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.
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
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
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
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.