Details have emerged of the multibillion-shilling teachers' health insurance cover following the filing of a case by some tutors who allege that they are not getting value for their money and that the services are substandard.
The teachers now want the Employment and Labour Relations Court to compel Minet Kenya Insurance Brokers Limited to ensure the main service provider offers quality services to match the Sh51.4 billion allocated to it.
The teachers also accuse the Teachers Service Commission (TSC) of allocating Sh60 million to a “ghost” company for actuarial services without advertising for competitive bidding.
Of the total contractual amount of Sh53 billion signed between Minet and TSC, Sh51.4 billion has been allocated to the master capitator—Bliss Health Care Services.
A tabulation of the three-year contract between TSC and Minet presented before Justice Bernard Odongo Manani Matanga by the teachers led by Mathai Boniface Ndirangu, shows how the Sh51 billion will be spent by Bliss. The petitioners have named TSC and Minet Kenya as the respondents.
As per the contract, which will run for three years, Bliss has allocated Sh32 billion for outpatient, Sh13.6 billion for in-patient, maternity (Sh2.07 billion), dental (Sh1.3 billion), optical (Sh2.2 million) and evacuation services Sh179 million.
Minet has objected to the petition alleging there is no employer-employee relationship between the company and the teachers to warrant their being sued in the employment court. But the teachers argue that Minet signed a contract with their employer, TSC, so they have been properly sued. They have told Justice Matanga that the case is properly before him having been referred by the Constitutional Court, which handles rights issues.
“So there is no reason why teachers should be turned away or asked to top-up by a medical administrator brought on board by Bliss,” state the petitioners.
Teachers are required to pay Sh100 (co-pay) before getting services yet they have unlimited in-patient and out-patient benefits.
The court has been told that TSC is paying Sh20 million per year for actuarial services to a company they alleged is phoney.
They add that the Sh60 million allocated for the services can be used to issue job and medical cards to teachers who will spend Sh3 billion of the contractual Sh53 billion for a system to identify them when they visit Bliss hospitals for treatment. Teachers do not have job identification cards.
Medical Administrators (K) Limited (MAKL), the aggrieved teachers say, was brought on board by Minet to ensure that they are not turned away from hospitals, yet Mr Mathai says he did not get treatment at Guru Nanak Hospital recently on grounds that he was not properly identified. The court has further been told that MAKL and Bliss are “one and the same in terms of ownership, and yet they are paid separately.”
Further teachers have faulted TSC for violating Article 277 (1) when it listed Star Discover Insurance Limited and Star Discover Life Insurance as part of the companies to bid for the Sh53 billion tender when they were just six months old and lacked the requisite capacity to bid for public tenders.
The petitioners say that from the contract documents, Star Discover Life Insurance, Star Discover Insurance Limited and MAKL share the same physical address—ARC Place Nyangumi Road—and postal address number 3421– Nyayo Stadium.
“This means the three companies are run from the same office and place and are owned by the same person,” Mr Mathai says in an affidavit.
Mr Mathai states that teachers are not asking the court to cancel the contract but to give directions to ease the authorisation process, which is frustrating.