Why teachers oppose SHA switch that threatens their medical cover

Teachers have listed benefits they risk losing if the government migrates them to the Social Health Authority (SHA).

In a detailed presentation obtained by The Saturday Standard, the 460,000 teachers said the planned migration would disrupt operations, alter medical service pathways and affect member experiences.

They argued that despite challenges in the Sh20 billion medical cover run by Minet,  which at times saw some of them turned away from medical facilities, they were better off under  the TS-managed scheme.

“What teachers wanted was improved service delivery and enhanced packages. We did not ask to be migrated to an already struggling SHA, marred by corruption accusations and fraud,” the paper reads.

The details are contained in a report titled; What teachers may miss about Minet: Implications of transitioning the teachers medical scheme.

It emerged that the report formed the basis of Friday’s meeting between teachers’ unions, the TSC and SHA officials.

Kenya National Union of Teachers (KNUT) and the Kenya Union of Post-Primary Education Teachers (KUPPET) held separate meetings with TSC and SHA.

The meeting came a day after TSC chief executive Evaleen Mitei announced that all teachers would be migrated to SHA by December 1.

In the brief, teachers argued that through the TSC-run scheme, they benefited from a highly digitized, clinically supervised, and member-centric administration managed by the Minet Consortium, with real-time approvals and about 98 per cent paperless processing.

KUPPET officials argued that under Minet, teachers currently enjoy comprehensive cover, including overseas treatment options, group life insurance and flexibility in hospital choice.

Higher benefits

The scheme covers about 1.3 million lives, including 360,000 teachers, 230,000 spouses and 677,000 children. 

It provides both outpatient and inpatient services, with inpatient cover ranging from Sh750,000 and Sh2.5 million depending on job group, while outpatient services are capped between Sh100,000 and Sh375,000.  

Teachers feared that these benefits could be eroded in the transition. They also note that the scheme had strong county-level governance forums, offered higher benefits, and enforced strict rules against top-up requests.

They noted that the TSC scheme had strong fraud, waste, and abuse controls, as well as resilient risk-sharing mechanisms—safeguards they feared could be absent under SHA.

“Preserving these capabilities should be a top priority in the next phase,” the report states.

The report was presented in four sections: Special Benefits under the TSC Scheme, What Worked Well under the Minet-led Consortium, What Teachers Are Likely to Miss and Potential Transition Risks (Teacher Experience).

Under special benefits, the report highlights the absence of sub-limits within inpatient cover and a Last Expense benefit, which provides Sh300,000 to families who lose a principal member.

Other benefits include access to IVF services, a robust wellness programme with 24/7 toll-free tele-counselling, an employee assistance programme and chronic disease management support.

The report highlights benefits teachers stand to lose under the shift, including the Last Expense benefit, which offers financial support to families upon a teacher’s death.

“Teachers have enjoyed fast, transparent Last Expense payouts, with digitally managed claims and M-Pesa-linked disbursements,” the report notes.

They also argued that the TSC-run scheme provides timely evacuation services by road and air, including helicopters and fixed-wing aircraft, for critical emergencies.

In addition, the scheme protects teachers from out-of-pocket charges through strict enforcement against provider top-ups.

Identification platform

Another key benefit is what teachers termed “speed to care,” with real-time pre-authorization and discharge through an online interface, minimized delays and predictable hospital workflows.

The scheme also offers structured post-discharge follow-ups, including standardized 21-day check-ins to monitor treatment outcomes and manage complications.

“Teachers may miss out on these critical benefits if migrated to SHA,” the report warns.

Teachers also argued that they may lose the benefit of support presence in all 47 counties, which ensured in-person assistance was available locally across the country.

“Teachers will also miss out because the TSC scheme had no sub-limits on the inpatient benefit, as it offered lump-sum inpatient limits without restrictive sub-limits,” the report reads.

They further noted that the TSC scheme had a robust identification platform for all beneficiaries.

“The scheme has maintained a fraud shield and member safety plan with biometric verification and analytics-based detection to curb misuse and protect benefits,” the report states.

Under potential transition risks, the report listed possible access gaps in medical care, pointing to temporary mismatches between teachers’ preferred or local providers with whom they had established rapport.

It also flagged looming communication challenges, including changes to USSD codes, mobile apps, contact centre numbers, hotlines, and chatbot features, which could confuse members.