Teachers will now be required to cover the costs of their own medical bills and those of their dependents, as certain hospitals are rejecting them, citing unpaid capitation claims totaling Sh5 billion.
The medical institutions argue that until these outstanding claims are settled, they cannot continue providing services.
Police and prison officers are also being turned away by hospitals due to the government’s failure to remit funds deducted from their payrolls.
In the current fiscal year, the government allocated Sh17.6 billion to the Teachers Service Commission (TSC) for the medical insurance of public school teachers and Sh13.6 billion to the National Police Service Commission (NPSC) for the coverage of police and prison officers.
The coverage for police and prison officers encompasses Sh5 billion for the Work Injury Benefits Act (WIBA), Group Personal Accident (GPA), last expense, and group life, with an additional Sh8.6 billion designated for medical cover.
As these issues unfold, both the Senate and the National Assembly are investigating the matter, particularly focusing on the legal status of Medical Administrators Kenya Limited (MAKL).
Nominated Senator Raphael Chimera, who raised concerns about the delayed processing of medical claims, is calling for the Health Committee of the Senate to summon Minet Kenya, a consortium of insurance companies led by CIC General Insurance Limited, and MAKL to provide explanations.
Chimera emphasized the need for MAKL to disclose the number of beneficiaries and panels of medical and healthcare service providers.
Senator Chimera is also questioning the legality of capitation practices in Kenya and suggests that the committee may request the Auditor-General, Nancy Gathungu, to conduct a forensic audit into the administration of teachers, police, and prison officer schemes.
The need for a special audit is so that the insurance companies provide a list of hospitals and the amount owed, the services rendered and if “indeed the hospitals have not been paid, where is the money?”