Teachers countrywide could be in for another scandal, after their employer, Teachers Service Commission (TSC), announced a suspicious multi-billion medical cover.
The commission is planning to dish out at least Ksh9 billion in the next three years to cater for medical covers for more than 318,000 teachers.
According to reports by the Nation, TSC has opted for four options with bidders expected to choose the option that fits them and TSC making the final decision.
The four options include Fully Insured Scheme, Hybrid Financing Model (inpatient, self-fund), Hybrid Financing Model (inpatient, fully insured) and Capitation Financing Model.
The Fully Insured Scheme entails a 100 per cent cover and the benefits and limits do not require co-payments between the patient and the client, while the Hybrid Financing Model entails a 50 per cent insurance or 50 per cent cash cover.
In the Hybrid Financing Model, only inpatient costs are covered while in Capitation Financing Model TSC pays a certain amount to a hospital for a period for unlimited number of patients treatment.
Tha Capitation Financing Model is however feared to be prone to fraud for lack of checks and balances, where insurance companies can collude with hospitals to defraud the teachers.
The proposed cover could be viewed as another cash cow for the TSC officials , who could have directly procured the services from the State-owned insurer National Hospital Insurance Fund (NHIF), and get a special package for teachers.
Previously, the contract has been held by AON which was contracted in July 1, 2015.
Before advertising the tender in August, TSC Chief Executive Officer Nancy Macharia wrote to the NHIF counterpart Nicodemus Odongo requesting for a proposal for consideration.
“I request the Fund to prepare and present proposals, including your indicative quote, to the Commission on how it may provide the service to teachers engaged in public service, their spouses and children,” said Macharia in a letter dated June 18.
Whether NHIF will get the tender or not remains a mystery, even as teachers lobby for a better medical cover.