The Mwalimu Comprehensive Medical Cover is the medical insurance scheme provided to teachers employed by the Teachers Service Commission (TSC), offering access to outpatient, inpatient, maternity, dental, optical, emergency, and specialized healthcare services through an accredited network of hospitals across Kenya. The scheme is designed to provide healthcare benefits to teachers and their registered dependants in accordance with the terms of the medical cover.
This guide provides a comprehensive overview of the Mwalimu Comprehensive Medical Cover, including eligibility requirements, registration procedures, categories of dependants, benefits available under the scheme, benefit limits, referral procedures, emergency services, and the list of accredited hospitals where members can access treatment.
Table of Contents
- What is Mwalimu Comprehensive Medical Cover?
- Why the Cover Was Introduced
- Who Is Eligible?
- Dependants Covered
- Registration Process
- Benefits Available (Full Breakdown)
- Benefit Limits by Job Group
- IVF Services
- Last Expense Benefit
- Overseas Referral Services
- Referral and Pre-Authorisation Process
- Accredited Healthcare Facilities
- Member Responsibilities
- Exclusions
- Challenges, Controversy and Government Response
- Frequently Asked Questions
1. What is Mwalimu Comprehensive Medical Cover?
Mwalimu Comprehensive Medical Cover is the medical insurance scheme for all teachers employed by the Teachers Service Commission (TSC) and their registered dependants. Since 1 December 2025, it has been administered by the Social Health Authority (SHA) under the Public Officers Medical Scheme Fund (POMSF) — a top-up arrangement that sits alongside the Social Health Insurance Fund (SHIF), which all employed Kenyans, including teachers, contribute to.
The scheme replaced a ten-year arrangement under AON Minet, delivered through Medical Administrators (K) Limited (MAKL), whose contract with TSC formally lapsed at midnight on 30 November 2025. The switch affected more than 400,000 TSC teachers and their households nationwide, expanding the accredited facility network from roughly 800 hospitals under the old scheme to more than 9,600 facilities under SHA.
2. Why the Cover Was Introduced
The shift to SHA-administered cover was driven by the government’s broader rollout of Universal Health Coverage (UHC) through the Social Health Insurance Fund, established under the Social Health Insurance Act. Rather than maintaining a separate, privately administered scheme for teachers, the government folded teachers’ medical benefits into the national SHA architecture, arguing this would:
- Widen access to a far larger, nationwide network of contracted facilities (public, faith-based, and private).
- Standardise benefits for public servants under one framework, alongside similar transitions for groups such as the National Police Service and Kenya Prisons Service, who moved to SHA in April 2026.
- Improve digital verification, claims processing, and data management through SHA’s centralised systems.
- Support the government’s wider Universal Health Coverage agenda.
3. Who Is Eligible?
Eligible principal members are all serving teachers employed by the TSC. As of March 2026, the scheme covered 413,577 teachers and 807,426 dependants — well over 1.2 million beneficiaries in total. To access benefits, a teacher must be a fully registered, paid-up contributor to the Social Health Insurance Fund (SHIF), with accurate, confirmed dependant details on file with SHA.
4. Dependants Covered
Under the scheme, coverage extends to:
- The principal member (the teacher).
- One declared, legally recognised spouse.
- Up to five declared children, from birth to age 21 automatically.
- Children aged 21–25, if they are full-time students and remain fully dependent on the teacher.
- Children living with disabilities, registered with the National Council for Persons with Disabilities (NCPWD) — for whom SHA has stated there is no upper age limit on coverage, provided they remain declared dependants of the principal member.
Teachers were urged, ahead of the 1 December 2025 rollout, to confirm and update their dependant details to avoid disruption, and this remains good practice periodically, since incomplete or unmapped dependant records have been flagged as a recurring operational issue (see Section 15).
5. Registration Process
To register, confirm, or update dependants under Mwalimu Comprehensive Medical Cover:
- Dial *147# on your mobile phone, or
- Visit the official SHA portals at sha.go.ke or afyayangu.go.ke, or
- Confirm your SHIF contribution status — you must be a fully paid-up SHIF member for the cover to activate.
- Update or add dependants (spouse and children) through the same channels.
- Access services at any accredited SHA-contracted facility using your ID and biometric verification, or an OTP where biometric verification is unavailable.
At the scheme’s launch, SHA also set up a dedicated 24-hour Customer Experience Centre for teachers, reachable via a toll-free hotline (0800 720 601) and email, specifically to handle transition-related queries on access, registration, and benefits.
