The National Assembly has instructed medical insurance providers for teachers to present a comprehensive policy document outlining the procedures for managing beneficiaries.
The National Assembly Education Committee also challenged the providers over concerns such as poor service delivery, low-quality medication, and lengthy processing times.
The MPs sought an explanation on the role of Bliss Healthcare after it emerged that they serve the roles of master capitator as well as service provider.
“What I want you to note is that we have drugs dispensed as generic and as branded. Complaints have been raised, where teachers are granted substandard drugs,” said Committee Chair Julius Melly while addressing Medical Administrators Kenya Ltd and Bliss Healthcare.
ALSO READ:
KNUT demands transfer of West Pokot education director over alleged mismanagement
However, Bliss Healthcare CEO Felix Wanjala denied allegations of poor drug quality, stating no client had lodged such complaints.
“We are always responding to our clients and any complaint raised is always addressed in terms of service. If an MP has anyone with a case we will address it,” he said.
“I do not want us to mix quality and generic. Let me pick an example of Panadol. It is the simplest that we know. Panadol is a brand name, but since it was the first molecule to be created so we call it an original molecule. Then, someone else comes and makes the same molecule that is called generic.” he added
Wanjala also rejected claims of delays, stating that their average service turnaround time is one hour. Despite this, MPs insisted they had received feedback indicating significant delays, particularly due to approval waiting times.
ALSO READ:
TSC to MPs: Teacher promotions fair, strategic and gender-sensitive
Parmanand Mishra, Chief Operating Officer of Medical Administrators Kenya, said that pre-authorization is no longer required for acute outpatient visits and that 96% of admissions and discharges are approved within 30–45 minutes.
He explained that in some cases, additional paperwork is needed to verify treatment requests when anomalies arise, which could cause delays.
“This measure is essential in safeguarding members’ benefits and protecting public funds from misuse or fraudulent claims,” he said.
Both companies outlined efforts to improve service gaps, especially in high-cost treatments, chronic illness care, and advanced procedures.
ALSO READ:
Knut official appeals for the release promotional letters amid call for tight scrutiny
Mishra emphasized that the scheme provides full coverage within members’ benefit limits and operates through 763 accredited providers across all 47 counties. In areas lacking private healthcare options, they partner with county government facilities.
Regarding payments, Mishra stated that the Teachers Service Commission had paid for services up to November 30 of the previous year. However, funding from the Exchequer for the quarter beginning December 1 and second quarter, which started on March 1 had delayed.
“This delay has affected the timely settlement of claims to service providers for services rendered during this period. While 36 providers have temporarily suspended services due to delayed payments, over 95 per cent of the 763 contracted providers continue to serve members,” he said.
Mishra added that they had received the pending funds last week and are in the process of disbursing payments to ensure providers are compensated by next week.
By Cornelius Korir
You can also follow our social media pages on Twitter: Education News KE and Facebook: Education News Newspaper for timely updates.
>> Click here to stay up-to-date with trending regional stories
>> Click here to read more informed opinions on the country’s education landscape
