The Teachers Service Commission, TSC, has awarded the contract for the medical cover all all its staff and teachers to AON Minet. The Insurance Company works closely with health providers like Bliss and Mediheal to provide various medical cover packages to teachers and their dependents.
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Requirements and Eligibility
All teachers employed by the Teachers’ Service Commission (TSC) and actively in service are automatically eligible to be covered under the Minet Teachers’ Medical Scheme as Principal Members. As thus, all teachers should benefit from the medical cover as they are covered.
The following persons are considered dependants and are eligible for cover:
• One (1) legal spouse of the member
• Four (4) unmarried biological or legally adopted children who are dependent upon the
member for support, provided that such children are aged not less than 38 weeks (full
term birth) and not more than 18 years, a condition that is extended to 25 years, if the
children are enrolled in a recognised post-secondary institution
• No age limit applies to child dependants with a disability
Change of Dependants
Once registered, it is not possible for the principal member to change their dependants until the end of the policy period unless as a result of death or divorce of a spouse. However, at the start of each policy period, you will have a chance to review your cover and make changes to your dependants should you wish to. The end of a policy year normally occurs in September of every year.
Terms and Conditions of Cover for Dependants
• Pre-mature babies i.e. babies born before 38 weeks are covered under maternity
• The legal spouse of the dependant will be covered up to the age limit of 70 years
• The cover does not cater for relatives of the principal member such as mother, father, sisters, brothers, nephews, nieces or grandchildren.
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Teachers/ Principal Members
All teachers in active service with Teachers’ Service Commission (TSC) are automatically eligible for cover. The principal member is, however, required to register themselves and their dependants.
The registration process is done in two steps:
Unstructured Supplementary Service Data (USSD) registration and biometric registration.
Ensure you have the below mandatory details:
• TSC Number
• ID Number
Principal Member Registration
Step by step Guide:
Step 1: Dial *865# from your Safaricom or Airtel mobile phone number
Step 2: Key in your TSC and National ID Numbers when prompted. The details will be verified against the AON Minet database.
Step 3: If successful, you will be prompted to enter your name (surname and other name), role and gender. Once done, you will receive a message confirming your
successful registration onto the scheme and a prompt to register dependants.
THE REGISTRATION PROCESS
Step 1: Dial *865# from your Safaricom or Airtel mobile phone number
Step 2: Select the dependant you wish to register, i.e. spouse or child
Step 3: Enter Date of Birth, full name, ID Number/Birth Certificate Number
If not successful, kindly contact AON Minet on their call centre hotline numbers for further assistance.
THE BIO-METRIC REGISTRATION PROCESS
Biometric Registration is carried out at the service provider’s premises. It follows the steps below:
Step 1: Present yourself at the service provider on their active panel (you can access the list of active providers by dialing *340#)
Step 2: Identify yourself or your dependant with the TSC number
Step 3: The service provider will generate an SMS that contains the One-Time-Pin (OTP), sent to the principal member’s mobile number
Step 4: You will present this OTP to the service provider representative to kickstart the fingerprint registration
Step 5: You will be requested to place your index finger and thumb on the biometric device and the impressions will be recorded against your membership record
NB: Children under 5 years of age will be registered under either the parent or an
HOW TO ACCESS MEDICAL SERVICES
Members of the Teachers’ Medical Scheme can access any of AON Minet service providers on the Company’s online panel countrywide. This list is accessible by dialling *340# from your Safaricom/Airtel line. Follow the on screen prompts to access the service you desire.
REFERRAL AND SPECIALIST SERVICES
Instances where a member may require referral/specialist services include:
1. Where the service sought cannot be accessed directly such as an x-ray, MRI, chemotherapy or specialised services such as gynae care, oncology, etc.
In this instance the member will visit a primary healthcare service provider who will issue a referral letter to the member allowing them to seek the service at a referral service provider within AON Minet’s panel.
2. Where the service provider is not contracted to give a particular service.
In this instance, the service provider will issue a referral letter to the member indicating the service they seek and the name of the service provider they are referring the member to.
