The government is on a collision course with teachers over the medical insurance cover even as it moved to streamline some of the areas of concern including claims that some facilities overcharging those seeking treatment.

The Teachers Service Commission (TSC) and Minet have also moved to avert an imminent strike by teachers, particularly those from the North Rift and reinstated some of the hospitals that had been struck off the panel of medical service providers.

Minet had removed Reale, Life Care and Top Hill hospitals in Eldoret from the list of facilities licenced to tend to teachers under the scheme and as such limited them to only one hospital within the town.

At a meeting with the teachers in Eldoret, the insurer also agreed to reduce the number of facilities designated as referrals to 17 so as to ensure teachers can directly seek medication from as many hospitals as possible.

Even with those 17 facilities designated referral hospitals, teachers can still walk in for primary care treatment. The 17 referral facilities are under Levels 4, 5 and 6.

“The referral process has only been streamlined to ensure that those specialised reviews, tests, procedures or medications are promptly referred to the appropriate hospitals,” a statement by the Teachers Medical Scheme Consortium said.

The Consortium led by Minet, comprises Bliss, Maki, Old Mutual, Britam, Pioneer Insurance and CIC group, among others.

In a bid to calm the restless teachers, a warning has been sent out to facilities found overcharging or inflating hospital bills that they would be removed from the panel.

Equally hospitals have been stopped from offering services, in particular admissions, to teachers without preauthorisation to stop the trend where some facilities have been invoicing teachers for services not rendered.

Preferred facilities
The facilities have also been instructed to ensure that the final bill incorporates costs for drugs and other charges, unlike before where teachers have been charged costs for drugs separately.

On Tuesday, the Kenya National Union of Teachers (Knut) and the Kenya Union of Post-Primary Education Teachers (Kuppet) had threatened to mobilise their members on a go-slow after the alleged healthcare access crisis left thousands of teachers unable to receive medical care at their preferred facilities.

According to the union leaders, teachers have not been able to access treatment after their insurance provider reduced the number of accessible healthcare facilities.

The unionists claimed that their members had been restricted from accessing health care in facilities that lack adequate equipment and fail to meet the standards of Level 4 and Level 5 hospitals, potentially compromising the quality of care they receive.

On Monday, hundreds of teachers, led by Knut and Kuppet representatives, marched to Minet’s North Rift offices in Eldoret. They were demanding immediate resolution to the healthcare disruption that has particularly affected those with chronic conditions.

The teachers expressed their frustrations over the withdrawal of services, stating that teachers are enduring hardships.

“We have teachers suffering from diabetes and other chronic illnesses who can’t access their regular doctors because of arbitrary directives from our insurer,” stated Rose Cheboi, Uasin Gishu Women Representative.

The unions observed that the government provided this insurance to cater to their needs, but the monopolistic approach being implemented was objectionable.

Under the earlier arrangement, Minet is said to have limited of particular facilities that teachers were allowed to visit for primary health care while designating several of the facilities as referrals.

Returning allowances
“Teachers must be allowed to visit any health of their choice be it Level 4, 5, or 6 without being taken through the process of being referred to the facilities. We cannot allow this to happen,” Kuppet Assistant National Treasurer Ronald Tonui told the People Daily last evening.

Tonui said TSC should also consider either reinstating the medical allowance it had removed from the teachers’ payslips or exempt them from deductions for the Social Health Insurance Fund (SHIF).

According to him, removing the allowance from the payslips while deducting SHA from teachers amounted to double taxation.

He also urged TSC and Minet to streamline hospitals reimbursement since their delay to remit the money to the facilities has always led to teachers being denied treatment.

“The TSC and Minet must ensure that service providers are paid promptly to ensure seamless delivery of service to teachers. At the moment, hospitals accredited to treat teachers are owed Sh1 billion in arrears,” Tonui said.

Tonui said TSC needs to relook at the Minet cover afresh to protect teachers from the suffering their go through whenever seeking treatment.

Reached for comment, Knut Secretary General Collins Oyuu assured the teachers that all their concerns are being addressed by TSC in consultation with the teachers.

“One of the good news is that all those facilities that had been removed from the panel have been reinstated. We had a successful meeting in Eldoret where most of the complaints were addressed,” Oyuu told the People Daily.

On his part Kuppet chairman Omboko Milemba said the union would issue a comprehensive statement on the matter today.