Officials from the Ministry of Health, Social Health Authority (SHA), and the Kenya National Union of Teachers (KNUT) have reached a consensus regarding key issues raised by teachers surrounding the transition from the Mwalimu Cover to the Public Officers Medical Scheme Fund (POMSF).
In a joint statement issued on Tuesday, March 28, the officials from the three parties agreed on six resolutions, including some to address the benefits to teachers made available by the POMSF.
The parties confirmed changes in the Last Expense Benefit, the Ex-Gratia Management Framework, Overseas Treatment and In Vitro Fertilisation.
SHA, KNUT and MoH confirmed that each teacher will be entitled to a Ksh300,000 last expense benefit.
“A prompt and seamless claims process has been established. This benefit is confirmed and payable at a rate of Ksh300,000 upon the demise of a principal member,” the statement read in part.
The tri-patriate team disclosed that all initial 160 claims had been fully processed and payments would be remitted to their next of kin on Wednesday, April 29.
The parties also agreed to establish an ex gratia management framework to protect teachers facing catastrophic health financial burdens that exceed standard medical limits.
“Teachers can formally request extra-gratia considerations in writing. TSC will finance, receive, vet and route these requests, while SHA will execute the payment of the approved compassionate claims,” the statement continued.
SHA has also approved overseas treatment for teachers to receive specialised and life-saving interventions. The Authority also listed 10 facilities overseas which accept SHA.
These facilities include five hospitals in Turkey, three in India, and two in Saudi Arabia and one in the United Arab Emirates.
Additionally, SHA, MoH and KNUT directed the immediate withdrawal of tariff locking in the system pending the conclusion of comprehensive negotiations with healthcare providers.
This will stop teachers from paying out of pocket when accessing medical care using SHA.
“Crucially, in this interim period following the withdrawal of the locked tariffs, all health facilities offering POMSF services are strictly prohibited from charging any teacher out-of-pocket fees or co-payment,” the joint statement declared.
SHA stated that it intends to complete negotiations with the healthcare providers within four weeks. The negotiations will target all Level 3, 4, 5 and 6 private and faith-based health facilities across the country.
The three bodies also agreed to remove operational bottlenecks that required teachers to travel to Nairobi by reactivating SHA and KNUT county structures.
The resolutions came after teachers expressed frustration over accessing medical care under SHA.
They claimed that the benefits had been reduced and that, in some cases, they were turned away from medical facilities that do not accept SHA.
