Summary of TSC Minet Nairobi County Governance Meeting Held on 15th October 2020

A meeting organized by TSC Minet Nairobi county was held at the Minet headquarters on Thursday 15th October 2020. In attendance were KUPPET Executive Secretary, Nairobi county, TSC representative, and Bliss representatives. Here are the details of the Minet meeting concerning the TSC AON Minet teachers insurance scheme:

1) INTERNATIONAL TREATMENT

There is a benefit of 1 million Ksh. for overseas treatment and 200,000/= for travel that is separate from inpatient cover.

Read more details at Teachers AON Minet Insurance Medical Scheme Details.

2) LAST EXPENSE AND GROUP LIFE

This only caters for the Principal Member and specific documentation and processes must be met.

3) BALANCE ON MEDICAL COVER

Medical Administrators Kenya Limited (MAKL) is a member of the consortium with Minet. MAKL shall provide balances when the cover for outpatient, dental and optical deplete to 50%.

Teachers are advised to demand for medical history/report and bill whenever treated.

Teachers are also advised to monitor billing and balances upon treatment under the insurance scheme.

4) SUPPLEMENTS

• “Good to have prescriptions” are not honoured by Minet
• Prescriptions for treatment of diseases e.g. Calcium for goitre, are honoured
• Minet shall look at the ripple effect and advise.

5) APPROVAL OF PRE-AUTHORIZATIONS

 a) Causes of delay

• All bills are payable net of NHIF
• Doctor’s reports on case notes and discharge notes
• Compiling of bills
• The insurance handles cases on a first come first serve basis; the TSC scheme covers over 1 million lives
• The insurer may request further details on a case.

b) Reducing Response Time

MAKL to make direct calls to health facilities when seeking further details on a patient.

6) OPTICAL SERVICE

• Teachers concerned should channel specific complaints to MINET directly
• Ophthamological (or eye infections) are handled at LIONS
• Quality frames and lenses can be obtained by committing the entire or a large proportion of the cover.

7) ISOLATION OF TEACHERS AT NAIROBI WEST HOSPITAL

AON Minet postulated that initial intentions were in the best interest and all those using insurance are isolated.

However, Minet shall look at how best teachers can be served at the facility.

8) ATTITUDE OF STAFF IN SOME HEALTH FACILITIES

Teachers should report cases whenever health staffs handle them with negative attitudes.

9) DENTAL SERVICES

• MINET shall take good care of teachers in regard to dental services
• Teeth lost in an accident during the policy are replaced and service paid for
• Replacement of teeth lost in any other way other than accident is excluded.

10) IMPROVED COMMUNICATION

MINET shall regularly update its website. Bulk SMS and Instagram shall be used to reach teachers.

11) SPECIAL NEEDS CHILDREN

Physiotherapies are available at Aga Khan on referral.

12) SPECIALISED TREATMENTS

Gynaecological, neurological, and other specialized services reside in specific health facilities. This helps minimize the cost of treatment for teachers unlike when specialists are sourced independently.

These services can be obtained as outpatient or inpatient.

13) CANCER TREATMENT

Brachytherapy and Hormonal therapies are available at Nairobi Hospital. Different types and stages have different treatment costs; costs are very expensive.

Members should approach Minet to intervene in negotiating the cost. NHIF however supports cancer treatment.

14) GENERIC VERSUS ORIGINAL DRUGS

Prescription by a doctor may be different from the supply given at the pharmacy because the doctor may not have full knowledge of the drugs available in the stores.

Generic is preferred as the first form of treatment. In the event that the patient doesn’t respond, the original drug is provided.

Consistent use of the strong original drugs wastes the body and original drugs are very costly and deplete the medical cover fast.

Generic is not counterfeit.

NOTE:

GERTRUDE HOSPITAL

Outpatient services at this facility are suspended and Minet shall inform members when the outpatient services resume. However, inpatient services are active.

Also read:

1. TSC AON Referral Hospitals
2. AON Teachers Dental Service Hospital Providers
3. AON Minet Kenya Teachers Medical Cover
4. How to Register for TSC AON Minet, Add Dependents and Check Details
5. List of NHIF Services in Kenya, NHIF Supa Cover Products and Services
6. How to Register for Self Employed NHIF Membership in Kenya