What teachers get in SHA deal as TSC dumps Minet

The new scheme is set to take effect on December 1, 2025, after union leaders met with SHA and Teachers Service Commission (TSC) officials in Nairobi to apprise themselves of the migration details.

The union leaders were from the Kenya National Union of Teachers (KNUT), Kenya Union of Post-Primary Education Teachers (KUPPET), and Kenya Union of Special Needs Education Teachers (KUSNET).

The teachers will benefit from the packages under the Public Officers Medical Scheme Fund (POMSF), a proposed fund in Kenya to provide comprehensive medical coverage for public officers and their dependents.

In the new package, the cover will cater for a principal member, a declared spouse and up to five children.

Children of 25 years, fully dependent on the principal member and enrolled in full-time study, are also eligible to benefit.

Services under cover will include inpatient and outpatient, dental, optical, overseas treatment, radiology, annual medical checkup and maternity.

It will also cover drug rehabilitation, chronic illness, renal dialysis, evacuation services and tests for organ donors.

Treatments at non-contracted facilities are, however, excluded from the cover, as well as services from chiropractors, acupuncturists, or herbalists.

Other exclusions include self-prescribed treatments or expenses for non-conventional therapies, including weight management drugs, nutritional supplements, stop-smoking aids, or domestic remedies, unless prescribed as part of medical treatment.

Some of the key financial coverages include a cap of Ksh.500,000 for overseas treatment, up to Ksh.1.1 million for overseas surgery, up to Ksh.400,000 for Oncology, and upto Ksh.200,000 for post-renal replacement therapy.

For maternity services, a limit of Ksh.10,000 is provided for normal delivery, and Ksh.30,000 for C-section.

The Teachers Medical Cover was set up in July 2015 under Minnet as the administrator, but a myriad of challenges arose during the implementation period.

They included limited empanelled hospitals across the country, rejection of admission requests forcing teachers to pay out of pocket, lengthy pre-authorisation procedures and restricted cover for dependants.

Through the POMSF, SHA will be accessed in 9,016 hospitals across the country, up from the previous 816. They will include public, private and faith-based hospitals.

The admission process will also be fully automated with zero human interference to tame the rejection of admission requests.

The teachers will now be required to utilise their limits responsibly to cover the year.

Registration.

The TSC advises teachers to register on SHA's website or dial *147# on your mobile device, then proceed to accept the SHA terms and conditions.

They can also opt for assisted enrolment at SHA branches, Huduma Centres and TSC County and Subcounty offices.

They have also been advised to update details for their beneficiaries, including proof of marriage for spouses, birth certificates for children and certification for persons living with disabilities (PWD).

Those wishing to register a spouse change will have a 30-day waiting period before the new spouse becomes eligible for services.

"In case the change is due to the death of a spouse, the waiting period does not apply," the statement noted.