Teachers, the Social Health Authority (SHA), and the Ministry of Health have reached a landmark agreement to address persistent medical scheme issues and prevent a nationwide teacher strike.
The agreement, finalized during high-level discussions between the ministry, SHA, and the Kenya National Union of Teachers (KNUT) on April 28, tackles operational challenges that had complicated the shift from Mwalimu Cover to the Public Officers Medical Scheme Fund (POMSF).
In a unified statement, the three organizations underscored their dedication to protecting teacher health and well-being, unveiling several binding measures intended to ensure uninterrupted medical access nationwide.
Key among these measures is the complete reinstatement of the Last Expense Benefit, featuring a simplified claims procedure. The benefit has been established at Ksh300,000, with 160 outstanding claims already processed and beneficiary payments set to commence from April 29.
Simultaneously, the agreement establishes an Ex-Gratia Management Framework to assist teachers with medical costs exceeding standard coverage boundaries.
Under this structure, the Teachers Service Commission (TSC) will handle applications, while the SHA will manage payments for approved compassionate claims.
The medical scheme has expanded to include specialized hospitals in India, Turkey, and Saudi Arabia, providing teachers with broader international healthcare options.
Teachers will gain access to improved reproductive healthcare services, with In Vitro Fertilization (IVF) treatment now available at selected facilities, enhancing coverage to better address varied health requirements.
In a significant policy change, SHA has committed to immediately removing tariff restrictions within the system, a measure previously met with strong opposition from educators.
Throughout this transition period, all participating healthcare institutions have been instructed not to impose additional charges on teachers.
“To ensure healthcare systems support rather than hinder teachers, SHA will promptly eliminate the tariff restrictions currently embedded in the system. Tariff limitations will only be applied after thorough negotiations are completed and exclusively with healthcare providers,” the joint statement noted.
To maintain long-term viability, an initiative targeting over 3,500 private and religious healthcare institutions has been launched. This four-week process seeks to standardize expenses while maintaining quality healthcare standards.