Are teachers` children medical cover in limbo?
Introduction
Most of the teachers in Kenya have more than four children. This means that they will be forced to leave some of their children uncovered in the insurance medical scheme, especially those employed by TSC.
Information from MiNET Kenya
MiNET Kenya Insurance is the one offering medical cover for teachers employed by TSC. It directs that the principal member can only have a maximum of five dependents.
The five dependents are one legal spouse and four children. This is a clear indication that, thousands of teachers’ children in Kenya will not be insured in the medical cover. So, if the teacher has more than four children, he/she has to choose only four and leave the rest.
MiNET Kenya Insurance Management via- Sammy Muthui has explained that; in cases where teachers are married to each other, the limit of insurance medical coverage is eight children. The husband is dependent on his wife`s benefits and the wife is dependent on her husband`s benefits.
For example, let us say; I and my wife are teachers. If we have four children and are dependents on my benefits and also dependents on her benefits, that is double coverage. If we have four children as said, we should divide them or agree under whose benefits they should be. This was elaborated by Sammy Muthui, in a media forum which was held in Nairobi.
Teachers, who are married to each other, can have up to eight children in the medical cover scheme. Â This is because; four can be under the husband`s benefits and four others under the wife`s benefits. Therefore, teachers who are not married to each other and have more than four children, have to make tough choices. They have to select the four who will be in the medical scheme and those who will be left out.
This is a requirement by the Salaries and Remuneration Commission (SRC) for the public sector employment act. It caters for one spouse and four children.
Who are considered as dependents by MiNET Kenya!
- MiNET Kenya covers children from 0 – 18 years old. This is the age bracket still under parental care. The documents required in this case are; a birth notification for 0-6 months, a birth certificate, a proof of guardianship or legal adoption papers for adopted children, aged 7 months to 18 years.
- The scheme also covers children aged 19 -25years. This age bracket is assumed to be in school. In such a case, documentary evidence of one being in a learning institution is provided, for one to access the medical benefits.
- Children dependents with disabilities. In this case, there is no maximum age limit. If the children with disabilities are above 18 years, documents needed are a birth certificate and a disability card from the Association for the Physically Disabled of Kenya (APDK).
NOTE: –  a lot is covered under MiNET medical scheme, but  it does not include cosmetic treatments, self-prescribed treatment, experimental treatment, costs already catered for by another insurance company and reimbursement costs, unless in cases of an emergency and notified to the insurance, within 24 hours of admission and maternity for children dependents.
–Â Those seeking medical services under MiNET Kenya insurance cover will not be subjected to daily limits for outpatient services. The service providers have been instructed to provide all the services required as per the diagnosis and the process of treatment. This has been strengthened; hence there is no rule which will limit the number of visits which will be made by patients seeking medical care.
Conclusion
Minet Kenya is determined to safeguard member benefits. These are public funds which should be guarded against fraudulent activities. In connection to that, each medical service visit should be preauthorized. This is necessary to ensure that the patient is not overcharged for medical services and that a member has the required limit.
Are teachers` children medical cover in limbo?