MEDICAL HEALTHCARE COVER FOR TEACHERS AND THEIR DEPENDANTS (INCLUDING LAST EXPENSE)

As an initiative toward the implementation of the National Policy on Universal Health Care for the citizens, the Teachers Service Commission, TSC, has contracted Minet Kenya Insurance Brokers Limited, (leading other service providers} to offer a medical cover for all teachers in their employment, together with their dependants with effect from 1^st December 2022.

MEMBERSHIP ELIGIBILITY

Eligibility Criteria

• All teachers in active service aged 1 8 years up to 65 years
• One (1 } legal spouse of the teacher
• Four (4} dependant children (biological/legally adopted} are eligible for cover from birth until the age of eighteen (18) years or to the age of twenty-five (25) years if residing with their parents and enrolled in a recognized post-secondary
• No maximum age limit shall apply to child dependants with proven disability

The maximum family size is six (6}, comprising the principal member plus five (5) dependants.

CO-PAY

There shall be a co-pay chargeable of Kenya shillings one hundred (Kshs.100) per outpatient visit per individual for dental, optical and specialized doctor consultation services.

The co-pay shall not be charged on repeat visits services within 1 4 days from date of previous visit and when picking medication for chronic conditions which does not require consultation with the doctor after 90 days from last visit.

SCHEME BENEFITS STRUCTURE

The Scheme benefits are graduated according to grading as outlined below: –

Continue reading:

Details of the new AON Minet Medical scheme for teachers; Benefits per job group

SCOPE OF COVER

The Medical cover includes Inpatient, Outpatient, Dental, Optical, Maternity, funeral (including mortuary fees, hearse, coffin, wreath, and transport for immediate family of maximum 10 people), air evacuation allocation, evacuation allocation-air (fix wing and helicopter) international travel and referral allocations..

Minet TSC Cover Inpatient Benefits

This is treatment which will require admission in and stay in a hospital or day care surgery/procedure. The benefits (paid net of NHIF rebates) under this cover include but are not limited to: –

• Doctor’s (Physician, Surgeon & Anesthetist)
• 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

Minet TSC Cover 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
• Prescribed Diagnostic Laboratory and Radiology services (X- ray, ultrasound, MRI and CT Scans).
• Prescribed physiotherapy
• Prescribed drugs and
• Referral Outpatient to
• 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
• 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)

Minet TSC Cover Maternity Benefits

Benefits under this cover include but not limited to; –

• Delivery/ Doctors Fees
• Routine Antenatal check-up
• Postnatal care
• Routine Immunizations (KEPI) and Baby Friendly Vaccines
• 1st emergency caesarean section, subsequent elective CS and normal delivery
• Pre-maturity/Pre-term
• Congenital conditions
• Private room if available, for all expectant principal member and their NB. The maternity benefit is available to principal members and/or their spouse only.

Minet TSC Cover Dental Benefits

Benefits under this cover include but not limited to; –

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

Minet TSC Cover 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
• Surgery

Minet TSC Cover Medical Emergency Road and Air Evacuation

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 annum within the policy period.

Minet TSC Cover 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.

Minet TSC Cover Chronic, critical and terminal disease management

• Cancer, kidney failure, hypertension, arthritis, diabetes, HIV and AIDS, liver diseases etc.
• Covid-1 9 and all outbreaks of pandemics
• Drugs and substance abuse including alcoholism and associated rehabilitation
• Work related trauma
• Domestic violence {including Gender based violence), trauma
• Depression
• Continuous medical education
• Social counselling
• Mental health and

Minet TSC Cover SCHEME EXCLUSIONS

• 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 dependant children
• Self-prescribed drugs
• Treatment other than by a registered medical practitioner
• Outpatient, 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
• 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 accidental injury
• 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 an accident
• Treatment otherwise covered by NHIF

Minet TSC Cover LAST EXPENSE

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

Minet TSC Cover SERVICE PROVIDERS

The full list of accredited medical service providers for both direct access and referral medical care facilities is available at the TSC website – www.tsc.go.ke

Teachers and their dependents 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.

Fraud and Malpractices

Teachers are strongly advised not to engage in fraudulent activities.

CONTACTS FOR ENQUIRIES

Members may direct their enquiries to the Administrator MIN ET Kenya through:

 Email: [email protected]

Tel: 0730604000

Twitter: @Minet_Kenya

Facebook: MinetKe

Telegram: Teachers’ Medical Scheme

Remote Assistance: *202*07#

App: Wallmucare App

Website: https://collaborationkenya.minet.com/MinetKe/Teachersmedicalscheme/

• Hotline: 1528

The purpose of this circular therefore, is to bring to your attention the provisions of the Scheme.