The Teachers Service Commission (TSC) has initiated sensitisation of teachers on new medical scheme cover, Social Health Authority (SHA).
TSC plans to teach teachers on how to register self and dependants and detailed benefits of the insurance cover.
Teachers will be migrated from AON MINET medical scheme to comprehensive SHA starting 1st December 2025.
SHA accepts the principal member (teacher) and one spouse and maximum of five children.
No medical allowance will be returned to teachers as they will be moved to comprehensive SHA which is similar to the MINET cover.
However two teachers i.e. education blogger, Peter Amunga, and Martha Omolo, the Kenya National Teachers Pressure Group (KNTPG) member have filed a case at Kisumu court seeking to stop TSC from migrating teachers from AON medical insurance to SHA.
Below is the circular by TSC targeting to sensitize teachers on SHA as required by law.
TEACHERS SERVICE COMMISSION
INTERNAL MEMO
TO: ALL TSC COUNTY DIRECTORS
REF: CS/TSC/2/VOL.XXXII/69
The Commission has procured a comprehensive medical cover for teachers from Social Health Authority (SHA) with effect from 1st December 2025.
The Commission together with SHA is required to sensitize teachers on the scope of the cover, member obligations and rights, Scheme operations and benefits structure.
The Authority (SHA) through their POMSF champions has organized member education exercise for all teachers for a period of two (2) weeks from 29th November 2025 to 5th December 2025.
You are therefore requested to mobilize all teachers within your Counties and provide the necessary support to the SHA officers during this exercise.
Limited empaneled hospitals across the country;
Insurance model;
Rejection of admission requests forcing teachers to use their own resources;
Lengthy procedures in Pre-authorization or approval for admissions and discharges;
Inadequate specialists in most facilities, especially outpatient services;
Inadequate supply of original quality drugs;
Poor management of Chronic conditions;
Few optical and dental care providers empaneled;
Restricted cover for dependants (moreso for teachers with more dependants than the maximum provided by the employer);
Lengthy onboarding criteria; and
• A child with disability who is wholly dependent on the principal member – in this case there shall be no age limit for coverage of a person with disability declared as a dependent of the principal member
• Additional children above the five covered can be included at an additional premium paid by the principal member.
REGISTRATION PLATFORMS & PROCESSES (SELF)
Web Self-registration
On your web browser, open the SHA website- https://sha.go.ke/
click on register and start the registration process.
USSD Self-registration
Dial *147# on your mobile device then proceed to accept the SHA terms and conditions.
Assisted Enrolment
It is assisted registration done in our SHA branches, Huduma Centres and TSC County and Subcounty offices
Registration of Teenage & Underage Mothers
Registration now possible for teenage mothers at SHA branches, Huduma Centres and TSC County and Subcounty offices.
REGISTRATION & UPDATING OF BENEFICIARIES
Spouse-ID of spouse and proof of marriage
Child-Birth notification/Certificate
Adopted Child-Adoption Order
A child for who the contributor is a Guardian-Will, Deed or court order or other document recognized under the Children’s Act
Person with Disability-ID & Certificate of Registration from National Council for Persons with Disabilities
Persons under lawful custody-Prison admission number or remand identification number of copy of ID
Child in conflict with the law-admission number of the children’s remand home, rehabilitation institution or borstal institution or Child’s birth certificate
CHANGE OF SPOUSE
A 30-day waiting period applies when a member changes their declared spouse for the first time before the new spouse becomes eligible for services.
For any subsequent spouse change, a 6-month waiting period applies before eligibility for services
In case the change is due to death of a spouse, the waiting period does not apply.
HOW TO ACCESS MEDICAL BENEFITS
Accessing Outpatient services
i. All scheme beneficiaries shall access outpatient services on fee for service within their limits which are on family shared basis.
Requirements at the Healthcare Provider
A copy of the National Identification Card with Biometric and/or OTP verification.
Accessing Inpatient Services
All scheme beneficiaries shall access inpatient services on fee for service within their limits which are on family shared basis.
Documents required at point of service
i. A copy of the spouse’s ID.
ii. Copy of birth certificate for a child or copy of birth notification for child below six (6) months or copy of adoption certificate.
iii. A copy of registration Certificate with the National Council for Persons with Disability
iv. A letter of proof that the child is enrolled in a full-time learning institution for children above 21 years will be required.
TEACHERS BENEFIT PACKAGE BY THE COMMISSION UNDER POMSF
Comprehensive Benefit Package Summary
1. Outpatient & Inpatient Cover
2. Maternity package
3. Dental and Optical
4. Radiology services
5. Renal Dialysis
6. Oversees treatment
7. Annual medical checkup
8. Chronic Illness
9.Tests for donors
10. Evacuation services
11. Drug and substance abuse rehabilitation
BENEFITS PACKAGE DETAILS
Outpatient Cover
Cover includes; Consultation with a General Practitioner & Specialist, basic laboratory investigations, drugs & dispensation, health education, wellness and counselling,
Physiotherapy services and the following vaccines; KEPI vaccines, Rota virus vaccine, Anti- rabies and Anti-snake venom.
Inpatient Cover
Optical Package
Includes cost of consultation with ophthalmologist/optometrist, eye testing, glasses for refractive errors, optical frames and lenses.
Emergency Care
Covers emergency evacuation(road & air) for principal members and dependants to facilities with adequate care, ensuring timely access to critical treatment.
Foreign Treatment
• These services shall be on fee for service basis.
• Services available in SHA Empaneled and Contracted Facilities
Services Covered
Renal Dialysis & Renal Transplant
Optical & Dental
Chronic Illness e.g., Diabetes, Hypertension
Radiological Tests e.g., MRI & CT Scan
Oncology
Orthopaedic Appliances
Drug and Substance Abuse Rehabilitation
Overseas Treatment
CRITICAL ILLNESS FUND
PRIMARY HEALTHCARE FUND
INDIVIDUALS CONTRIBUTE PREMIUMS
GOVERNMENT FUNDING
Benefits accessed by all registered members to SHA
Benefits accessed only by paid-up members
Accident and Emergency services accessible to all Kenyan residents
PHC Package
• Outpatient – KES 900 per annum per beneficiary
Optical Services – Limit of KES 1,000 per annum (children < 18 years)
SHIF PACKAGE
Inpatient
KES 2,240 – 4,480 per day of admission up to 180 days per household
Maternity
Normal delivery – KES 10,000 • C- section – KES 30,000 • Anti-D Serum – KES 6,000
Oncology
KES 400,000 per member per annum
Renal Care
• Renal Dialysis – KES 10,650 upto 2 sessions per week
• Peritoneal Dialysis – KES 85,200 per month
• Pre-transplant recipient evaluation – Limit of KES. 150,000 per household
• Recipient surgery – KES 700,000
• Donor nephrectomy – KES 168,000
• Post-renal replacement therapy – Limit of KES 200,000 per household
Medical Imaging
• MRI – KES 11,000
• Mammography – KES 3,000
• CT Scans – KES 6,900
• Fluoroscopy – KES 4,000
• CT Angio – KES 8,000
• Echocardiograms (ECHO) – KES 3,500
catastrophic illnesses (e.g., accident & emergency, cancer treatment, ICU/HDU). Accessible to all Kenyans. Public officers benefit from ECCIF first, like all citizens, for life-threatening conditions. POMSF bridges any financing gaps not fully covered by ECCIF, ensuring public officers and their dependents have full access to advanced treatment.
PHCF Role: Provides basic outpatient and promotive health services at the primary level, fully funded by government. Accessible to all Kenyans registered under SHA. POMSF only supplements by covering enhanced or specialized services once basic care pathways are exhausted