SHA: Your Benefits Breakdown – What Every Teacher Gets Based on Job Group
Understanding Your Medical Cover Limits
The new TSC medical scheme offers graduated benefits based on job groups, ensuring that all teachers receive substantial coverage while recognizing career progression. Here’s your complete guide to understanding what you’re entitled to:
The Benefits Structure Explained
The scheme covers seven key areas: Inpatient care, Outpatient services, Dental care, Optical services, Maternity benefits, Overseas treatment, and Last Expense (funeral cover). Let’s break down what each job group receives:
Entry and Mid-Level Teachers (B5 – C2)
Job Groups B5, C1, and C2 receive:
- Inpatient Care: KSh 1,000,000 per year
- Outpatient Services: KSh 150,000 per year
- Dental Care: KSh 45,000 per year
- Optical Services: KSh 60,000 per year
- Maternity Benefits: KSh 120,000 per year
- Overseas Treatment: KSh 2,200,000 (when authorized)
- Last Expense: KSh 300,000
Senior Teachers (C3 – C5)
Job Group C3:
- Inpatient: KSh 1,300,000 (+30% increase)
- Outpatient: KSh 200,000 (+33% increase)
- Other benefits remain consistent with entry levels
Job Group C4:
- Inpatient: KSh 1,500,000
- Outpatient: KSh 225,000
Job Group C5:
- Inpatient: KSh 1,800,000
- Outpatient: KSh 250,000
Deputy Heads and Principals (D1 – D5)
Job Group D1:
- Inpatient: KSh 2,000,000 (double the B5 allocation)
- Outpatient: KSh 300,000 (double the B5 allocation)
- Maternity: KSh 200,000 (+66% increase)
Job Group D2:
- Inpatient: KSh 2,200,000
- Outpatient: KSh 325,000
Job Group D3:
- Inpatient: KSh 2,500,000
- Maternity: KSh 250,000
Job Group D4:
- Inpatient: KSh 2,800,000
- Outpatient: KSh 400,000
Job Group D5 (Highest Tier):
- Inpatient: KSh 3,000,000
- Outpatient: KSh 450,000
- Maternity: KSh 300,000
Universal Benefits Across All Job Groups
Regardless of job group, ALL teachers receive:
- Dental Care: KSh 45,000 per year
- Optical Services: KSh 60,000 per year
- Overseas Treatment Allocation: KSh 2,200,000 (when medically necessary and authorized)
- Last Expense (Funeral) Cover: KSh 300,000
What the Numbers Mean
These aren’t just figures on paper. A teacher in job group D5 with a serious illness requiring hospitalization can access up to KSh 3 million in inpatient care annually. For context, this could cover extended ICU stays, major surgeries, cancer treatments, and post-hospitalization care—all critical interventions that previously might have caused financial devastation for families.
The outpatient benefits are equally significant. Even entry-level teachers can access KSh 150,000 for routine consultations, diagnostic tests, prescribed medications, and management of chronic conditions—all without hospital admission.
Important Notes
- Benefits are paid net of SHIF (Social Health Insurance Fund) rebates for inpatient care
- The maternity benefit is available ONLY to principal members and their spouses (not dependent children)
- Overseas treatment requires prior authorization and medical referral reports
- All benefits are per family unit, per annum (yearly)
Coming up in Post 3: We’ll dive deep into inpatient benefits—what’s covered when you need hospital admission.