The Teachers Service Commission (TSC) has officially unveiled the medical tariffs under the new Social Health Authority (SHA) scheme, which will be effective from December 1, 2025. This transition, which affects over 400,000 teachers in Kenya, will replace the Minet health insurance scheme with a comprehensive medical package. The scheme is designed to provide extensive medical coverage for TSC teachers, including outpatient services, inpatient care, specialized treatments, and emergency services. The SHA scheme aims to offer quality health care to teachers and their dependents across the country.
Primary Health Care (PHC) and Outpatient Services
TSC teachers enrolled under the SHA program will enjoy routine outpatient services at a fee of Ksh 900 per beneficiary per year. Additionally, children under 18 years will have access to optical services, with an annual maximum of Ksh 1,000. This affordable coverage ensures that teachers and their families can access basic health services without financial strain.
Inpatient and Maternity Care
The SHA plan also covers inpatient services, with hospital admissions reimbursed at rates between Ksh 2,240 and Ksh 4,480 per day, depending on the treatment required. This coverage extends for up to 180 days per household annually. For maternity care, the scheme provides Ksh 10,000 for normal deliveries and Ksh 30,000 for Caesarean sections (CS). Additionally, the cost of Anti-D serum is covered at Ksh 6,000 per member.
Oncology and Renal Care
One of the standout benefits under SHA is its robust coverage for oncology and renal care. Teachers undergoing cancer treatment can access up to Ksh 400,000 per year for oncology services. Kidney-related treatments, including dialysis, are also covered under the scheme at rates of Ksh 10,650 per session. For advanced renal care, including peritoneal dialysis, the scheme offers coverage up to Ksh 85,200 per month. Furthermore, pre-transplant evaluations are supported up to Ksh 150,000 per household, with recipient surgeries covered up to Ksh 700,000.
Medical Imaging and Diagnostics
SHA ensures that TSC teachers have access to critical medical imaging and diagnostic services. MRI scans are reimbursed up to Ksh 11,000 per year, and CT scans are covered up to Ksh 6,900. Additionally, procedures such as mammography, fluoroscopy, and heart examinations like echocardiograms (ECHO) are included in the scheme’s tariffs. For chronic conditions, teachers and their dependents can access diagnostic tests for conditions like diabetes, hypertension, sickle cell, and asthma at subsidized rates.
Surgery and Emergency Tariffs
The SHA scheme also covers surgical procedures, with minor surgeries reimbursed up to Ksh 145,600, major surgeries up to Ksh 280,000, and specialized surgeries up to Ksh 1,120,000. Emergency services are a crucial part of the package, with intensive care (ICU) and high-dependency unit (HDU) admissions reimbursed at Ksh 28,000 per day. Furthermore, accident and emergency services are covered up to Ksh 107,633, ensuring timely medical assistance in critical situations.
Additional Benefits Under Emergency and Critical Care Fund (ECCF)
In addition to routine health services, the SHA package offers coverage under the Emergency and Critical Care Fund (ECCF), which includes ambulance services for emergency transportation. For intra-metro transport within a 25 km radius, ambulance services are reimbursed at Ksh 4,500, with an additional Ksh 75 for each kilometer beyond the 25 km radius. The scheme also supports rehabilitation services for drug and substance abuse up to Ksh 67,200.
TSC teachers and their dependents will also have access to overseas treatment for certain conditions, with a reimbursement limit of Ksh 500,000. This ensures that teachers receive the best possible care, both locally and abroad, when necessary.
Conclusion
The TSC’s transition to the SHA medical scheme marks a significant improvement in the healthcare benefits available to teachers across Kenya. The comprehensive coverage ensures that teachers and their families have access to quality medical services, from routine consultations to specialized treatments. As the scheme continues to roll out, teachers can expect an enhanced healthcare experience that prioritizes their well-being and ensures they are supported throughout their careers.
