TSC Medical SCheme maternity benefits www.businesstoday.co.ke
In the Teachers’ Medical Scheme, the policy guidelines place preterm deliveries or costs emanating from a preterm delivery under the overall maternity cover. [ Photo / CNN ]

When it comes to medical insurance, maternity cover is often a sensitive and tricky affair. Being a delicate but heart-warming condition, maternity cover is a critical component for any medical scheme.

Like many professionals, teachers employed by the Teachers Service Commission (TSC) are eligible for maternity benefits under the Teachers Medical Fund.

According to Minet Kenya, the TSC medical scheme administrator, the maternity benefit is available to the principal member (teacher) and spouse, while dependent children are excluded from maternity benefit.

Benefits under the TSC maternity cover include: routine antenatal check-up, delivery/ doctors’ fees, postnatal care up to six (6) weeks after delivery, routine immunisations (KEPI) and baby-friendly vaccines.

Other expenses covered include first emergency caesarean section, subsequent elective caesarean and normal delivery as well as pre-maturity/pre-term up to 37 weeks and congenital conditions.

There is an accredited panel of service providers for maternity services which can be viewed using the following channels;

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*340# | *202*06# | https://collaborationkenya.minet.com/MinetKe/Teachersmedicalscheme/index

In general insurance, expenses associated with premature births would be covered as part of maternity. Alternatively, one may purchase this as a separate benefit to the existing cover but this makes it an expensive benefit due to the cost associated with the admission of a preterm baby, owing to the delicate care they get mostly in the Neonatal Intensive Unit.

The overall limit coverage for preterm babies under most insurance policies are capped to specific amounts mainly due to huge variances related to cost of care and length of stay, which are key determinants when it comes to pricing of this benefit.

The industry practice is to ideally cover for the baby’s hospital accommodation costs, including while in NICU, doctors’ fees, medicines, lab charges and other medical costs associated with hospitalization. The cost associated with a hospital stay for the mother/caregiver may sometimes also be included in the coverage.

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 In the Teachers’ Medical Scheme, the policy guidelines place preterm deliveries or costs emanating from a preterm delivery under the overall maternity cover. The structure of the scheme guides the administrators on the policy application. Cases are payable based on the claim adjudication process, which determines the benefit applicable and the limit thereof.

 For further clarification on this and other benefits relating to the scheme, queries can be directed to Minet Kenya through official communication channels; Email: [email protected] Telephone: 0730 604 000 Helpline: 1528 Incidence Reporting Tool: *202*07# | *340# | *202*06# | https://collaborationkenya.minet.com/MinetKe/Teachersmedicalscheme/index

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