reduce documentation errors that delay approvals.

However, Committee Members expressed dissatisfaction, citing continued bottlenecks. Hon. Nabii Nabwera raised concerns about teachers in rural areas travelling long distances to access care. “Some of your facilities are very far from the teachers. What strategies are being implemented to decongest urban hospitals and improve rural access?” he asked.

Documents submitted to the Committee revealed that while Minet operates 47 facilities and Bliss runs 35, with the broader network comprising 763 accredited facilities. However the Committee noted that coverage rural areas remained inadequate.

Hon. Mary Emaase raised alarm over the alleged use of low-quality medication. “We’re receiving complaints about poor services and the use of low-quality generic drugs,” she noted, demanding stronger oversight and enforcement of medical standards.

The legislators also grilled the consortium over delayed payments to hospitals, with some providers reportedly turning away teachers due to unpaid bills. “What steps have been taken to ensure timely payments and how do you address cases of service denial?” asked Hon. Phylis Bartoo.

Mr. Mishra of MAKL assured the committee that reconciliation and payment timelines were being streamlined. “We are working closely with service providers to ensure prompt settlements and resolve any backlogs,” he said.

“Teachers need to be fully informed about their benefits and the procedures for accessing care,” said Hon. Julius Taitumu with Hon. Melly added that, “Our teachers deserve better, and we will hold each player accountable until they get the healthcare they are entitled to.”

Members noted that the consortium, led by Minet Kenya, was awarded the tender for the 2022-2025 period under a hybrid model that combines capitation and insurance. Other consortium members include Bliss GVS Healthcare, Medical Administrators Kenya Limited, Old Mutual, CIC, Britam, Pioneer Assurance, and Star Discover.

The Medical Administrators Kenya Ltd is expected to submitted a detailed reports on the status of its facilities before the Committee on Education within seven days.