Access to services and instances of fraud have emerged as major concerns that plague the medical insurance cover for teachers as the contract between their employer and Minet Kenya approaches expiry on November 30, 2025.
Minet Kenya said that while the majority of its network hospitals –about 95 percent – remain operational and accessible to teachers, some facilities have been temporarily suspended following investigations into fraudulent or unethical practices.
A consortium led by Minet Kenya has twice won the tender to provider medical insurance cover to all the teachers employed by the Teachers Service Commission (TSC).
Speaking to the Nation , the general manager for managed medical care at Minet Kenya, Mr Edwin Kegode, defended the overall operations of the teachers’ medical scheme, acknowledging that there are gaps in its implementation.
“We are aware of concerns around access and reports of fraud in some facilities. While these cases are isolated, we are taking them seriously and have suspended certain hospitals pending investigations to protect teachers and ensure integrity in the scheme,” said Mr Kegode.
Minet Kenya, Medical Managed Care Division, General Manager, Edwin Kegode, during an interview at his office in Nairobi on August 26, 2025.
Photo credit: Wilfred Nyangaresi | Nation
He noted that pre-authorisation, often raised as a concern by teachers, is a standard global practice that ensures administrative oversight before medical services are provided. He added that this process helps prevent misunderstandings or disputes between members and medical service providers, ensuring that services are properly coordinated and approved in advance.
“Delays in pre-authorisation can affect access to care. When a beneficiary visits a hospital and admission is required, patients are often asked to provide documents themselves instead of the hospital submitting them. Sometimes hospitals do not provide all the necessary information, which can slow down decisions and create the perception that the process is subjective. In some cases, patients may stay longer or shorter than recommended, depending on the treatment administered, and this can cause confusion among members,” Mr Kegode explained.
Further, the official explained that most pre-authorisation requirements for medical procedures have been reduced to streamline access. He noted that in some cases, teachers may request admission for a procedure, but the documentation provided initially does not clearly justify the need.
“However, under the teachers’ scheme, we have scrapped a lot of the need for pre-authorisation. Previously, some of the complex outpatient services required pre-authorisation, so there is no form of pre-authorisation of all of the patient services. You also extend that to include services in this study… Those that may go beyond could be as a result of requiring additional information,” he said.
However, he said, concerns over teachers paying out of pocket have been addressed, with the scheme eliminating the upfront or co-payment component. He noted that teachers encountering service providers demanding direct payments are encouraged to report them, with action taken against non-compliant providers.
“There could be other situations where teachers walk into a hospital or their dependents go into a hospital, and they are asked to pay out of pocket. One of the things that we did on this scheme is to scrap off any form of co-payment, which is a feature you will find with many other schemes. This scheme does not expect any teacher or dependent to pay out of pocket. Should you encounter a service provider that requires payment directly to the hospital, we have put our lines open so you can report that provider, and appropriate action will be taken against them,” he said.
The medical scheme covers a staff complement of over 400,000 teachers, translating to about 500,000 families. In total, the scheme covers close to 1.4 million lives across the country, making it one the largest in Kenya.
“One of the things that we would like to develop from the deposit of opportunity is that teachers, in that number, we are talking about staff complement of over 400,000 teachers, which means 500,000 families,” Mr Kegode said.
He outlined several areas where Minet Kenya plans to improve the teachers’ medical cover, in case it is awarded another tender. He said the scheme will address concerns from younger teachers that lower cadres receive lower mortality benefits compared to higher cadres.
“We are aware of concerns from our younger teachers regarding mortality benefits. We are exploring options to make the death-in-service benefits more equitable across all ranks. We are also considering reintroducing the death-in-service benefit to provide financial support to families of deceased teachers, ensuring that they are not left vulnerable,” he said.
Mr Kegode noted that Minet is considering reintroducing the death-in-service benefit to provide financial support to families of deceased teachers. He noted that enhancing communication with teachers is a priority.
“It is important that teachers are fully aware of the services available to them. We are looking beyond social media to engage teachers directly wherever possible. We are exploring options to make the death-in-service (group life cover) benefits more equitable across all ranks,” he added.
