Confusion surrounds the proposed Sh26 billion medical cover for tutors under the Social Health Authority (SHA), as internal documents raise questions on the costs and the range of services available.
The new scheme, which will cost taxpayers Sh11 billion more to cover the 400,000 teachers, has caused a split in the education sector, with some protesting the lack of proper consultation.
Union officials and the Teachers Service Commission (TSC), however, said that those covered will not face higher deductions for the SHA scheme, with the taxpayers absorbing the additional Sh11 billion.
A union official, who requested anonymity so as to freely share confidential details, said that some of his colleagues who approved the deal are concerned that the SHA backlog of hospital debts, which has been a constant complaint since the new system was set up for all Kenyans, could eventually affect access to healthcare for teachers.
Pay delays have seen some hospitals deny service to patients unable to use private insurance or pay out of pocket.
The official added that if the new scheme does not take off smoothly, unions will invoke a clause in the contract to notify SHA of termination within 30 days.
The transition is anchored in the Public Officers Medical Scheme Fund Regulations No 195 of 2024, which established the Public Officers Medical Scheme Fund (POMSF) to manage healthcare benefits for public servants.
A TSC presentation to unions during negotiations for the transition indicates that the new scheme could force teachers to pay for some expensive tests to detect conditions and illnesses like cancer, severe pneumonia and sepsis as outpatients.
On Friday, the TSC acting CEO Evaleen Mitei maintained that the new cover offered to teachers will retain and enhance all the benefits offered by the current scheme managed by a consortium led by Minet Kenya Insurance Brokers.
Teachers Service Commission Acting CEO Evaleen Mitei.
Photo credit: File | Nation
A presentation by the TSC to unions, which the Saturday Nation has seen, indicates that under outpatient services, the new scheme will cover consultations, basic laboratory investigations, health education, counselling, physiotherapy and State-provided vaccines.
The wording of the document suggests that advanced lab tests, which at times help with early detection of terminal illnesses, are covered under inpatient services.
Documents detailing the Minet Kenya package, which will end on December 1 if all relevant unions sign on, show advanced laboratory tests under outpatient services.
“The teachers’ medical cover is a comprehensive scheme with all the benefits under the outgoing scheme duly retained. The benefits structure/package was made public to all stakeholders during stakeholder engagement phases and will be a core component of the contract between parties,” CEO Mitei told the Saturday Nation .
“The previous medical allowance paid to teachers was costing a total amount of Sh9 billion only. The comprehensive teachers Medical Scheme will cost the Government over Sh26 billion. This means that the Government has injected over Sh15 billion into the fund to accord teachers superior medical cover. The teachers Medical Scheme shall be financed by the TSC through its budgetary provisions,” she added.
Fearing increased deductions
Under the new arrangement, teachers will continue contributing to the same scheme as before, with only the management shifting from Minet to SHA. However, this shift has triggered confusion, with some educators fearing increased deductions or reduced cover.
“Teachers will also continue to benefit from SHIF deductions as per the guidelines, but will receive a comprehensive cover over and above the universal cover,” said Ms Mitei.
Under the Social Health Insurance Act, 2023, three funds now anchor the system: The Primary Healthcare Fund, the Social Health Insurance Fund (SHIF), and the Emergency, Chronic, and Critical Illness Fund (ECCI).
Teachers will continue contributing to SHIF, while POMSF cushions them with enhanced benefits.
“The teachers’ contributions remain the same. The only change is in management, moving from Minet to SHA. This is the same scheme teachers have been contributing to. There is nothing being subsidised by anyone, and teachers are not paying more than before,” said Hesbon Otieno, the Deputy Secretary-General of the Kenya National Union of Teachers (Knut).
Kenya National Union of Teachers officials, led by deputy secretary general Hesbon Otieno (centre), address the media in Litein, Kericho County on June 7, 2025.
Photo credit: Vitalis Kimutai | Nation Media Group
Talks for the transition ended on Monday following a closed-door meeting between the TSC and union officials. What began as a tense standoff gradually turned into a detailed discussion of the new scheme’s benefits.
Kenya Union of Post Primary Education Teachers (Kuppet) Deputy Secretary-General Moses Nthurima acknowledged that some concerns remain over the planned transition to a new medical scheme.
He said the law provides only a framework, leaving the details of coverage to the contracting parties.
“When the legislation gives the framework, it is left to the contracting parties to agree on what should be provided. The solution is only a skeleton framework. Once the parties are given registration to contract, the registration has not limited them to the extent of the cover,” Mr Nthurima said.
Kenya Union of Post Primary Education Teachers Deputy Secretary-General Moses Nthurima.
Photo credit: File | Nation Media Group
On funding, Mr Nthurima stressed that teachers will not face deductions. He urged members to wait for the finalised contract before raising concerns.
“The government is handling up to Sh21 billion. So, teachers will not be deducted any more money. We want the teachers to wait. The law only provides a framework for engagement. Once the law gives a review to the engaging parties to work on the contract, it is upon them now to look at all the ingredients of treatment,” Mr Nthurima said.
This came as the documents seen by Saturday Nation revealed details of benefits for different categories of teachers. Job Group B (5,233 teachers) will have unlimited inpatient and outpatient cover, with others covered including dental (Sh45,000), optical (Sh60,000) and maternity (Sh120,000).
There is also Sh300,000 funeral expenses; and Sh2 million international treatment plus Sh200,000 travel.
Job groups C1 (112,165 teachers) to C5 (28,036 teachers) retain unlimited outpatient and inpatient cover for the lower C groups, rising to Sh1.5–Sh1.8 million limits for higher C groups.
All enjoy standard benefits including dental, optical, maternity, evacuation and funeral allowances, and international treatment where provided.
Job groups D1 (8,183 teachers) to D5 (428 teachers) enjoy the highest coverage limits, ranging from Sh2 million in D1 to Sh3 million in D5.
Among the benefits of the new SHA medical scheme are comprehensive coverage for teachers and their immediate families, including a spouse and up to five children.
Teachers with more than five children will be advised on how to manage additional coverage. The scheme is designed exclusively for teachers, ensuring it is not lumped together with other public servants.
The new SHA scheme expands access to healthcare facilities from 800 to 9,600 nationwide, covering level two to level six hospitals across public, private, and faith-based sectors.
Teachers will also benefit from overseas treatment coverage, including air travel.
“It is now official that teachers’ medical cover will now be comprehensively undertaken by SHA. This is a comprehensive cover exclusively for teachers, extending beyond treatment in dispensaries to include overseas care, air travel, and access to specialised personnel for the sick. It is a scheme that many of our teachers will truly appreciate,” said Kuppet Secretary-General Akelo Misori.
Kenya Union of Post-Primary Education Teachers (Kuppet) Secretary-General Akelo Misori.
Photo credit: File | Nation Media Group
Further, documents show that the scheme will also include the management of chronic conditions, which has been simplified, allowing teachers to access private sector care without pre-qualification. Turnaround times for approvals and claims have been improved, addressing delays and prioritisation issues that affected the previous scheme. Dedicated officers will be available to support teachers during the transition, ensuring a seamless shift to the new cover.
“Looking at the presentation we received, the key factor is that this scheme will significantly improve on what we had earlier. The additional benefits were clearly addressed, and we want to ensure that this remains a comprehensive cover for teachers, not for everyone, as some perceptions suggest. We are also keen to manage any shortfalls to make sure things work well,” said Knut Secretary-General Collins Oyuu.
