Kenya Insights

Tag: AON Minet CEO Sammy Muthui

  • Teachers Have Given Birth To 80,000 Babies In Five Years

    Teachers Have Given Birth To 80,000 Babies In Five Years

    About 80,000 babies have been born under the teachers’ multibillion-shilling medical scheme in the last five years.

    The teachers are entitled to a maternity cover of between Sh100,000 and Sh200,000 annually. Maternity cover was previously capped at Sh75,000.

    A status report of the cover also reveals details of childbearing visits and the number of births per county.

    Details of the cover also show that in cases where female teachers have fully exhausted their maternity cover, they have another pool of between Sh15,000 and Sh40,000 to draw from.

    “For the past six years, we have seen some 117,000 maternity visitations and birth across all our facilities,” said Minet Kenya Chief Executive, Sammy Muthui.

    The Teachers Service Commission (TSC) contracted Minet on July 1, 2015, to manage the medical scheme.

    Finer details in the report reveal that Uasin Gishu County leads in the number of births, with 12,251 children born since the scheme was rolled out.

    Nakuru County is second with 6,991 births as Nairobi ranks third with some 6,396 babies born.

    Bungoma County is fourth with 4,988 births as Kiambu closed the top five counties with 3,783 births.

    Other counties that have had higher births registered are Meru with 3,402, Kisumu with 2,975, Kwale (2,128), Kisii (2,119) and Embu closing the top 10 category with 2,070 births.

    Counties with the least births are Turkana with no baby born since the scheme’s inception, West Pokot has five births and Elgeyo Marakwet has seven babies born under the scheme.

    Nyandarua County has only had eight new births, Samburu 14, Wajir (88), Isiolo (100), Marsabit (174), Baringo (257) and Kirinyaga with 260.

    Among the Coast counties, Lamu has had 266 births, and Taita Taveta 278.

    Overall, the report reveals that a total of 74,595 babies have been born under the cover since 2016.

    During the first year, 2016/2017, the report shows that a total of 22,226 babies were born nationally.

    In the second year of implementation of the scheme, 16,930 babies were born during the 2017/18 year.

    And in 2018/19, the report shows that 13,532 babies were born. Another 11,157 babies were born in 2019/2020. And under 2020/21, some 10,750 babies have been born.

    “Previously, teachers earned a monthly medical allowance of between Sh954 and Sh4,412. Clearly, this was not adequate to give teachers better healthcare,” said Macharia.

    Under the enhanced cover, inpatient cover ranges between Sh750,000 and Sh2.5 million.

    The outpatient cover is now capped at between Sh100,000 and Sh375,000 across job groups. Other improved benefits are under optical cover, for which teachers and their dependents have a total of Sh45,000.

    Dental cover is presently capped at a flat rate of Sh35,000. The scheme also offers overseas treatment and transport costs for the accompanying person.

    The report shows that since the medical cover was rolled out, female beneficiaries have visited hospitals 117,000 times for maternity services.

    During the first year, only 3,968 maternity visits were recorded across the facilities. The visitations went up to 13,169 in 2017.

    In 2018, data shows that some 24,186 maternity cases were registered. A slight drop was noted in 2019 and 2020 when only 19,331 and 16,353 maternity cases were registered.

    The cases again went up to 39,503 this year, signalling a major leap in maternity cases under the care.

    “As we continue to roll out wellness programmes, we have noted that teachers are getting healthier and many are getting more comfortable to sire babies,” said Muthui.

    The wellness programme includes any activity designed to support better health and to improve health outcomes for all beneficiaries.

    “These programmes include medical screenings that aim to prevent chronic conditions; activities that also promote emotional and psychological well-being and stress management,” said Muthui.

    Overall, since 2016, teachers and their dependents have visited hospitals to seek medical care 12 million times.

    These visits include inpatient, outpatient, dental and optical treatment, and maternity and delivery benefits.

  • Teachers Hospital Visits Not Limited, Minet Clarifies

    Teachers Hospital Visits Not Limited, Minet Clarifies

    There should be no limitation in the number of times a teacher accesses medical care in approved medical facilities, insurance firm managing the scheme has affirmed.

    Minet Kenya chief executive Sammy Muthui said some service providers had misinterpreted the seven-day rule to frustrate teachers and then accuse the insurer of mishandling them.

    “We like the truth and own up when there are problems and try to solve them. Under the seven-day rule, there is no limitation to treatment… There is no limit on the number of visits but providers, because they are motivated to make more money, misinterpret the rule and then distress our teachers,” he said at a media workshop.

    Out of pocket

    Minet Kenya, Muthui said, had started taking disciplinary action against service providers who misinterpret the rule.

    He said if a member returns to the hospital within seven days for the same condition, the agreement states that the member should be attended to and the visit should not be charged to the members’ account.

    This means the teacher should never be asked to pay out of pocket. “It is rogue service providers who want to charge capitation more times than they are allowed,” said Muthui.

    “The seven-day rule should be for that incident that was treated. Even when someone is paying in cash, if you go for dressing, you do not get charged for consultation every time. We have not seen a situation where a dependent is locked out because of the seven-day rule and if there are such cases it should not happen.”

