The Teachers Service Commission has moved teachers’ medical cover under the Social Health Authority framework. This article explains the TSC SHA medical scheme (POMSF), what it covers, how to register and how teachers and their dependants can access benefits under the new fee-for-service model.
Key Takeaways
- The TSC SHA medical scheme (POMSF) replaces the older insurance-style arrangement with a fee-for-service model managed by SHA.
- Coverage is family-shared and includes the principal member, a declared spouse and up to five declared children (with age limits and exceptions for full-time students and dependants with disabilities).
- Registration is available online, via USSD (*147#) and through assisted enrolment at SHA branches, Huduma Centres and TSC county offices.
- Major benefits include outpatient and inpatient care, maternity, dental and optical services, radiology, renal dialysis, oncology and overseas treatment subject to preauthorization and limits.
- Additional national funds (PHCF, SHIF, ECCIF) interact with POMSF to provide layered protection for emergency, chronic and specialized care.
What is the TSC SHA medical scheme (POMSF)?
The TSC SHA medical scheme (POMSF) places teacher medical cover under the Social Health Authority (SHA). The scheme shifts from a commercial insurance model to a fee-for-service approach, increasing the number of empanelled facilities and automating admissions and preauthorizations to reduce delays and rejections.
Who is covered and scope of cover
- Principal member: the teacher registered with TSC and SHA.
- Declared spouse: requires ID and proof of marriage.
- Declared children (up to 5): covered to age 21; up to 25 if wholly dependent and in full-time post-secondary education; no age limit for a child with disability who is wholly dependent. Additional children may be added at the principal member’s cost.
How to register and update dependants
Teachers can register and update beneficiaries using three channels:
- Web self-registration: visit the SHA website and follow the register flow.
- USSD self-registration: dial *147# and accept the terms.
- Assisted enrolment: available at SHA branches, Huduma Centres and TSC County and Subcounty offices.
Common documents required include national ID, birth certificates (or birth notifications for infants), adoption orders where relevant, and disability registration certificates from the National Council for Persons with Disabilities.
How to access benefits
Under the fee-for-service model beneficiaries access care at SHA-empanelled facilities within their limits on a family-shared basis. At point of service providers will verify identity (biometric or OTP) and require supporting documents for dependants.
- Outpatient: consultations with GPs and specialists, basic labs, drugs, counselling, physiotherapy and selected vaccines.
- Inpatient: hospital stays, theatre charges, specialist fees, diagnostics and prescribed medications.
- Maternity: antenatal, delivery (normal and C-section) and postnatal care within applicable inpatient limits.
Main benefits and specialized services
The scheme provides a comprehensive benefits package, including:
- Outpatient and inpatient care
- Maternity and reproductive health services
- Dental and optical services
- Radiology (CT, MRI, mammography, EEG, ECG)
- Renal dialysis and transplant pre-test support
- Oncology (chemotherapy, radiotherapy and related care)
- Drug and substance abuse rehabilitation
- Emergency evacuation and overseas treatment where services are not available in Kenya
- Annual medical checkups for principal and spouse
Interaction with national funds (PHCF, SHIF, ECCIF)
The TSC arrangement operates alongside national funds:
- PHCF (Primary Healthcare Fund) provides basic outpatient services; POMSF supplements beyond PHCF limits.
- SHIF (Social Health Insurance Fund) covers inpatient and other services for all employed Kenyans; POMSF acts as a top-up when SHIF limits are exhausted.
- ECCIF (Emergency, Chronic and Critical Illness Fund) provides government-funded coverage for severe and catastrophic illnesses; POMSF fills financing gaps after ECCIF support.
Important limits, examples and exclusions
Some SHIF and additional fund limits to note (illustrative figures used by SHA):
- Inpatient daily rates: KES 2,240–4,480 up to 180 days per household.
- Oncology: substantial per-member annual limits for major cancer care.
- Renal dialysis and transplant support with specific caps for sessions and surgeries.
- Exclusions include care at non-contracted facilities, treatments by unapproved practitioners (chiropractors, herbalists, acupuncturists), self-prescribed therapies and clinical trial costs.
Practical steps for teachers
- Register on SHA via web or USSD and list your spouse and children with supporting documents.
- Use empanelled facilities to avoid denial of cover—SHA now lists thousands of public, private and faith-based hospitals.
- Keep copies of ID, birth certificates and any disability registration accessible when seeking care.
- For specialized or overseas treatment, obtain a referral and follow preauthorization procedures with SHA.
Where to find related education resources
Teachers and parents planning student support or curriculum work can find free curriculum materials and past papers useful alongside health planning. See the CBC curriculum designs, download KCPE past papers for revision practice, or use the KCSE/KSCE revision exams for secondary-level preparation.
Summary
The transition to the TSC SHA medical scheme (POMSF) aims to widen access, speed admissions through automation and provide layered protection with national health funds. Teachers should register promptly, confirm their listed dependants, use empanelled facilities and follow SHA preauthorization rules for specialized care to maximise benefits.
