Teachers AON Minet Insurance Medical Scheme Details

The Teachers Service Commission has contracted AON Minet to provide medical cover to all teachers under TSC for the period 2019 to 2022.

The latest guidelines released by the TSC for AON Minet insurance for teachers reveal members benefits pegged on their respective job groups. The scheme benefit structure is as shown in the image above.

For one to be eligible, he/she must be a practicing teacher and aged between 18 and 65 years.

A maximum family size of Six (6) is permitted, comprising of the principal member plus five dependents.

AON Minet Insurance Outpatient Co-Pay

When you visit an accredited outpatient facility, you have to pay a co-pay fee of ksh. 50 per visit for outpatient, dental, and optical services. This is chargeable per every individual requesting for AON services per each visit.

However, the co-pay is not charged for maternity and related conditions in repeat visits for services accessed within 7 days from the date of the previous visit, and when picking medication for chronic conditions that may not require consultation with a doctor.

Also Read: How to register AON dependents

AON Minet Insurance Scope of Cover

The TSC AON medical cover includes inpatient, outpatient, dental, optical, maternity, local, and international medical emergency evacuation.

AON Minet Insurance for Teachers Outpatient Benefits

This is the treatment that does not require admission or stay in a hospital or day care. The outpatient benefits include but not limited to:

Routine outpatient consultations.
Prescribed Diagnostic Laboratory and Radiology services (X-ray, ultrasound, MRI, and CT Scans).
Prescribed physiotherapy
Prescribed drugs and dressing.
Referral Outpatient to specialists.
HIV/AIDS-related conditions and prescribed ARV’s to the full cover limit per family per annum.
Newly diagnosed chronic conditions
Pre-existing chronic conditions (including cancer)
Pap smear for ladies and PSA for men- (for principal members only)
Medical Emergency Road ambulance evacuation services.
Rehabilitation service as per limits
Preventive care: to include free Medical camps, Mobile Clinics for events, counseling on
lifestyle and wellness
Prescribed preventive and curative drugs/care (Including pressure stockings and clinical
corset belt)
There shall be portability with no restrictions to the panel of medical providers. Teachers are free to visit any medical service provider within the Country within the list of accepted hospitals.

AON Minet Insurance for Teachers Inpatient Benefits

This is a treatment that requires admission in and stay in a hospital or day care surgery/ procedure. The benefits (paid after subtracting NHIF rebates) under this cover include but not limited to:

Bed entitlement: Job Group B5 to D2 (Standard ward bed) and Job group D3 to D5 (Standard Private Wing),

Doctor’s (Physician, Surgeon & Anesthetists) Fee.
ICU/HDU/Critical care and theatre Charges
Drugs/Medicines, dressings, and internal surgical appliance
Pathology/Laboratory
X-ray, Ultrasound, ECG and Computerized Tomography, MRI Scans
Radiotherapy and Chemotherapy
In-Patient Physiotherapy, Hydrotherapy
Occupational therapy
Hospital accommodation for accompanying parent and /or guardian for hospitalized children below seven (7) years
Medical education and wellness program for members with pre-existing and chronic conditions
Medical Emergency Road evacuation services leading to admission
Congenital defects/genetic disorders
Post- Hospitalization benefit of up to two (2) weeks for other sicknesses and six (6) weeks for accident cases after discharge.
Day care Surgery for minor surgical treatment that may not require admission
In-vitro Fertilization (IVF)
Renal dialysis
Cancer Treatment and related procedures and tests

AON Minet Insurance for Teachers Maternity Benefits

The maternity benefit is available only to the principal member and/or spouse.

Benefits under this cover include but not limited to:

Delivery/ Doctors Fees
Routine Antenatal check-up
Postnatal care up to six (6) weeks post-delivery
Routine Immunizations (KEPI) and Baby-Friendly Vaccines
1st emergency cesarean section, subsequent elective CS and normal delivery
Pre-maturity/Pre-term
Congenital conditions

AON Minet Insurance for Teachers Optical Benefits

Benefits under this cover include but not limited to:

Cost of lenses and frames- members who have obtained frames will not be entitled to a replacement within one year unless necessitated by a medical condition and prescribed by an ophthalmologist.
Prescription for ophthalmic treatment and eye lenses
Ophthalmic ultrasound if prescribed by the Ophthalmologist

AON Minet Insurance Dental Benefits

Benefits under this cover include but not limited to:

Dental Consultation and Anesthetist’s fees
Dental X-rays and Root canal treatment.
Tooth Extraction
Scaling necessitated by prevailing medical conditions and prescribed by a dentist
Dentures necessitated by an accident/ injury
Deformation surgery

Psychiatric and Counselling Services

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

Psycho-Social tele-counseling services through the Minet Tele-counselling center.
On-site counseling services in some special instances

Referral for face to face counseling by a specialist.

International Travel and Referral Allocations

This will be paid out where authorization has been granted for the member to travel to another country for specialized treatment which is either not available locally or is reasonably cheaper and better quality than is locally, air ticket for patient and aide, and their accommodation. A medical referral report shall be required to facilitate overseas treatment.

All requests for specialized treatments outside Kenya shall be approved by the Director, Medical Services in the Ministry of Health.

Medical Emergency Road and Air Evacuation Benefits

This benefit allows for emergency transportation and transfer of sick or injured members or dependents from a place of incident or facility with inadequate care to the appropriate facility using road ambulance, fix-wing, and helicopter services within East Africa (Kenya, Uganda, Rwanda, and Tanzania). Air evacuation will be limited to two (2) per family per annum within the policy period.

Medical Scheme Exclusions

TSC AON scheme does not cover the following:

Active participation in war, invasion, riots or terrorism
Cosmetic treatment unless relating to an accident
Massage (except where certified as medically necessary)
Nutritional supplements unless prescribed by a doctor as part of the treatment of a deficiency
Maternity cover for dependent children
Self-prescribed drugs
Treatment other than by a registered medical practitioner
Outpatient, dental and optical co-pay of fifty shillings on each visit
Reimbursement of costs incurred outside the appointed panel of providers unless for emergency cases, accident cases and on pre-authorization
Private vaccines and travel vaccines
Alcohol-related rehabilitation
Maternity for child dependants
Cost of lenses and frames not prescribed by an Ophthalmologist
Replacement of spectacle frames within the same year of cover.
Photochromatic and/or antiglare lenses unless prescribed by a doctor
Cosmetic dental care Cosmetic Crowns, Caps, Bridges, Orthodontics & Dentures, self-prescribed teeth cleaning and whitening, unless necessitated by
Infertility investigation and family planning procedure expenses
Replacement or repair of old dentures bridges and plates unless damage to dentures, bridges, and plates becomes necessary as a result of an accident
Treatment otherwise covered by NHIF

GROUP LIFE AND LAST EXPENSE (FUNERAL) COVER

a) Last Expense Benefits

The Last Expense (Funeral) cover provides a fixed amount graduated per grade and payable only in the event of death of the principal member to defray funeral expenses.

b) Group Life Benefit

A fixed amount to be paid graduated according to grade as per the table of benefits above. This will be a benefit rider under the Health Care Medical Scheme.

AON Minet Insurance for Teachers Service Providers

The list of Minet medical service providers can be accessed on the TSC website or Minet website.

TSC Replacement of Teachers For Public Primary and Secondary Schools – September 2020

Members can also view a full list of medical service providers through:

TSC and MINET Kenya websites
Use of Mobile phone USSD code – dial *340#

Teachers and their dependants are required to access medical care services only from the approved panel of service providers. The Administrator shall not reimburse costs incurred outside the appointed panel of providers except for emergency cases.