As published on businessdailyafrica.com on August 26th 2025
Access to services and fraud emerged as major concerns that plague the medical insurance cover for teachers as the contract between the Teachers Service Commission (TSC) and Minet Kenya nears expiry on November 30, 2025.
Minet Kenya said that while the majority of its network hospitals – about 95 percent – remain operational and accessible to teachers, some facilities have been temporarily suspended following investigations into fraudulent or unethical practices.
A consortium led by Minet Kenya has twice won the tender to provide medical insurance cover to all the teachers employed by the TSC.
General manager for Managed Medical Care at Minet Kenya, Edwin Kegode on Tuesday defended the overall operations on the teachers’ medical scheme, acknowledging that there are gaps in its implementation.
“We are aware of concerns around access and reports of fraud in some facilities. While these cases are isolated, we are taking them seriously and have suspended certain hospitals pending investigations to protect teachers and ensure integrity in the scheme,” said Mr Kegode.
He noted that pre-authorisation, often raised as a concern by teachers, is a standard global practice that ensures administrative oversight before medical services are provided. He added that this process helps prevent misunderstandings or disputes between members and medical service providers, ensuring that services are properly coordinated and approved in advance.
“Delays in pre-authorisation can affect access to care. When a beneficiary visits a hospital and admission is required, patients are often asked to provide documents themselves instead of the hospital submitting them. Sometimes hospitals do not provide all the necessary information, which can slow down decisions and create the perception that the process is subjective,” Mr Kegode explained.
The medical scheme, covers close to 1.4 million lives across the country, making it one of the largest in Kenya.
Further, the official explained that most pre-authorization requirements for medical procedures have been reduced to streamline access.
He noted that in some cases, teachers may request admission for a procedure, but the documentation provided initially does not clearly justify the need.
“However, under the teachers’ scheme, we have scrapped a lot of the need for pre-authorisation. Previously, some of the complex outpatient services required pre-authorisation, so there is no form of pre-authorisation of all of the patient services. You also extend that to include services in this study…Those that may go beyond could be as a result of requiring additional information,” he said.
However, he said, concerns over teachers paying out-of-pocket have been addressed, with the scheme eliminating the upfront or co-payment component. He noted that teachers encountering service providers demanding direct payments are encouraged to report them, with action taken against non-compliant providers.
“There could be other situations where teachers walk into a hospital or their dependents go into a hospital, and they are asked to pay out of pocket. One of the things that we did on this scheme is to scrap off any form of co-payment, which is a feature you will find with many other schemes. This scheme does not expect any teacher to dependent to pay out of pocket. Should you encounter a service provider that requires payment directly to the hospital, we have put our lines open so you can report that provider, and appropriate action will be taken against them,” he said.
The medical scheme, covers a staff complement of over 400,000 teachers, translating to about 500,000 families. In total, the scheme covers close to 1.4 million lives across the country, making it one of the largest in Kenya.
Mr Kegode outlined that several areas where Minet Kenya plans to improve the teachers’ medical cover, in case it is awarded another tender. He said that the scheme will address concerns from younger teachers that lower cadres receive lower mortality benefits compared to higher cadres.
“We are aware of concerns from our younger teachers regarding mortality benefits. We are exploring options to make the death-in-service benefits more equitable across all ranks. We are also considering reintroducing the death-in-service benefit to provide financial support to families of deceased teachers, ensuring that they are not left vulnerable,” he said. Mr Kegode further noted that enhancing communication with teachers is a priority. “It is important that teachers are fully aware of the services available to them,” he added.