6. Benefits Available (Full Breakdown)
The Mwalimu Comprehensive Medical Cover consolidates a wide range of benefits:
Outpatient services: consultations, diagnostics, laboratory tests, prescribed medication, and routine outpatient care, with limits reported up to KSh 450,000 depending on job group.
Inpatient services: hospital admission, surgery, specialist treatment, and general hospitalisation, with reported limits ranging from about KSh 1 million to KSh 3 million, depending on job group.
Maternity services: antenatal, delivery, and postnatal care — reported at roughly KSh 10,000 for a normal delivery and KSh 30,000 for a caesarean section, subject to job-group variation.
Dental services: routine consultation and treatment.
Optical services: eye examinations, corrective lenses, and related care.
Emergency treatment: stabilisation and emergency care, including road and air evacuation where medically necessary.
Chronic disease management: ongoing support for long-term conditions.
Renal care/dialysis: with dialysis sessions reported at around KSh 10,650 per session.
Cancer care: specialised treatment within approved benefit limits.
Mental health services: counselling and psychiatric consultation where covered.
IVF services: introduced in 2026 (see dedicated section below).
Overseas referral services: for specialised treatment unavailable locally (see dedicated section below).
Last Expense Benefit: a cash payout to next of kin upon a covered teacher’s death (see dedicated section below).
Health Cabinet Secretary Aden Duale has repeatedly stressed publicly that these benefits have not been reduced from earlier levels, even as tighter utilisation controls and pre-authorisation rules have been introduced — a distinction the Ministry of Health describes as “not a reduction in benefit, but discipline in how public funds are used.”
7. Benefit Limits by Job Group
Benefit ceilings under the scheme are tiered by a teacher’s job group, with higher grades attracting higher limits. Based on figures shared by TSC and Ministry of Health officials in 2026:
| Benefit | Reported Range |
|---|---|
| Inpatient cover | KSh 1,000,000 – 3,000,000 |
| Outpatient cover | Up to KSh 450,000 |
| Maternity (normal delivery) | ~KSh 10,000 |
| Maternity (caesarean) | ~KSh 30,000 |
| Dialysis | ~KSh 10,650 per session |
| Overseas treatment | Up to KSh 500,000–2,200,000 (varies by source and job group) |
| Last Expense Benefit | KSh 300,000 |
Important caveat: exact figures continue to be refined through ongoing tariff and reimbursement negotiations between SHA and healthcare providers, and reported limits have varied somewhat across official statements and media reports over the scheme’s first months. Teachers should always confirm their specific job-group entitlements directly through SHA, the Afyayangu portal, or TSC/union communication rather than relying solely on any single published table.
8. IVF Services
In April 2026, TSC and SHA formally activated In-Vitro Fertilisation (IVF) as a covered benefit under Mwalimu Comprehensive Medical Cover — a first for the scheme. Services initially launched at The Nairobi Hospital, with plans to expand to additional accredited facilities (officials have referenced identifying further IVF-capable centres as implementation continues). IVF access is subject to clinical eligibility criteria and pre-authorisation. SHA also clarified and corrected an earlier communication error that had suggested a marriage certificate was required for IVF access — this is not a requirement.
9. Last Expense Benefit
When a teacher covered under the scheme dies, a KSh 300,000 cash payment is made directly to the named next of kin’s bank account. Unlike most other benefits, this payout is not tied to hospital bills — it is a direct cash benefit intended to ease the immediate financial burden on a deceased teacher’s family, alongside limited related support such as short-term mortuary storage under the broader scheme.
The Last Expense Benefit faced early implementation delays, with government officials confirming in April 2026 that a backlog of claims had been cleared, and that by 28 April 2026, 160 claims had been fully processed and paid out. Government and union officials subsequently agreed on a target of processing new Last Expense claims within 48 hours, as part of a broader package of enhancements agreed in a March 2026 tripartite deal between the Ministry of Health, SHA, TSC, and KNUT.
10. Overseas Referral Services
For specialised treatment unavailable within Kenya, the scheme provides for referral to contracted overseas facilities. As of April 2026, officials confirmed that top-tier hospitals in Turkey, India, and Saudi Arabia had been contracted for this purpose, with hospital lists and access guidelines published on the SHA and TSC websites. By that point, at least one teacher had already been treated abroad under the scheme, and officials described the overseas referral pathway as “fully formalised and operational” following further talks with teacher unions in April 2026.
11. Referral and Pre-Authorisation Process
The scheme generally operates on a tiered referral structure:
- Primary healthcare — first point of contact for routine consultations and treatment.
