Insurance referral services a boost to specialized treatment

Specialized treatment is the norm as health care becomes more prevalent in the country and the need for focused approach to ensure wellness is needed.

As years go by, some diseases that were in the periphery are now some of the leading killers, raising concerns of not only the need for prevention but also better management and treatment.

According to the Economic Survey 2017, Cancer cases record an upward trend throughout the five-year period analyzed. Between 2015 and 2016, all the other diseases record decreases in the number of cases reported with the exception of cancer. Cancer records an increase of 48 cases; this represents a 0.3 percentage points increase between these years.

The Minet medical cover for teachers includes both the need for chronic treatment as well as referrals.

Chronic diseases covered include but not limited to: cancer, hypertension, asthma, diabetes, pepticulcer diseases, arthritis, cardiac failure, epilepsy, chronic renal disease, schizophrenia, bronchiectasis, chronic obstructive pulmonary disorder, thyroid disease, systemic lupus erythematosus and hyperlipidaemia.

Teachers Medical Scheme Fingerprint Registration Process.

To enroll, members are supposed to contact the Chronic Disease Management (CDM) programmes and fill in a CDM form available at Minet county offices countrywide. The CDM form is also available on the website. A supportive internention is that the CDM team will ensure your drugs are delivered to you and that your progress is monitored regularly.

Under the Minet’s teachers scheme, instances where a member may require referral/specialist services are categorized into two. The first is where the service sought cannot be accessed directly such as an x-ray, MRI, chemotherapy or specialised services such as gynae care, oncology, etc.

In this instance the teacher or beneficiary will visit a primary healthcare service provider who will issue a referral letter to the member allowing them to seek the service at a referral service provider within the panel the company has.

The second instance is where the service provider is not contracted to give a particular service. Here, the service provider will issue a referral letter to the member indicating the service they seek and the name of the service provider they are referring the member to.

These measures are meant to reduce abuse of referral system, allow for specialized treatment of diseases, some of which are chronic and guarantee access to the best care possible.

The Minet’s cover is cover ensures that all benefits are family shared, last Expense and Group Life are payable upon the death of the principal member and inpatient services are payable net of NHIF.

Job Group and limits to the benefits of Minet’s medical cover for teachers and their dependants.

Last expense is a benefit payable to the next of kin upon the demise of the principal member to aid in funeral arrangements. It is payable within 48 hours and via Mobile Money Transfer provided all information required has been availed to Minet. The benefit is sh100,000 across all job groups.

On its part, the group life cover benefit is payable to the family of the deceased to assist in re-organising their lives after the demise of the principal member. This benefit graduates progressively across job groups and is only applicable upon the demise of a principal member.

In addition, the cover allows for overseas treatment. In this case, members can be evacuated for treatment abroad in cases where the treatment required is not available locally and where the Director of Medical Services approves it.

In case one is referred for treatment abroad, the benefits are airfare – economy class for the patient and accompanying person/doctor/nurse in cases where the patient is not ambulant and is critically ill and accommodation and transport within the destination of treatment at local rates.


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