TSC Unveils Enhanced Medical Cover for Teachers Under Social Health Authority (SHA)
In a major breakthrough for Kenya’s education sector, the Teachers Service Commission (TSC) has announced a comprehensive transition of all teachers to the Public Officers Medical Scheme Fund (POMSF) under the newly established Social Health Authority (SHA).
The transition, set to take effect on December 1, 2024, follows an agreement between TSC, the State insurer, and the country’s three main teacher unions — Kenya National Union of Teachers (KNUT), Kenya Union of Post Primary Education Teachers (KUPPET), and the Kenya Union of Special Needs Education Teachers (KUSNET).
The agreement guarantees uninterrupted access to medical services for over 400,000 teachers and their dependents, marking one of the most significant health reforms for public servants in recent years.
TSC Confirms Seamless Transition to SHA
Speaking during a consultative meeting at Safari Park Hotel in Nairobi, Acting TSC Chief Executive Officer (CEO) Eveleen Mitei reaffirmed the Commission’s commitment to improving teacher welfare through dialogue, transparency, and collaboration with all stakeholders.
Mitei noted that the transition to the SHA-managed POMSF will ensure that teachers access quality, affordable, and timely healthcare services across the country.
“All teachers will transition to the Social Health Authority beginning December 1, following a deal reached between KUPPET, KNUT, KUSNET, and the State insurer,” said Mitei.
She explained that the move is part of the government’s broader health reform agenda aimed at integrating all public officers into a unified national medical scheme.
Unions Praise the Move
Representatives from KUPPET, KNUT, and KUSNET lauded the government’s decision, terming it a progressive step toward healthcare equity and efficiency.
They emphasized that the transition guarantees teachers’ continued access to essential medical services without the interruptions that often accompany insurance policy changes.
KUPPET Secretary-General Akello Misori said the union had long advocated for a system that would minimize bureaucratic delays and expand hospital networks for teachers, especially in rural areas.
KNUT Secretary-General Dr. Collins Oyuu echoed these sentiments, adding that the SHA framework ensures accountability, transparency, and better service delivery for members.
“This agreement safeguards the health rights of our members. We are optimistic that this new structure will eliminate inefficiencies that have long plagued the old medical scheme,” Dr. Oyuu said.
TSC’s Commitment to Teachers’ Welfare
TSC has assured teachers that all necessary measures have been taken to ensure a smooth transition and continuous access to medical care.
According to Mitei, the Commission has already formed a joint technical committee comprising officials from TSC, SHA, and teachers’ unions to oversee the implementation process.
Additionally, stakeholder consultations have been conducted with key associations, including the Kenya Secondary School Heads Association (KESSHA) and the Kenya Primary School Heads Association (KEPSHA), to ensure the transition addresses all concerns from the ground up.
Mitei further revealed that TSC has revamped its Medical Division to enhance oversight, efficiency, and service quality.
“The revamped division will coordinate with SHA and medical providers to eliminate delays and ensure teachers receive timely care,” Mitei stated.
Challenges Addressed Under the New Scheme
One of the most common complaints among teachers under the previous scheme involved limited medical providers, delayed preauthorization, and poor service quality in hospitals.
Under the new SHA-managed POMSF, these challenges are expected to be resolved through:
- Expansion of accredited hospitals and clinics countrywide, including in remote regions.
- Reduction of preauthorization delays through an automated approval system.
- Improved oversight mechanisms to ensure prompt service delivery.
- Integration with national digital health platforms for real-time claim processing.
This overhaul means teachers and their dependents can now enjoy faster, more reliable, and better-quality healthcare services.
Comprehensive Benefit Package for Teachers
The TSC also released details of the new teachers’ medical benefit package under the POMSF.
Below is the full breakdown of the benefit structure for all job groups, from B5 to D5.
| Job Group | Inpatient (Ksh) | Outpatient (Ksh) | Dental (Ksh) | Optical (Ksh) | Maternity (Ksh) | Overseas Treatment (Ksh) | Last Expense (Ksh) |
|---|---|---|---|---|---|---|---|
| B5 | 1,000,000 | 150,000 | 45,000 | 60,000 | 120,000 | 2,200,000 | 300,000 |
| C1 | 1,000,000 | 150,000 | 45,000 | 60,000 | 120,000 | 2,200,000 | 300,000 |
| C2 | 1,000,000 | 150,000 | 45,000 | 60,000 | 120,000 | 2,200,000 | 300,000 |
| C3 | 1,300,000 | 200,000 | 45,000 | 60,000 | 120,000 | 2,200,000 | 300,000 |
| C4 | 1,500,000 | 225,000 | 45,000 | 60,000 | 120,000 | 2,200,000 | 300,000 |
| C5 | 1,800,000 | 250,000 | 45,000 | 60,000 | 120,000 | 2,200,000 | 300,000 |
| D1 | 2,000,000 | 300,000 | 45,000 | 60,000 | 200,000 | 2,200,000 | 300,000 |
| D2 | 2,200,000 | 325,000 | 45,000 | 60,000 | 200,000 | 2,200,000 | 300,000 |
| D3 | 2,500,000 | 325,000 | 45,000 | 60,000 | 250,000 | 2,200,000 | 300,000 |
| D4 | 2,800,000 | 400,000 | 45,000 | 60,000 | 250,000 | 2,200,000 | 300,000 |
| D5 | 3,000,000 | 450,000 | 45,000 | 60,000 | 300,000 | 2,200,000 | 300,000 |
Key Highlights of the New Medical Cover
- Uniform Dental and Optical Benefits:
All teachers, regardless of job group, will enjoy Ksh 45,000 dental and Ksh 60,000 optical cover annually. - Generous Inpatient and Outpatient Limits:
The package offers up to Ksh 3 million inpatient cover for senior job groups (D5) and Ksh 1 million minimum for entry-level teachers (B5–C2). - Maternity Coverage Up to Ksh 300,000:
The new scheme has enhanced maternity cover, allowing teachers and their dependents to access quality maternity services in accredited facilities. - Overseas Treatment Allocation:
All teachers across job groups are entitled to Ksh 2.2 million for overseas treatment in cases requiring specialized care unavailable locally. - Last Expense Benefit:
In case of death, a Ksh 300,000 last expense allowance will be paid to the teacher’s next of kin to assist with funeral arrangements.
Why the Transition Matters
The transition to SHA comes at a time when teachers have been raising concerns about delayed reimbursements, hospital rejections, and insufficient medical coverage under the previous insurance provider.
The new arrangement under SHA aims to centralize healthcare management for all public officers, eliminating fragmented schemes that often led to inconsistencies and inequitable access.
By integrating teachers into the broader Public Officers Medical Scheme Fund, the government seeks to enhance efficiency, accountability, and service delivery.
Moreover, the SHA’s nationwide hospital network ensures that teachers in both urban and rural areas can access services without incurring out-of-pocket expenses.
Stakeholder Collaboration and Future Outlook
TSC reiterated that it will continue engaging all education stakeholders to monitor implementation progress and address any emerging challenges.
The Commission also promised to conduct periodic performance reviews of the scheme to ensure that teachers receive value for money and that service providers adhere to quality standards.
As part of the rollout, awareness campaigns and sensitization workshops will be conducted across all counties to familiarize teachers with the new system, benefits, and procedures for accessing medical services.
The unions have pledged to work closely with TSC and SHA to ensure the success of the transition and to address any complaints prompt.
