Minet gives directive after delisting thousands of teachers’ dependants.

As published on arena.co.ko on February 19th 2022

The teacher’s insurance service provider, Aon Minet, has suspended thousands of teacher’s dependants for lacking required documentation.

Teachers’ dependants include wife or husband and children. Teachers are allowed to register up to four children under the cover.

“Dear Mwalimu, kindly not that the KELVIN, listed as your dependant has been deactivated from the hospital system. Please contact us on 1528 or 0730604000 to avoid inconveniences while accessing cover. Upload documents via https://collaborationkenya.minet.com/tsc,” reads a text message sent to teacher jane Wambia in Taveta.

According to Aon Minet teachers affected failed to upload required documents that would serve as evidence for their dependants listing.

However, the insurance officials say the teachers only need to upload required documents to support their dependants for them to be reinstated in the hospital system.

For spouse, a teacher is required to upload the national ID card and a marriage certificate. Those lacking marriage certificate can apply to get a sworn affidavit which they can use instead.

For children recently born, a birth notification can be used. Teachers can upload birth certificates for older children. Those with eighteen years and above must be in colleges and universities to be supported and their college or university ID must be uploaded.

Early this month, Aon Minet issued new terms for its teachers and dependants seeking medical services in various facilities beginning 1st February 2022.

Teachers who want to change their dependants can only do that once a year and only at the end of the policy year.

Among the new rules, Aon Minet, which covers more than 300,000 teachers on Teachers Service Commission (TSC) payroll, said it will no longer use code verification in all facilities it listed.

The insurer said it will use biometric verification for teachers and their dependants in its medical service providers to curb unethical practices.

Minet also said referrals will be through TSC offices, Bliss hospitals or referral and teaching hospitals if one needs a specialized check-up.

Aon Minet sent short messaging services to teachers informing them of the changes it planned to roll out.

“Dear Mwalimu, expect changes to the panel of service providers from 1st Feb 2022. Dial *202*06# or visit the link https://bit.ly/TMServiceProviders to view the updated list for year 2022”, reads the SMS sent to teachers.

The medical cover cost TSC Sh9 billion in 2019, Sh 12 billion in 2022 and Sh 14 billion last year.

Two months ago, Aon Minet blacklisted at least 20 hospitals for engaging in unethical practices, exposing dubious ways the health facilities use to defraud the multibillion-shilling teachers’ medical scheme.

Teachers and their dependents also came into sharp focus as it was revealed that they collude with hospitals to fleece the TSC of the insurance cover.

The vices ranged from making fake claims, overcharging members, listing fake ailments to impersonation.

A brief by Minet Kenya, the firm contracted by TSC to manage the scheme, listed at least 10 ways that teachers, their dependents, and hospitals use to fleece the scheme.

They include impersonation, billing for services not rendered, billing for conditions not covered under the scheme, double billing of medical expenses and falsification of the length of stay of patients in hospitals.

Incorrect reporting of diagnosis or procedures, false and unnecessary prescription of drugs, abnormal utilisation of services, bribery and unethical inducement are also ways used to cheat.

In addition to these, Minet Kenya Chief Executive Sammy Muthui said many facilities have been blacklisted and others presently put under investigations for abusing the seven-day-rule. Under this rule, Muthui said if a patient is treated for a condition and within seven days returns to the hospital to be cared for over the same ailment, they should not be charged.

“The member should never be asked to pay out of pocket. But we have had cases where this rule has been breached and patients asked to pay money or turned away. This is fraud and we take it seriously”. He said.

AON MINET BENEFIT STRUCTURE FOR TEACHERS

Below are benefits teachers get from the Aon Minet cover.

INPATIENT BENEFIT

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

  • … (read full list in article)

OUTPATIENT BENEFIT

This is 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::

  • … (read full list in article)

MATERNITY BENEFIT

The benefits under this cover include but are not limited to:

  • … (read full list in article)

NB: The maternity benefit is available to principal members and/or their spouse only.

DENTAL BENEFIT

The benefits under this cover include but are not limited to::

  • … (read full list in article)

OPTICAL BENEFIT

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

  • … (read full list in article)

GROUP LIFE BENEFIT

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

  • … (read full list in article)

NB: “payment will be made to a valid account number held in a registered commercial bank”.

LAST EXPENSE BENEFIT

This benefit is payable to the next of kin upon the demise of a principal member mainly to cater for funeral expenses. It is payable within 48 hours subject to confirmation of the Next of Kin and upon provision of the following documents:

  • … (read full list in article)

Chief’s letter in case the deceased had not declared their next of kin. NB: Submission of Group Life and Last Expense Claims must be done within 12 months after which it will not be payable.

PSYCHIATRIC AND COUNSELLING SERVICES

Provision of Psycho-social support programs for employees for conditions such as chemical dependency, stress, post-traumatic counselling, relationship difficulties, anxiety and depression, parenting, legal or financial distress etc. services will include but not limited to:

  • … (read full list in article)

SCHEME EXCLUSIONS

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

  • … (read full list in article)

PRINCIPAL REGISTRATION

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 our 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.

DEPENDANT REGISTRATION

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 Relation, full names, Disability status, Date of birth, ID number if you are over 18 years old.

After successful registration, the member will receive a link to complete the registration process: https://collaborationkenya.minet.com/TSC

If not successful, kindly contact us on our call centre hotline number 1528 for further assistance.

PROCEDURE FOR ACCESS TO MEDICAL COVER UNDER THE SCHEME

Members of the Teachers’ Medical Scheme can access any of the service providers on our panel countrywide. This list is accessible via USSD code *340# or Minet/TSC website.

Step 1:

Present yourself at the service provider on our active panel

Step 2:

Identify yourself or your dependant with the TSC number

Step 3:

The service provider will generate an SMS that contains a One-Time-Pin (OTP), sent to the principal member’s registered mobile number.

Step 4:

You will present this OTP to the service provider representative to register the fingerprints.

Step 5:

You will be requested to place a finger on the biometric device and the impressions will be saved against your membership record.

On successful registration the member or dependant can access medical services.

NB: Children under 5 years of age will be registered under either the parent or an appointed guardian

MEDICAL FACILITIES

Direct Facilities: these are primary care facilities that members can access directly without the need of a referral letter.

Referral facilities: these are facilities that offer medical services for cases that require specialised treatment. A referral letter from a direct facility is required to access medical services in these facilities.

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