MAKL introduces 17 referral facilities to streamline teachers’ medical scheme

Medical Administrators Kenya Limited (MAKL), the administrator of the teachers’ medical scheme, has introduced 17 designated referral facilities as part of efforts to streamline healthcare services.

In a statement on Wednesday, MAKL said the decision was made in consultation with the Teachers Service Commission (TSC) to enhance the referral management system and improve access to specialised care nationwide.

“Encouragingly, while these 17 facilities have been converted into referral hospitals, members still have access to care at primary healthcare facilities,” MAKL stated.

Recently, some teachers have raised concerns over adjustments to the panel of medical facilities under the TSC medical scheme, with reports of some being turned away or asked for referrals.

However, MAKL clarified that only 17 hospitals across the country have been designated as referral facilities following consultations with the TSC.

This adjustment aligns with national protocols for Level 4, 5, and 6 hospitals, ensuring that specialized services, tests, procedures, and medications are accessible at appropriate facilities.

“The referral process has only been streamlined to ensure that those requiring specialized care are promptly directed to the appropriate hospitals,” MAKL explained.

The medical scheme panel includes 800 healthcare facilities spread across all counties and sub-counties in Kenya.

Of these, only about 60 facilities operate on a referral basis.

This means that over 740 facilities remain open for walk-in access.

The panel consists of private, faith-based, and public hospitals, each with different contracting protocols to accommodate teachers' diverse healthcare needs.

“Minet reassures all teachers under the scheme that they can continue to access services from accredited medical providers within the scheme,” MAKL said.

The Teachers’ Medical Scheme, launched in 2015, aims to provide comprehensive health coverage for teachers and their families, ensuring access to quality healthcare.

Since its inception, the scheme has evolved into the largest medical scheme in Eastern and Central Africa.

Currently, the scheme includes 146 public hospitals, 133 mission hospitals and 63 anchor clinics run by Bliss Healthcare.

There are 487 private hospitals under the panel.

Members of the scheme can access inpatient, outpatient, dental, optical, and maternity services at these facilities.

The Teachers’ Medical Scheme is managed through a consortium led by Minet Kenya Insurance Brokers Limited, which serves as the Lead Consortium Member and Coordinator.

Six insurance underwriters provide coverage under the scheme:Old Mutual, Britam, CIC Insurance, Pioneer Insurance, Star Discover General Insurance and Star Life Insurance.

MAKL serves as the medical administrator, overseeing contracting service providers and processing payments.

Additionally, Bliss Healthcare acts as the master capitator, managing 63 clinics and handling third-party partnerships to extend coverage to areas where Bliss facilities are unavailable.