Teachers’ medical scheme expands with 17 newly designated referral hospitals

Teachers can now seek specialised medical services at 17 newly designated referral hospitals under their medical scheme.

Medical Administrators Kenya Limited (MAKL), which manages the scheme, announced on Wednesday that the move was made in collaboration with the Teachers Service Commission (TSC) to enhance the referral system and improve healthcare access.

Despite the changes, MAKL assured that teachers will still be able to receive treatment at primary healthcare facilities. This comes as teachers are protesting a healthcare access crisis that has left many unable to receive treatment at their preferred facilities.

MAKL, which administers the teachers’ medical scheme, revealed the introduction of 17 designated referral hospitals as part of efforts to streamline healthcare services.

In a statement, the company explained that this decision was made in consultation with the TSC to enhance the referral management system and broaden access to specialised care countrywide.

“Encouragingly, while these 17 facilities have been converted into referral hospitals, members still have access to care at primary healthcare facilities,” MAKL said.

The move follows concerns raised by teachers regarding adjustments to the panel of medical facilities under the TSC medical scheme.

Reports had surfaced of teachers being turned away or being required to get referrals before receiving treatment. However, MAKL clarified that only 17 hospitals nationwide have been designated as referral facilities after consultations with the TSC.

The decision aligns with national protocols for Level 4, 5, and 6 hospitals, which are equipped to provide specialised services, tests, procedures, and medications.

“The referral process has only been streamlined to ensure that those requiring specialised care are promptly directed to the appropriate hospitals,” MAKL said.

While the referral hospitals have been redefined, the medical scheme panel still includes 800 healthcare facilities across all counties and sub-counties in Kenya. Of these, only about 60 operate on a referral basis, meaning over 740 facilities will remain open for walk-in access.

The panel consists of a diverse mix of private, faith-based, and public hospitals, each offering various contracting protocols to accommodate the healthcare needs of teachers.

“Minet reassures all teachers under the scheme that they can continue to access services from accredited medical providers within the scheme,” MAKL said.

Launched in 2015, the Teachers’ Medical Scheme provides comprehensive health coverage for teachers and their families, offering access to quality healthcare. Since its launch, it has become the largest medical scheme in Eastern and Central Africa.

Currently, the scheme includes 146 public hospitals, 133 mission hospitals, and 63 anchor clinics run by Bliss Healthcare, along with 487 private hospitals under the panel.

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Members of the scheme can access inpatient, outpatient, dental, optical, and maternity services at these facilities.

The scheme is managed by a consortium led by Minet Kenya Insurance Brokers Limited, with six insurance underwriters providing coverage: Old Mutual, Britam, CIC Insurance, Pioneer Insurance, Star Discover General Insurance, and Star Life Insurance.

MAKL, as the medical administrator, oversees the contracting of service providers and processes payments.

Additionally, Bliss Healthcare acts as the master capitator, managing 63 clinics and handling third-party partnerships to extend coverage in areas where Bliss facilities are unavailable.