- Referral to higher-level or specialist facilities — where a condition requires care beyond what a primary facility can offer.
- Pre-authorisation — required for specific procedures, specialised treatment, and overseas referrals, in line with standard SHA protocols. Facilities are required to sign a POMSF Addendum and follow SHA’s standard pre-authorisation process to avoid claim rejections.
- Biometric or OTP verification at the point of service — where biometric verification fails, facilities are expected to initiate an immediate SHA “whitelisting” request using the patient’s name, ID number, and facility code, to avoid delaying care.
12. Accredited Healthcare Facilities
Mwalimu Comprehensive Medical Cover is accessible at SHA-contracted and accredited healthcare facilities nationwide — figures cited by officials at various points in 2026 have ranged from roughly 6,000 to over 9,600 facilities, spanning public hospitals, faith-based institutions, and private providers across all 47 counties. As part of the government’s May 2026 push to strengthen implementation, an updated list of approved facilities was set to be shared with KNUT leadership and published on the SHA platform, reflecting ongoing negotiations between SHA and providers over tariffs and reimbursement.
Because the facility network and specific hospital participation are updated periodically as tariff negotiations conclude, teachers should always check the current list directly via the SHA website or Afyayangu app before assuming a particular hospital is accredited.
13. Member Responsibilities
To ensure smooth, uninterrupted access to benefits, members are expected to:
- Keep personal registration details current and accurate.
- Promptly update dependant information (marriages, births, changes in student status, etc.) via *147# or the SHA portals.
- Present valid identification (and complete biometric/OTP verification) when seeking treatment.
- Follow the required referral and pre-authorisation procedures for specialist or overseas care.
- Use SHA-accredited facilities to ensure claims are honoured.
- Confirm SHIF contributions are up to date, since the cover’s financial liability is contingent on active, paid-up SHIF membership.
14. Exclusions
While a full, authoritative exclusions list should be confirmed directly with SHA/TSC, commonly cited exclusions under comparable public-sector medical schemes — and referenced in relation to this scheme — typically include:
- Treatment at non-contracted or non-accredited facilities.
- Purely cosmetic or elective procedures not medically necessitated.
- Experimental or unproven treatments.
- Certain non-routine/non-KEPI vaccinations.
- Conditions arising from illegal acts or gross negligence.
- Charges incurred without following required referral or pre-authorisation procedures.
15. Challenges, Controversy and Government Response
The rollout has not been without friction, and a balanced account should note this clearly:
- Benefit-cut concerns: In April 2026, claims circulated that the scheme had reduced daily benefits to as little as KSh 1,200. CS Aden Duale publicly dismissed this characterisation, describing the changes as a restructuring for efficiency and accountability rather than a cut to benefits, while reaffirming the KSh 1 million–3 million inpatient and up to KSh 450,000 outpatient limits.
- Strike threat: Teachers had, at points in early-to-mid 2026, expressed strong frustration over service delivery under the new cover, reportedly threatening a national strike — a factor that pushed the Ministry of Health into a series of consultative meetings and corrective measures through the year.
- Co-payment disputes: Some facilities were found to be levying unauthorised out-of-pocket charges on teachers. Following talks with KUPPET in April 2026, the government said it had restored the co-payment structure to its original terms and placed non-compliant providers under review.
- Data and registration issues: Government reviews in March 2026 identified operational challenges including missing biodata and unmapped dependants, prompting SHA and TSC to commit to accelerating automation of beneficiary registration and real-time data exchange.
- Tariff negotiations: Reimbursement rates between SHA and contracted providers were still being finalised well into 2026, a process officials describe as necessary for the scheme’s long-term financial sustainability.
In response to these issues, the Ministry of Health, SHA, TSC, and teacher unions (KNUT and KUPPET) have held a series of joint reviews throughout 2026 and established 47 County Joint Committees — chaired by TSC County Directors and including SHA managers and union representatives — meeting quarterly to resolve local implementation issues.
16. Recent Developments (Timeline)
30 November 2025: MAKL’s administration of the TSC Medical Scheme (under AON Minet) formally lapses at midnight, ending a roughly decade-long arrangement.
1 December 2025: Mwalimu Comprehensive Medical Cover launches under SHA and the Public Officers Medical Scheme Fund. TSC confirms that records for all affected teachers, including 320 patients already admitted across 100 hospitals, transferred successfully to avoid disrupting ongoing treatment. SHA reports a smooth overnight transition, citing Kenyatta National Hospital’s handling of 46 transitions in the first hours.
