The Teachers Service Commission says prayers by 12 teachers seeking to halt the signing of a contract for medical insurance have been overtaken by events since the new contract came into force on December 1, 2022.
The contract with Minet Kenya Insurance Brokers Limited to provide health insurance to over 341,000 teachers on the TSC payroll plus thousands of others the commission plans to hire will run from December 1, 2022, according to documents filed in court by Julius Olayo, director of human resource management and development at TSC.
It is worth Sh53.3 billion, up from the previous one that was worth Sh27 billion.
Under the contract, some 359 health facilities across the country have been identified to provide medical services.
Dr Olayo argues that the petitioners should have sought redress from the Procurement Review Board. “To the extent the prayer to quash execution of the contract between TSC and Minet and a declaration that the procurement process was opaque is not only overtaken by events but it is also outside the jurisdiction of the court,” he says.
Dr Olayo says during the first year TSC shall remit Sh14.9 billion to Minet. In the second tranche, a sum of Sh17.9 billion shall be wired to the insurer. The last batch of Sh20.6 billion which will be handed over to Minet.
Sh53.3 billion cover
“The Sh53.3billion cover is for 341,847 teachers and their dependants for outpatient, inpatient, dental, optical, funeral expenses, air and road evacuation, international travel and referral allocations and access over loss services,” Dr Olayo explains in response to a petition by 12 teachers over the quality of services by the insurer.
However, teacher interns that the commission has been engaging since 2019 are not covered in the scheme.
Dr Olayo says the contract was reached together with other consortium members with TSC playing the role of lead consortium member comprising Bliss Health Care Limited, Medical Administrators Ltd, Old Mutual General Insurance Ltd, Britam General Insurance, CIC General Insurance, Star Discover Insurance Limited, Pioneer Assurance Company Ltd and Star Discover Life Insurance Ltd.
TSC says due to budgetary allocations from the national assembly towards the medical cover, it could not fully support the scheme with payments of premiums as stipulated under the Insurance Act.
The allocated funds were, therefore, channeled towards provision of the core medical services rather than procurement of smart cards which have potential of financial expenses.
“The primary purpose of the smart card is to facilitate its identification of members,”
The teachers had complained they were being asked to send a text message to Minet for identification before they could be treated. They are asking the court to compel Minet to furnish them with smart cards.
The petitioners say they have been forced to finance their treatment yet Minet has been paid billions to offer services.
To avoid abuse of the health scheme, TSC has negotiated a fee of Sh100 as co-pay per outpatient visits. Under the new contract, TSC says the health provision services have been enhanced.
Minet through its general manager Edwin Kegode has opposed the cancellation of the multi-billion health insurance contract.
Mr Kegode says Minet experienced problems in verification and identification of the patients through the messages sent.
Greatly prejudiced
“There was over one million lives covered under the scheme and there may have been some challenges under the former contract,” says Mr Kegode.
Minet lawyer Wilson Mwihuri has opposed the 12 teachers being represented by more than one lawyer saying chaos and confusion will reign.
“Minet shall be greatly prejudiced if the petitioners are represented by multiple sets of counsel as the claim will be presented in a manner that is likely to cause chaos and confusion,” Mwihuri.
He claims the case is an academic exercise since a new contract is inforce.
However, Justice Matanga allowed the teachers’ lawyer to file evidence answering the issues raised by TSC and Minet within 10 days from December 15, 2022. He fixed the hearing for January 17, 2023.
The 12 teachers who filed the petition have alleged to have been threatened with sacking and transfer by top officials national of the Kenya National Union of Teachers for suing their employer.
The union is not party to the suit.