    Muthui said that in the capitation agreement between the payer and the service provider, the latter is required to provide quality services to all teachers without warranting a return to hospital for primary healthcare unless for a different diagnosis or a complication.

    “Please note that there are no daily limits for outpatient services. Based on the capitation agreement with the service providers, the service provider is required to provide all the services required as per the diagnosis and the mode of treatment.”

    Minet Kenya was contracted by Teachers Service Commission (TSC) to manage teachers’ medical scheme since 2015.

    To reach out to more teachers, Muthui said, they have been increasing the number of providers, including government hospitals, so that remote areas can be served well.

    He said the insurer is in talks with Council of Governors to allow the insurer to accredit all government hospitals though the challenge at hand is that most do no have the administrative capability to do all the online transactions needed.

    Medical allowance

    “There are cases of inadequate service providers in some areas and we have to work with what is on the ground but that does not mean we can just work with everyone. Sometimes we even blacklist some providers and have about 20 cases for service providers across the country,” he said.

    Currently, Minet Kenya works with 34 public facilities which have been added to the service providers’ panel.

    In all, there are 577 outpatient, 367 inpatient, 338 maternity, 95 optical and 154 dental service providers in all 47 counties.

    Teachers previously earned a monthly medical allowance, which ranged from Sh954 to Sh4,412.

    However, there was a policy shift to grant teachers a medical scheme to improve their welfare.

    Owing to constraints in budgetary provisions, TSC settled for a hybrid insurance model namely capitation financing model and fully insured component.

    “This scheme continues to cushion 341,760 teachers and 1.7 million households against the Covid-19 pandemic,” says the TSC.

  • How Teachers, Medics Collude To Defraud Insurer

    How Teachers, Medics Collude To Defraud Insurer

    A brief by Minet Kenya, the firm contracted by TSC to manage the scheme, revealed more than 10 ways that teachers, their dependents and hospitals use to fleece the scheme.

    They include impersonation, billing for services not rendered, billing for conditions not covered under the scheme, double billing of medical expenses and falsification of the length of stay of patients in hospitals.

    Incorrect reporting of diagnosis or procedures, false and unnecessary prescription of drugs, abnormal utilisation of services, bribery and unethical inducement are also ways used to cheat.

    Mutheu cited impersonation as one of the most unethical ways both teachers and medical facilities exploit the scheme.

    “We are talking about public funds and we have a duty to care. We have a legal and investigations department dealing with these. As we speak, many cases are under investigation and dozen others in court,” said Muthui.

    He explained that in most cases, hospitals collude with teachers to abet impersonation.

    “As we speak we have about six IVF patients who are not scheme members. This is an expensive treatment and we are presently carrying out investigations,” said Muthui.

    He said male teachers have been caught taking members of their second family to benefit from the scheme against the laid down rules.

    Muthui said in most cases, teachers use their identity to help their relatives such as parents, siblings, or unregistered spouses.

    “In our African setup and tradition, your cousin may have a similar name as yours. Your niece or nephew may have the same name as your children. So they use the same name to get treatment from hospitals,” said Muthui.

    “When the preauthorisation team comes, they find a totally different person from the listed beneficiary on the hospital bed.”

    Impersonation is also done by teachers to cheat maternity cover. “In most cases, you find the person who is on the bed is not the one on the scheme roll,” said Muthui.

    “For teachers who are caught in this malpractice we pass them over to TSC for the disciplinary procedure,” he added.

    It also emerged that some hospitals make huge claims based on false diagnoses while others presented bills for members who were never admitted.

    In other cases, the health facilities demand payment for patients not even treated.

    “Other facilities also cheat on the number of days patients were admitted,” said Muthui.

    Some hospitals also make claims on services not covered under the medical scheme. “They (hospitals) manufacture bills and forward them for payments,” said Muthui.

    He said in the past, the scheme administrator has had cases where some hospitals made claims for gynaecological and maternity services offered for male members of the scheme.

    Cases of bribery have also been reported among teachers and hospitals.

    “We have had cases where hospitals bribed scheme members or members’ representatives to cover up false claims and other corrupt practices,” said Muthui.

    “In one such case, a patient confirmed that no breast ultrasound or excision was carried out, yet the two services were included in the final bills.”

  • Vocal Teacher Transferred Hours After Calling Out TSC On Insurance Scheme

    Vocal Teacher Transferred Hours After Calling Out TSC On Insurance Scheme

    Teachers Pressure Group (TPG) spokesperson, Martha Omollo, has been transferred from Nairobi to Trans Nzoia County. This comes a day after Omollo called for the revocation of tutors’ medical insurance under Aon Minet.

    According to Omollo, TSC is fighting back TPG since it’s the only saviour for teachers, that would fill the vacuum left by the Kenya National Union of Teachers (Knut) in fighting for the welfare of teachers.

    Omollo terms the transfer as malicious and meant to intimidate and silence her and the team from exposing the frustrations teachers are facing under the medical insurance and other oppressions introduced by the TSC.

    She recounted how Nairobi TSC County director gave her a phone call through her headteachers phone, warning her from speaking to the media.