As part of the inpatient cover, the principal member and/or dependants are eligible to receive the following benefits:
• Hospital accommodation charges:
Group G-N standard ward bed rate net of NHIF rebate pay
Group P-R standard private ward bed rate net of NHIF rebate per day
• Doctor’s/Surgeon’s fee
• ICU/HDU theatre charges
• Drugs/medicine, dressings and internal surgical appliances
• Pathology, x-ray, ultrasound, ECG, MRI scans and computerised tomography
• Inpatient radiotherapy, physiotherapy, hydrotherapy and chemotherapy
• Emergency road and air evacuation within East Africa leading to admission
• Hospital accommodation for accompanying parent or guardian for hospitalised children below seven (7) years
• Post hospitalisation benefit (within 21 days after discharge from hospital)
• Treatment of congenital defects/genetical disorders
• Treatment of pre-existing and chronic conditions (including cancer)
• Treatment of HIV/AIDS related conditions
• Rehabilitation services including services like home care, physiotherapy and occupational therapy
• Inpatient ophthalmological and dental surgeries
Note that all the payments related to the medical cover are net of NHIF rebates, rates and deductions.
The Teachers’ Medical Cover offers unlimited outpatient consultations. These will include but are not limited to:
• Routine outpatient consultations
• Diagnostic laboratory and radiology services including x-ray, ultrasound, MRI and CT Scans
• Day care surgery for minor surgical treatment that may not require admission
• Prescribed physiotherapy
• Prescribed drugs and dressing
• Prescribed routine laboratory tests
• HIV/Aids related conditions and prescribed ARVs to the full limit per family per annum
• Routine immunisations and KEPI vaccinations
• Pap smear for ladies and PSA for men (principal member only)
• Routine antenatal check-ups
- Routine antenatal check-ups
- Delivery fees
- Postnatal care up to six weeks
- Routine immunisations and/or KEPI vaccinations
- Emergency and elective caesarean section
- Congenital conditions
- Pre-maturity expenses
Maternity benefits are only available to the principal member and spouse. New born babies must be registered immediately upon birth.
Dental benefits under this cover included but not limited to:
• Dental consultation and anaesthetist’s fees
• Root canal treatment
• Tooth extractions
• Scaling necessitated by a prevailing medical conditions and prescribed by a dentist
This benefit caters for expenses related to eye treatment. This includes but is not limited to the cost of:
• Spectacle frames
Should an emergency occur, contact Minet immediately via the Call Centre Hotline number. Scheme members will be covered for the following Road and Air ambulance and Evacuation services:
i. Emergency Air Ambulance Evacuation Services within East Africa
ii. Emergency Road Ambulance Evacuation services within East Africa
iii. Overseas Evacuation/Treatment abroad in India, where treatment is not available locally and within policy limits
In cases where a member is involved in a medical emergency, they will access services at the appointed service providers in the region. Minet Kenya Insurance Brokers Limited’s emergency response team will be receiving the requests and will coordinate the evacuation process.
To ensure the wellbeing of clients, AON takes time to conduct wellness checks & educate members. The benefits under this scheme include, but are not limited to:
• Health education and lifestyle improvement programmes – doctors and other experts educate and engage members on lifestyle choices and disease management
• Preventive care programmes carried out during wellness drives
• HIV/AIDS workplace programmes – the team engages the clients in voluntary counselling
Chronic Disease Management
Chronic diseases covered include but not limited to: cancer, hypertension, asthma, diabetes, pepticulcer diseases, arthritis, cardiac failure, epilepsy, chronic renal disease, schizophrenia, bronchiectasis, chronic obstructive pulmonary disorder, thyroid disease, systemic lupus erythematosus and hyperlipidaemia.
To enrol to AON Chronic Disease Management (CDM) programmes, fill in a CDM form available at Minet county offices countrywide. The CDM form is available on the website.
AON CDM team will ensure your drugs are delivered to you and that your progress is monitored regularly.
Psychiatric & Counselling Services
This covers psycho-social support programmes for employees for conditions such as chemical dependency, stress, post-traumatic counselling, relationship difficulties, anxiety and depression, parenting, legal or financial distress, etc.
Services include but are not limited to:
• Psychosocial tele-counselling services through the Minet tele-counselling centre toll free line 0800 720 029
• On-site counselling services in some special instances
• Referrals for face to face counselling by a specialist
Last Expense Benefits
Last expense is a benefit payable to the next of kin upon the demise of the principal member to aid in funeral arrangements. It is payable within 48hrs and via Mobile Money Transfer provided all information required has been availed to Minet. The benefit is KShs. 100,000 across all job groups.
A Death Notification, a Burial Permit or an official TSC letter can be sent by email to Minet Kenya. The email should include the following:
• Name of Deceased
• TSC Number
• Date of Death
• Next of kin’s name and designation (spouse and children)
• Next of kin’s ID Number
• Next of kin’s contact (mobile number)
Teachers should ensure that the next of kin information held by their employer (TSC) is correct and up to date including phone numbers.
NOTE: This benefit is only applicable to the principal member (teacher) and not dependants.
