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Kenya Civil Servants Medical Cover Now A Reality

The much-touted medical scheme for civil servants is now a reality.

Starting Sunday 1 2012, civil servants and members of the disciplined forces will have a

Public Service Minister Dalmas Otieno;
comprehensive medical insurance cover administered by the National Hospital Insurance Fund (NHIF).

The decision to have NHIF administer the scheme was taken after the short-listed consortium of private medical insurance companies failed to meet the threshold amount set by the Government.

The medical scheme will be partly funded through current monthly medical allowance payable to civil servants estimated at Sh7 billion, funds allocated to ex-gratia assistance and in-patient refunds and additional funding from the Government whose details were still being worked out between Public Service ministry and Treasury by Thursday this week.

The circular, dated December 21, 2011, was released by Public Service Permanent Secretary Titus Ndambuki, and addressed to all Accounting Officers/Permanent Secretaries including Commissioner of Police, Administration Police Commandant, Commissioner of Prisons and Director of National Youth Service. It was copied to the PS and Secretary to the Cabinet Francis Muthaura.

The scheme, according to the circular, will cover out-patient and in-patient medical services.

"The Government, in fulfilment of its obligation under the Employment Act 2007 and the Constitution of Kenya 2010, to ensure access to quality health care has introduced a comprehensive medical insurance cover for its employees and their eligible dependants," Mr Ndambuki said.

"The cover is expected to bring relief to civil servants and disciplined services that have had to meet high costs of medical bills from their resources in most cases."

Unlike in the earlier proposals where the scheme was to cater for two children only, this time it will cater for a minimum of three with possibilities of additional children through a separate arrangement with NHIF.

Principal member

"The medical cover caters for the principal member, spouse, and three children less than 18 years of age and up to a maximum of 25 years if still a full time student in school/college," Ndambuki said.

"NHIF will also make provision for officers who wish to cover additional members to pay extra premium directly to NHIF at reasonable rates."

Under the new cover, all 475,480 civil servants and their eligible dependants will access out-patient and in-patient medical services in NHIF accredited Government, mission and private hospitals. However, in-patient treatment in high cost private hospitals such as Nairobi, Aga Khan, and Mater will have specified ceilings.

"In-patient treatment will be without limits/ceilings in Amenity Wards in Government, mission, and some private hospitals for all officers and their eligible dependents while it will have specified ceilings in high cost hospitals for officers in Job Group N-T/SL 4-9/PG 10-15."

Upon commencement of the scheme, civil servants will be expected to choose their preferred hospitals as per the list provided for by NHIF.

"NHIF has a number of accredited hospitals across the country. Civil servants will choose three service providers from the list. Some of the service providers have more than one outlet so it should not be a problem to settle on any," Richard Kerich, CEO NHIF said.

Service providers

"Unless there is an emergency, one is expected to seek medical care at those identified service providers," Mr Kerich said.

The out-patient costs covered include doctors’ consultation fee, all laboratory tests, radiological tests including X-ray and CT scan, prescriptions and dressings. It will also include pharmacy services among other out-patient procedures deemed medically necessary.

"In order to access outpatient services, an officer will have to pay Sh100 at a Government hospital and Sh200 at other providers," Kerich said.

Unlike teachers who recently signed for medical cover only with NHIF, the new cover also provides for Life Insurance and Last Expense Covers for the principal members at graduated rates based on individual officer’s job group.

Civil servants are to surrender their monthly medical allowance that ranges between Sh375 for the lowest paid to Sh2,940 for the highest paid civil servant. This in effect implies civil servants will earn less their medical allowances starting January 2012.

Expenses for the annual mandatory general medical check-up for principal members will also be part of the benefits under the cover.

"You are required to stop payment of monthly medical allowances to all staff with effect from January 1, 2012 and stop further processing of any medical ex-gratia claims and in-patient refunds which will not have been committed in the Vote Book by December 31, 2011," Ndambuki said.

A sum total of all medical allowances paid as outlined above create a bank of Sh7 billion a year.

The Government is to supplement the figure through an additional provision of 25 per cent to meet the difference between what the civil servants can offer to purchase the premiums.

Government contribution

Public Service Minister Dalmas Otieno was on Thursday said to be in consultation with Treasury on the actual figure the Government will add. The total Government contribution is expected to be officially announced in the first week of January.

Confirming the decision to award NHIF to administer the scheme instead of the proposed consortium of private medical insurance companies, Kerich said he was awaiting details from specific ministries on the number of employees and their job groups to be able to make arrangements for the commencement of the scheme.

"NHIF was given an offer to provide medical insurance to civil servants at a premium of Sh4.5 billion. The amount excludes the mandatory Sh320 paid to NHIF. While the details of what the Government intends to provide are not yet available, NHIF is ready to administer the scheme at Sh12 billion or thereon," Kerich said.

He said more organisations were willing to join NHIF’s in-patient and out-patient schemes.

"Kuppet are already with us. We are also expecting a number of employees from the sugar and tea industries. This will be a challenge to service providers which we expect the Government to address," Kerich said.

Speaking to the press separately, Tom Odege, the secretary general of Union of Kenya Civil Servants said his union has accepted the arrangements and will encourage members to join.

"This is something we have been looking for a long time. Now that it is ready, we encourage our members to fill in the forms for purposes of administering the scheme," Mr Odege said.

"The package was negotiated between the union and the Government."

The scheme, for 214,126 civil servants, also covers 2,978 Teachers Service Commission (TSC) employees, and more than 200,000 teachers, even though members of Knut have rejected it.

Source: The Standard

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