    “On Friday I received a call from TSC Nairobi County director through my headteacher who told me that I should be cautious of what I speak to the media and that any issues I have I should go through the teachers’ unions,” she said.

    A few minutes before 4pm, an official from TSC head office drove to the school and handed her the transfer letter and ordered her to start clearing from the school immediately.

    She claims the headteacher was informed about the transfer earlier and had typed and signed her release letter.

    “To my surprise, the head teacher seemed to have been informed about my transfer as he had already typed and signed a release letter from the school, which he also handed it to me,” revealed Omollo.

    The letter signed by Fredrick Mwaniki on behalf of TSC CEO Nancy Macharia directed Omollo to report to the Trans Nzoia TSC county director by Monday.

    “The commission has decided that you be transferred from Nairobi to Trans Nzoia County with effect from November 15 to teach all subjects,” reads the letter.

    Nairobi TSC director was directed to inform the commission’s head office on the date she is released from the region and that the time of her release should not take more than 14 days.

    Trans-Nzoia TSC director was also directed to inform the commission’s head office on the date Omollo reports on duty.

    “Please note that it is an offence to leave your present station and join another without formally being released in writing as stipulated in the TSC Code of Regulation for teachers,” reads the letter.

    On giving reason for Omollo’s transfer, the director said that the commission is treating her transfer like any other transfer.

    When she asked about her disturbance allowance, which is supposed to equal her salary, the director was non-committal.

    “I have decided to report to the commission’s Trans Nzoia office on Monday to be sent to the school I am supposed to teach, but after that I will move to court because that decision was made out of malice,” said Omollo.

    Omollo reveals that TSC summoned her last week and directed her to retract the call for teachers to resist the TPD.

    Teachers countrywide have come out to resist AON minet medical scheme claiming that they do not obtain adequate medical care from the scheme.

    Teachers are now calling upon the abolition of the AON Minet medical scheme for it has failed to provide quality services to teachers and their dependents.

    According to Nation media reports, the insurer has refused to pay medical bills forcing teachers to pay for treatment out of their own pockets.

    On the other hand, several teachers have tabled their complaints saying that some of the hospitals listed by the scheme are inaccessible to wheelchair-bound patients due to their location in storey buildings. Additionally, other hospitals are far from teachers’ homes.

    Teachers further complained that scan approvals take too long. The majority of teachers give up and seek treatment in other hospitals which are not accredited by minet. Some large hospitals can take up to a month to approve for treatment.

    The Kenya National Teachers Pressure Group which is made up of teachers from primary, secondary schools as well as teacher training colleges has put pressure on the Teacher Service Commission to suspend the scheme or replace it with a better one.

    Martha Omollo, the group spokesperson said that TSC forced teachers to register with the AON minet scheme without allowing teachers to participate in the process of identifying and selecting the scheme administrator and health provider.

    According to Ms Omollo Minet, the way the teachers were forced into the AON Minet medical scheme was unconstitutional, and a violation of the TSC Act (2012) and the code of regulations for teachers.

    From a reliable source, “TSC has today transfered the Nairobi KNTPG coordinator Madam Martha Omolo from Nairobi to Trans Nzoia county allegedly for speaking up against AoN/Minet. Well ours could be coming too but then what is TSC hiding on behalf of AoN/Minet? Teachers this is just one extreme extent our employer is ready to take us to in their fight to defend this AoN deal that is worth billions. We will continue to fight as we welcome her to the great Rift Valley.” The source confirmed.

    Another teacher also noted that no serious hospital has been approved except a few which are not accessible to all teachers. Teachers have always complained that some of the approved hospitals lack drugs and qualified doctors while the medical scheme refuses to pay bills for some hospitals in some cases.

    Serious challenges Ms Omollo said teachers must allowed to choose a scheme that meets their needs. Teachers have accused Kenya Union of Post Primary Education Teachers (Kuppet) and Kenya National Union of Teachers (Knut), of colluding with TSC to allow the AON Minet medical scheme to continue providing services to teachers.“AON Minet is a cash cow for union officials and the TSC. No serious hospital has been approved except a few private hospitals that are not accessible to all teachers,” said a teacher. To seek treatment in some big hospitals, approvals take up to a month, said the teachers.

    Teachers said some approved hospitals lack drugs, while, in some instances, the medical scheme refuses to clear bills for some hospitals.In most of the approved hospitals, there are no doctors and patients are attended to by nurses.“Teachers don’t want AON Minet, it is just a scam and a true definition of frustration. They want a medical scheme negotiated by them because it’s their money,” said Ms Omollo.

    They lamented that some of the hospitals listed by the scheme are inaccessible to patients on wheelchairs because they are located in tall buildings, while others are far from teachers’ locations.They also complained that approvals for scans take too long, forcing the teachers to give up and seek services in unaccredited hospitals.

    “The medical scheme has limited the number of days a teacher can visit a hospital to once every seven days, meaning that a teacher’s medical card cannot be used twice in a week. This means that once a teacher has gone to a hospital within a week, their dependants cannot access treatment within that week,” explained a teacher.

    The Teachers Service Commission (TSC) supports the medical scheme claiming that it is the best of its kind in the region.