9 March 2026: CS Aden Duale chairs a review meeting with TSC (led by Acting CEO Eveleen Mitei); the scheme is confirmed to cover 413,577 teachers and 807,426 dependants, with over 227,000 teachers having already accessed care since launch. Stakeholders agree to strengthen TSC processes and establish a joint SHA–Digital Health Agency technical team.
12 March 2026: A tripartite agreement between the Ministry of Health, SHA, TSC, and KNUT introduces enhancements including zero co-pay commitments, a 48-hour target for Last Expense claims, and IVF and overseas treatment provisions, alongside the creation of 47 County Joint Committees.
20–30 April 2026: CS Duale publicly rebuts claims of a KSh 1,200 daily benefit cap; TSC formally activates IVF services at The Nairobi Hospital; officials confirm 160 Last Expense claims fully processed by 28 April; overseas referral hospitals in Turkey, India, and Saudi Arabia are confirmed as contracted, with at least one teacher already treated abroad; KUPPET–Duale talks in Naivasha result in restoration of the original co-payment structure.
7 May 2026: The government announces further measures to strengthen implementation, including advancing SHA–provider tariff negotiations, publishing an updated accredited-facility list for KNUT, and directing SHA to operationalise county-level joint coordination committees within a week.
This section will be updated as new reviews, benefit clarifications, or facility-list updates are officially announced.
17. Frequently Asked Questions
What is the Mwalimu Comprehensive Medical Cover? It is the SHA-administered medical insurance scheme for TSC-employed teachers and their registered dependants, launched on 1 December 2025 under the Public Officers Medical Scheme Fund, replacing the previous AON Minet-administered scheme.
Who qualifies for the scheme? All actively employed TSC teachers, as principal members, along with one declared spouse and up to five declared children (or dependants with disabilities, with no age limit for the latter).
Are retired teachers covered? The scheme as described is built around active, employed TSC teachers as principal members; retired teachers should confirm their specific medical cover status directly with TSC, SHA, or their pension/retirement benefits scheme, as retiree medical arrangements can differ from those of serving teachers.
How do I register or update my dependants? Dial *147#, or visit sha.go.ke or afyayangu.go.ke.
How many dependants can be covered? Up to five children plus one spouse, in addition to the principal member (teacher); children with disabilities registered with NCPWD are not subject to the usual age limits.
Which hospitals accept the cover? Any SHA-accredited and contracted facility — officials have cited figures ranging from roughly 6,000 to over 9,600 facilities nationwide. Always check the current, official facility list via SHA or Afyayangu, since the network is updated periodically.
Does the cover include maternity services? Yes, including antenatal, delivery (normal and caesarean), and postnatal care, with reported maternity benefit figures of around KSh 10,000 for normal delivery and KSh 30,000 for caesarean section.
Are dental and optical services included? Yes, both are part of the standard benefits package.
Is cancer treatment covered? Yes, specialised cancer care is included within approved benefit limits.
Does the scheme cover dialysis? Yes — dialysis has been reported at around KSh 10,650 per session under the scheme.
Is IVF covered? Yes, as of April 2026. IVF services were formally activated, initially at The Nairobi Hospital, subject to clinical eligibility and pre-authorisation.
How do referrals work? Care typically starts at a primary facility, with referral to specialist or higher-level facilities as needed; certain procedures and all overseas referrals require pre-authorisation.
What is the Last Expense Benefit? A KSh 300,000 cash payment made directly to a deceased teacher’s designated next of kin, intended to help cover funeral and immediate financial needs, separate from any hospital-bill-linked benefit.
Read Also: Ksh1.5 Billion Released, Yet Teachers Remain Unpaid as KNUT Threatens 2026 Exam Boycott
What should I do if a hospital declines my cover or asks for unauthorised payment? Report the issue through SHA’s Customer Experience Centre (toll-free 0800 720 601) or TSC/union channels — the government has stated it is actively reviewing facilities found levying unauthorised out-of-pocket charges.
Where can I obtain the latest list of accredited facilities? Through the official SHA website (sha.go.ke), the Afyayangu portal/app, or updated lists shared with teacher unions such as KNUT and KUPPET.
Is this the same as the Mwalimu National DT Sacco’s medical products? No — this is distinct from any Sacco-based medical or welfare products (such as Mwalimu National DT Sacco’s Risk Fund, BBF, or retiree health cover). Mwalimu Comprehensive Medical Cover is a TSC/SHA government scheme, not a Sacco product.
