Minet Teachers’ Medical Scheme 2022-2025: Complete Info Guide

Media Team @Educationnewshub.co.ke

TEACHERS’ MEDICAL SCHEME 2022-2025

AFYA KWA WALIMU

Get all the details on:

Also read: TSC Minet Medical Scheme For Teachers

Benefits Table

The Unlimited Benefits For Both Inpatient And Outpatient For Job Group B5 – C3 Shall Apply In Government Hospitals, Faith Based Hospitals (Mission Hospitals) And Private Hospitals Owned By The Capitation Provider.

However, Teachers In This Category Who Wish To Seek Medical Services From Alternative Empaneled Hospitals Shall Be Free To Do So Under The Above Limits.

Job Group Inpatient Outpatient Dental Optical Maternity Funeral Cover  

Evacuation

 International Treatment & Travel  
B5 Unlimited Unlimited 45,000 60,000 120,000 300,000  

 

 

Air (Fix-wing and Helicopter) at four (4) per family per annum

  

 

 

KShs 2,000,000 for International treatment and KShs 200,000 for international travel for the patient and one person

  
1,000,000 150,000
C1 Unlimited Unlimited 45,000 60,000 120,000 300,000
1,000,000 150,000
C2 Unlimited Unlimited 45,000 60,000 120,000 300,000
1,000,000 150,000
C3 Unlimited Unlimited 45,000 60,000 120,000 300,000
1,300,000 200,000
C4 1,500,000 225,000 45,000 60,000 120,000 300,000
C5 1,800,000 250,000 45,000 60,000 120,000 300,000
D1 2,000,000 300,000 45,000 60,000 200,000 300,000
D2 2,200,000 325,000 45,000 60,000 200,000 300,000
D3 2,500,000 325,000 45,000 60,000 250,000 300,000
D4 2,800,000 400,000 45,000 60,000 250,000 300,000
D5 3,000,000 450,000 45,000 60,000 300,000 300,000

 

COMPREHENSIVE BENEFITS INPATIENT BENEFITS

This benefit covers treatment that requires admission to a hospital or day-care surgery/procedure. The benefits (paid net of NHIF rebates) under this cover include but are not limited to:

OUTPATIENT BENEFITS

This benefit covers treatment that does not require admission or day-care surgery in a hospital. The outpatient cover caters for all routine outpatient services which include but are not limited to:

ADDITIONAL COVERED BENEFITS

Chronic & Critical Disease Management (CDM) and Employee Assistance Program (EAP)

These are classified as;

  1. Cancer, kidney failure, hypertension, arthritis, diabetes, HIV/AIDS, liver diseases,
  2. COVID-19 and all outbreaks of pandemics
  3. Drug and substance abuse including alcoholism and associated rehabilitation for member and spouse
  4. Work-related trauma
  5. Domestic Violence (including Gender Based Violence) Trauma
  6. Depression
  7. Social counselling
  8. Mental Health and Wellness

To enroll to our CDM program you need to fill in a CDM form available at Minet county offices countrywide or enroll on our website https://collaborationkenya.minet.com/cde This form can also be sent to your e-mail upon request.

PSYCHIATRIC AND COUNSELLING SERVICES

These services are available for employees and include but are not limited to:

MATERNITY BENEFIT

The benefits include but are not limited to:

SCHEME EXCLUSIONS

Expenses for the following will not be covered for under the scheme:

  1. Cosmetic Treatments
  2. Self-prescribed treatment
  3. Experimental treatment
  4. Costs already catered for by another insurance company
  5. Maternity for child dependants
  6. Reimbursement without prior approval from the insurance which should be notified within 24hrs

ELIGIBILITY

REGISTRATION PROCESS

The registration process is done in two steps. Ensure you have the below mandatory details:

if you use a birth notification, then a birth certificate should be produced after the

  1. Delivery fees
  2. Emergency Caesarean section
  1. Prenatal and antenatal care
  2. Preterm care child attains 6 months.

Maternity benefit available to principal member and their spouse only

OPTICAL BENEFITS

This benefit caters for expenses related to eye treatment which includes but not limited to:

  1. 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
  2. Prescription for ophthalmic treatment and eye lenses
  3. Ophthalmic ultrasound if prescribed by the Ophthalmologist

DENTAL BENEFITS

LOCAL ROAD AND AIR EVACUATION BENEFITS

For emergency cases needing evacuation please contact our hotline 1528 for assistance.

INTERNATIONAL TREATMENT & INTERNATIONAL TRAVEL

  1. Overseas Treatment if not locally available where advised by a medical practitioner and approved by the Ministry of Health at Ksh. 2,000,000.00 and Kshs. 200,000 Air ticket, and accommodation for the
  2. This is a cover that shall be over and above the inpatient normal cover limits specified for the members and the person accompanying the
  3. 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 the patient has been referred for better quality medical
  4. This shall be a referral to any country within East Africa, South Africa, India and any other international country as may be recommended by a medical doctor and approved by by the Director, Medical

FUNERAL BENEFITS

This benefit is payable to the next of kin upon the demise of a principal member. To access the Funeral Benefit, the following information should be availed to Minet at the earliest possible convenience;

Kindly note:

STEP 1: – MOBILE PHONE REGISTRATION (USSD REGISTRATION)

Confirmation of registration

*865# from your mobile phone.

STEP 2: – THE BIOMETRIC REGISTRATION PROCESSESS ACCESS TO MEDICAL SERVICES

MEDICAL FACILITIES (HOSPITALS)

Direct facilities

These are hospitals that members can access directly without the need for a referral letter.

Referral facilities

These are hospitals that offer medical services for cases that require specialized treatment. Referral letters from direct facilities (see above) are required to access services in these facilities.

*Kindly note you do not need a card to access medical services. Simply present the TSC number to the empaneled service providers.

COPAY

Copay is a fixed amount for a covered service paid by a patient to the provider of service

before receiving the service. Not all medical visits require copayments from patients.

For Teachers’ Medical Scheme, a co-pay of Kenya shillings one hundred (Kshs 100) is required

NB: Children under 7 years of age will be registered under either the parent or an appointed guardian.

*This Biometric registration is only done the first time one tries to access services. This process is not required after subsequent visits.

chargeable only for Specialist outpatient doctor consultation services, Dental and Optical visits.

The co-pay shall not be charged in the following cases:

MEMBER EDUCATION

Scheme member education is a continuous process to sensitize members on the operations of the medical scheme.

Medical education and wellness program for members with pre-existing and chronic conditions

Hotline: 1528

Telephone: 0730 604 000

Email: mmc.customerservice@Minet.co.ke

Website: www.minet.com/Kenya Remote assistance: USSD *202*07# Website: www.minet.com/Kenya App: WalimuCare App

Telegram: Teachers’ Medical Scheme

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