- The Education ministry rolled out the student medical cover in May 2018 to enable students in public secondary schools to access comprehensive medical services.
The scheme was further enhanced in January this year. The government pays Sh1,350 for each student.
Thousands of secondary school students are unable to access the National Health Insurance Fund’s (NHIF) EduAfya medical services. This came after the fund said it will not pay for services offered by unaccredited health facilities in schools.
With school administrators in a quandary over the directive, a crisis meeting is set for Wednesday between the Ministry of Education and NHIF officials to unlock the impasse.
In a September 5 letter to the health service providers, NHIF said it will not pay for services offered to students by the unaccredited facilities stationed in schools. “It has been noted with great concern that some facilities are generating EduAfya claims from non-accredited facilities especially from school clinics or sanatoriums,” read the letter.
The Nation has learnt that the most affected facilities are those that previously offered services to schools before the government launched the students medical scheme. NHIF said some schools breached the service contract and engaged facilities that are not recognised by NHIF.
“You are advised not to submit any claims that may have been raised from the above mentioned arrangements,” the hospitals have been told.
The health facilities have been advised to refer to their contracts for the definition of accreditation or accredited facilities. The insurer has further said all claims from hospitals offering services to schools will be subjected to audit verification and if found unsuitable for payment, necessary actions will be taken against them.
“No claim should arise from medical camps or outreach treatment plans,” read the letter.