Policyholders in the government-funded medical insurance scheme for teachers, police officers, and prison officers are facing a new hurdle. Hospitals hired to provide medical services under the scheme are threatening to suspend services due to unpaid capitation claims totaling Sh5 billion. Despite the government allocating Sh13.6 billion to the National Police Service Commission (NPSC) and Sh17.6 billion to the Teachers Service Commission (TSC) for medical insurance during the current fiscal year, policyholders are now required to pay for their medical expenses out of pocket.
The Senate and the National Assembly are currently investigating the matter, focusing on the delays caused by Medical Administrators Kenya Limited (MAKL) in processing capitation claims. Nominated Senator Raphael Chimera has called for the Senate Health Committee to summon Minet Kenya, a consortium of insurance companies, and MAKL to discuss the issue. The concern revolves around MAKL being a private company, and there is a call for a specific audit to examine the list of hospitals owed money, the services rendered, and the overall functioning of the medical service system for teachers.
To address the challenges, the Senate has summoned key entities, including TSC, NPSC, and the Insurance Regulatory Authority (IRA), to provide answers regarding the efforts taken by MAKL to resolve the delays in processing medical claims. The teachers’ medical service system, operational for nine years, is under scrutiny amid concerns about poor service and transparency in the procurement of insurance.
