SHA: Dental and Optical Benefits – Caring for Your Smile and Vision
Comprehensive Coverage Beyond General Medical Care
The TSC-POMSF scheme recognizes that complete healthcare extends beyond treating illnesses—it includes maintaining your dental health and vision. Here’s what’s covered for all teachers, regardless of job group.
Dental Benefits – KSh 45,000 Per Year
Every teacher receives the same dental allocation: KSh 45,000 annually, regardless of job group. This equality ensures all teachers can maintain good oral health.
Core Dental Services Covered
Consultations and Assessments:
- Dental consultation fees
- Oral examinations
- Treatment planning
Anesthetist’s Fees: When dental procedures require anesthesia (local or general), the anesthetist’s professional fees are covered.
Diagnostic Services
Dental X-rays:
- Panoramic X-rays (full mouth imaging)
- Periapical X-rays (individual tooth imaging)
- Bitewing X-rays (for cavity detection)
- X-rays necessary for treatment planning
Root Canal Treatment: Complete coverage for endodontic procedures, including:
- Diagnosis and treatment planning
- Root canal procedure
- Temporary and permanent fillings
- Follow-up care
Surgical Procedures
Tooth Extraction:
- Simple extractions
- Surgical extractions
- Wisdom tooth removal when medically necessary
- Post-extraction care and management
Medically Necessary Procedures
Scaling:
- Covered when necessitated by prevailing medical conditions
- Must be prescribed by a dentist
- Important for conditions like diabetes, heart disease, and pregnancy
Dentures Necessitated by Accident/Injury: If an accident causes tooth loss:
- Denture fabrication is covered
- Includes partial and full dentures
- Essential for restoring function and appearance after traumatic injury
Deformation Surgery: Corrective dental surgery for deformations, including:
- Jaw realignment procedures
- Correction of facial/dental abnormalities
- Reconstruction after accidents
Dental Crowns:
- Crowns when medically necessary
- Restoration of damaged teeth
- Protection of teeth after root canal treatment
What’s NOT Covered in Dental
Cosmetic Dental Care:
- Cosmetic crowns, caps, and bridges
- Orthodontics (braces) for purely aesthetic reasons
- Dentures for cosmetic purposes
- Self-prescribed teeth cleaning and whitening
- Veneers and cosmetic bonding
Maintenance and Replacement:
- Replacement or repair of old dentures, bridges, and plates
- Exception: Damage resulting from an accident is covered
Non-Prescribed Services:
- Self-directed dental treatments
- Services not prescribed or supervised by a licensed dentist
Optical Benefits – KSh 60,000 Per Year
Like dental benefits, optical coverage is KSh 60,000 annually for all teachers, regardless of job group.
Vision Care Services Covered
Comprehensive Eye Examinations:
- Vision testing and assessment
- Eye health evaluations
- Prescription determination
- Glaucoma screening
- Diabetic eye examinations
Lenses and Frames:
- Prescription eyeglasses
- Single vision lenses
- Bifocal lenses
- Progressive lenses
- Lens coatings when prescribed
Important Limitation: Members who have obtained frames are not entitled to replacement within one year unless:
- Necessitated by a medical condition AND
- Prescribed by an ophthalmologist
Specialized Optical Services
Ophthalmic Treatment:
- Prescription medications for eye conditions
- Treatment for infections, inflammations, and diseases
- Management of chronic eye conditions
Ophthalmic Ultrasound:
- Advanced diagnostic imaging of the eye
- Must be prescribed by an ophthalmologist
- Used for conditions affecting internal eye structures
Eye Surgery: Complete coverage for medically necessary eye surgeries, including:
- Cataract surgery
- Glaucoma surgery
- Retinal surgery
- Pterygium removal
- Corneal procedures
- Strabismus correction (eye muscle surgery)
What’s NOT Covered in Optical
Non-Prescribed Items:
- Lenses and frames not prescribed by an ophthalmologist
- Over-the-counter reading glasses
- Fashion eyewear without medical necessity
Specialty Lenses (Unless Prescribed):
- Photo-chromatic lenses (transition lenses)
- Anti-glare lenses
- Tinted lenses for non-medical purposes
Important Note: These specialty lenses ARE covered if prescribed by a doctor for medical reasons (e.g., light sensitivity due to eye condition or medication).
Maximizing Your Dental and Optical Benefits
For Dental Care:
Annual Preventive Visits: Even though routine cleaning isn’t covered unless medically necessary, comprehensive check-ups are. Schedule annual dental consultations to:
- Identify problems early
- Get necessary scaling prescribed if you have conditions like diabetes
- Prevent expensive procedures through early intervention
Emergency Dental Care: Dental emergencies and pain management are covered. Don’t delay seeking care for:
- Severe toothache
- Dental abscesses
- Broken or knocked-out teeth
For Optical Care:
Regular Eye Examinations: Schedule comprehensive eye exams:
- Every two years if you’re under 40 with no vision problems
- Annually if you’re over 40
- Annually if you have diabetes or other conditions affecting vision
Timing Your Prescriptions: Since frame replacement is limited to once per year (unless medically necessary):
- Plan your eye exam timing strategically
- Keep spare glasses if possible
- Report significant vision changes promptly
Protect Your Eyes: While the scheme covers corrections and treatments, prevention is still better:
- Use proper lighting when reading and working
- Take screen breaks during digital work
- Wear protective eyewear in hazardous environments
Special Considerations for Teachers
Occupational Eye Strain:
Teachers spend considerable time:
- Reading student work
- Using computers and projectors
- Writing on boards
These activities can strain eyes. Your optical benefits support:
- Computer glasses if prescribed
- Regular prescription updates as vision changes
- Treatment for eye strain and fatigue
Professional Appearance:
Both dental and optical health contribute to professional presence in the classroom:
- Dental care ensures clear speech and confidence
- Vision correction ensures you can effectively monitor students and read materials
Real-World Application
Example Scenario: Teacher discovers cavity during check-up:
Services covered under KSh 45,000 dental allocation:
- Dental consultation: ~KSh 2,000
- Dental X-ray: ~KSh 1,500
- Filling or root canal: ~KSh 8,000-15,000
- Follow-up visit: ~KSh 1,500
Remaining balance: KSh 30,000+ for additional family member needs
Vision Example: Teacher needs new prescription glasses:
Services covered under KSh 60,000 optical allocation:
- Comprehensive eye exam: ~KSh 3,000
- Prescription lenses (progressive): ~KSh 12,000
- Frames: ~KSh 8,000
- Lens coatings (if prescribed): ~KSh 4,000
Remaining balance: KSh 33,000 for spouse or dependent needs
Coming up in Post 7: Emergency evacuation services—when you need urgent care or transfer to specialized facilities.