Reprieve as Major Improvements are made to the TSC Teachers’ Medical Scheme

Reprieve as Major Improvements are made to the TSC Teachers’ Medical Scheme; public officers Medical Scheme Fund {Circular}

JOINT COMMUNIQUÉ ON THE MANAGEMENT OF THE TEACHERS’ MEDICAL SCHEME UNDER THE PUBLIC OFFICERS MEDICAL SCHEME FUND (POMSF)

The Teachers Service Commission (TSC), the Social Health Authority (SHA), the Kenya Union of Post Primary Teachers (KUPPET), and the Kenya National Union of Teachers (KNUT) have had a consultative meeting to discuss and address pertinent issues relating to the management of the Teachers Medical Scheme under the public officers Medical Scheme Fund (POMSF) which has been in operation for the past five months since 1^st December, 2025.

At the outset we jointly reaffirm our unwavering commitment to the health, dignity, and well-being of the Kenyan teacher. To this end, we have agreed on the following:

1. Processing and payment of Last Expense Benefit.

Parties confirm that the last expense benefit is a key component of cover payable at the rate of 300,000 upon demise of the Principal Member. The initial 160 claims received by TSC and SHA have since been processed and payment to the Next of Kin will be released effective Wednesday 29^thApril, 2026.

As clarified during our last consultative meeting we clarify that the Group Life Cover and Work Injury Benefits Act (WIBA) provisions are not administered under the Social Health Authority (SHA). The Teachers Service Commission (TSC) is actively pursuing a separate budgetary allocation to cover these provisions for teachers.

2. Allegations of Co-Pay by Teachers.

The provisions of the contract signed between SHA and TSC is crystal clear on this subject. Teachers are guaranteed medical services within applicable limits under the Cover without the requirement of Co-pay.

Teachers are urged to report any cases of denial of services on the basis of Co-pay. The Authority will take stern action on medical facilities found to be charging this unauthorised levy.

3. Specialized Treatment and In Vitro Fertilization (IVF):

The cover guarantees comprehensive access to specialized services, including advanced cancer care, specialized surgical procedures, IVF and other fertility treatments. SHA has since approved Nairobi West Hospital to offer this service and an official communication will be made before close of business tomorrow.

3. Overseas treatment.

SHA has finalised the process of contracting overseas facilities to provide service to teachers. The following are the contracted facilities contracted by SHA.

• Acibadem Mehmet Ali Aydinlar University, Atakent Hospital-Istanbul Turkey
• AcibademMaslak Hospital-Istanbul, Turkey
• AcibademAltunizade Hospital-Istanbul, Turkey
• Acibadem Adana Hospital-Istanbul, Turkey
• Workhardt Hospital-Mumbai, India
• Soliman Fakeeh Hospital-Jeddah, Saudi Arabia
• King Faisal Specialist Hospital- Riyadh Saudi Arabia
• Apollo Hospitals Enterprise Ltd (Apollo Cancer Centre)-Chennai, India
• Kims Hospital Enterprises Private Ltd- Andhra Pradesh, India

The authority has issued the guidelines for access to the benefit and has been published on the SHA and TSC website.

5. Operationalisation of the National Joint Steering Committee:

TSC, SHA, KNUT, KUPPET and KUSNET have agreed to immediately operationalise the National Joint Steering Committee and will meet within 21 days to review the scheme performance and provide oversight on the management of the scheme.

6. Activation of County Joint Committees:

As agreed in our last meeting, we have activated 47 County Joint Committees. These committees will be chaired by the TSC County Head and will comprise the SHA County Manager and one representative from KUPPET, KNUT and KUSNET. They will convene quarterly meetings or on a need by need basis to facilitate structured dialogue, address emerging operational issues, and enhance communication with beneficiaries. Teachers are encouraged to seek guidance from these Joint Committees.

6. Ex-Gratia payment:

Following the institutionalization of Ex-Gratia Management Framework, teachers who exhaust their medical limits and are facing catastrophic health financial burdens are required to request in writing for ex gratia considerations. TSC is responsible for financing, receiving, vetting, and routing all ex-gratia requests, while SHA shall be responsible for payment of these approved compassionate claims. We need to emphasize that this is a payment of mercy and its not within the benefits under the cover.

6. Continuous Member Education:

SHA, TSC, KNUT and KUPPET will immediately co-facilitate a continuous, nationwide member education campaign to empower teachers with accurate knowledge regarding their benefit entitlements, patient portal navigation, and their rights and responsibilities.

SIGNED ON THIS 22^ndDAY OF APRIL 2026

Dr. Jamleck Muturi John, MBS, Chairman, Teachers Service Commission.

Dr. Abdi Mohamed, Chairman,Social Health Authority

Dr. Mercy Mwangangi, CBS Chief Executive Officer, Social Health Authority

Ms. Evaleen J. Mitei, MBS Ag. Commission Secretary/CEO, Teachers Service Commission (TSC)

Mr. AkeloMisori Secretary General, Kenya Union of Post Primary Education Teachers (KUPPET)

Mr. Collins Henry Oyuu Secretary General, Kenya National Union Teachers (KNUT)