SHA: Emergency Evacuation and International Referrals – Access to Critical Care

SHA: Emergency Evacuation and International Referrals – Access to Critical Care

Life-Saving Transportation and Overseas Treatment Coverage

Medical emergencies don’t always happen near quality healthcare facilities, and some conditions require treatment unavailable in Kenya. The TSC-POMSF scheme includes comprehensive evacuation and international referral benefits to ensure you can access the care you need, wherever it’s available.

Medical Emergency Road and Air Evacuation

What is Emergency Evacuation?

Emergency evacuation provides transportation for sick or injured teachers or dependents from:

• The location of an incident OR
• A facility with inadequate care

TO:

• An appropriate facility with adequate care

Types of Evacuation Covered

Ground Transportation:

• Road ambulance services: Fully equipped ambulances with medical personnel
• Mobile ICU: Advanced life support ambulances when required
• Coverage across all East African partner states

Air Transportation:

• Fix-wing aircraft: For longer distances requiring rapid transport
• Helicopter services: For emergency situations requiring immediate evacuation
• Particularly crucial in remote areas or when ground transport would be too slow

Geographic Coverage

Emergency evacuation is available within East Africa:

• Kenya (all counties)
• Uganda
• Rwanda
• Tanzania

This regional coverage ensures teachers working in border areas or traveling within East Africa have access to quality healthcare.

Air Evacuation Limitations

Important Restriction: Air evacuation is limited to two (2) per family per annum within the policy period.

This means:

• Your family can use air evacuation up to twice per year
• Ground ambulance evacuations are not subject to this limit
• The limit resets annually

When is Evacuation Used?

Common Scenarios:

• Serious road traffic accidents in remote areas
• Heart attacks or strokes requiring immediate specialized care
• Severe trauma requiring surgical intervention not available locally
• Complications during pregnancy in areas without obstetric services
• Serious illnesses in schools located far from major hospitals
• Life-threatening emergencies requiring ICU-level care during transport

How to Access Emergency Evacuation

In an Emergency:

1. Call the emergency number provided by the scheme
2. Provide location and nature of the emergency
3. Medical personnel will assess and dispatch appropriate transport
4. No pre-authorization required for genuine emergencies

Important: This service is for genuine medical emergencies, not routine transfers or convenience.

International Travel and Referral Allocations

What is International Referral?

The scheme provides KSh 2,200,000 (for all job groups) when authorization is granted for international medical treatment.

When Does This Apply?

International referral is approved when specialized treatment is:

1. Not available locally in Kenya OR
2. Reasonably cheaper AND better quality than available locally

This recognizes that some highly specialized treatments or procedures may not be available in Kenya, or that treatment abroad may offer better outcomes or value.

What the Allocation Covers

Travel Costs:

• Air ticket for the patient: Return ticket to the treatment destination
• Air ticket for one aide: A family member or caregiver to accompany the patient
• Economy class travel unless medical necessity requires otherwise

Accommodation:

• Accommodation for both patient and aide
• Duration based on medical necessity
• Reasonable hotel or furnished apartment costs

Medical Treatment Costs

The international referral allocation may also contribute to:

• Consultation fees abroad
• Diagnostic tests not available in Kenya
• Specialized procedures
• Follow-up care during the international visit

Note: The KSh 2,200,000 allocation covers travel, accommodation, and may contribute to treatment costs, but your primary medical benefits (inpatient/outpatient allocations based on job group) are the main funding source for actual medical treatment.

Required Documentation

Medical Referral Report: A comprehensive medical referral report is mandatory to facilitate overseas treatment. This must include:

• Complete medical history
• Diagnosis and current condition
• Treatment received locally
• Reason international treatment is necessary
• Specific treatment or procedure recommended
• Estimated duration of treatment
• Prognosis and expected outcomes

Who Prepares the Referral:

• Your treating physician in Kenya
• Specialist doctors managing your condition
• May require input from multiple medical professionals
• Should include all relevant test results and imaging

Authorization Process

Steps for International Referral:

1. Medical Assessment: Your doctor determines need for international treatment
2. Documentation: Comprehensive referral report prepared
3. Submission: Application submitted to SHA/POMSF for review
4. Medical Review: Scheme medical team evaluates necessity
5. Authorization: If approved, travel and accommodation arrangements made
6. Treatment: Travel for treatment with financial support
7. Follow-up: Return to Kenya with continuation plan

Common International Referral Destinations

While the scheme doesn’t limit destinations, common referral locations include:

• India: Cost-effective specialized care, particularly for cardiac surgery, cancer treatment, orthopedics
• South Africa: Advanced cancer treatments, specialized surgeries
• Europe: Rare disease treatments, specialized pediatric care
• Middle East: Specialized surgical procedures, cancer treatment

What’s NOT Covered

Unauthorized Travel:

• Medical tourism (travel abroad for treatment without authorization)
• Routine procedures available