Group Life Benefits
This benefit is payable to the family of the deceased to assist in re-organising their lives after the demise of the principal member. This benefit graduates progressively across job groups and is only applicable upon the demise of a principal member.
To access group life benefit, the following information should be availed to Minet at the earliest possible convenience:
• Name of Deceased
• Death Certificate of Deceased
• Burial Permit
• Surrender of original or copy of ID card of the deceased
• Bank details: Bank Name, Branch, Account Name and Account Number
Overseas Evacuation/Treatment Abroad
In line with Ministry of Health regulations, members will ONLY be evacuated for treatment abroad in cases where the treatment required is not available locally and where the Director of Medical Services has approved.
In case one is referred for treatment abroad, the following benefitis are payable within the medical scheme:
• Airfare – economy class for the patient and accompanying person/doctor/nurse in cases where the patient is not ambulant and is critically ill
• Accommodation and transport within the destination of treatment at local rates
Verification of Requests
• Receipt of request for overseas treatment and vetting by Minet clinicians
• Request for a comprehensive medical report from the doctor which should include:
o Reason for overseas referral;
o The facility the member is being referred to; and
o Whether treatment is locally available or not.
• Analysis of medical history and recommendation of most appropriate treatment plan
• Initial consultation with local doctors (if deemed necessary) and advice on the admissible and inadmissible bills as per policy
• The member will be referred to the Director of medical services for clearance Securing Credit Facility
• The medical report will be shared with the overseas providers for quotation purposes
• Where the referral is not specific to one particular provider, we will request for several quotations
• Once credit facilities are secured, all travel arrangements finalised and travel date confirmed, we shall issue a guarantee of payment.
• Minet will ensure that all details relating to the particular treatment are available and communicated to you e.g. in case of a renal transplant, all relevant medical and legal documents required
• All information relating to travel preparation will be made available e.g. yellow fever vaccination, etc.
• Scanned copies of the passport (bio data details) for the patient and a medical aide (if necessary) will be requested at this stage
• Minet will send an invitation letter to the hospital and a copy will be mailed to you for visa application
• Once a visa has been issued, the dates of travel will be confirmed and tickets booked and issued While abroad, the following process will be followed to ensure that the patient and accompanying person are well taken care of.
Through AON travel agency, we will:
a. Facilitate airport pick up and transfer to the hospital
b. Introduce you to a Guest Relationship Officer (GRO) who will give assistance in:
• Mobile connectivity – acquiring a local calling (pre-paid) card
• Money exchange – changing your foreign currency to the local currency
• Overseeing your admission to hospital and hotel check-in and hospital registration
• Frequent updates – regular follow up and monitoring of your treatment plan including daily updates to Minet
Upon Discharge from Hospital
• Minet will facilitate transfer to the airport. The patient will be requested to fill in our customer satisfaction feedback form prior to departure
• Minet will link them up to a local specialist upon returning to the country for follow up and monitoring of health.
NATIONAL HOSPITAL INSURANCE FUND, NHIF
Members are entitled to statutory benefits under the NHIF scheme as they still pay their statutory deductions. The Minet Teachers’ Medical Scheme is a private health insurance cover designed to draw on the benefits offered by public health insurance. Contributing to the NHIF increases the overall health benefits that teachers can utilise. It also increases the facilities accessible to members.
Teachers covered under the scheme are encouraged to visit the nearest NHIF office and update all dependant details.
Recent changes by NHIF have resulted in more benefits for all those who make contributions to the fund. NHIF now caters for additional expenses besides the daily hospitalisation rebate and outpatient services offered at any NHIF accredited facility across the country. Members of the fund can also access particular services in most facilities including certain private hospitals. Minet Teachers’ Medical Scheme, like all private insurances, will only cater for bills net of NHIF.
However, in order to tap into your NHIF benefits, it is important to ensure that you have your NHIF card and ID card during hospital visits, and that all dependants are duly registered.
Minet Teachers’ Medical Scheme members also need to be aware of NHIF services which require the patient to seek pre-authorisation from NHIF. The pre-authorisation procedure is as follows:
1. Request your healthcare provider/hospital/doctor to fill in the NHIF pre-authorisation form. The provider will attach the following documents: a pro-forma invoice/quotation and the relevant medical records/diagnosis.
2. Submit the documents at any NHIF office.
3. An approval/undertaking will be issued within 24 hours. The letter of undertaking should be collected from the same NHIF office.
4. Attach a scanned copy of the NHIF undertaking when sending your private insurer’s pre-authorisation form to us.
5. Minet will issue an undertaking for the difference.
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