Staff Health Insurance

Teachers’ Questions

When we first set up the scheme, we received some answers in response to teachers’ questions:

Maternity Care: Can a member travel to another country within their geographical area to deliver a baby?
“Indeed a member can travel to another country for the delivery providing that they are fit for travel. The member would need to ensure that they call our assistance company CEGA in advance to ensure that the treatment is case managed and guarantees of payment can be in place with the hospital. We would however not be able to meet the travel costs if treatment is available locally.”

Chronic Conditions: Is all treatment for these fully covered within the limits specified for general care?
“Yes, all treatment for Chronic conditions is fully covered within the terms and benefit limits of the policy.”

Treatment unavailable in Moshi/Arusha?: We commonly have a situation where a doctor recommends that the treatment available in the Moshi/Arusha area is either unsuitable or non-existent. In these cases a member may elect to travel to Nairobi or elsewhere for treatment. Assuming this is NOT an emergency, but is nevertheless medically necessary, would any travel costs be covered?
“If a doctor recommends treatment that is not available locally, we will meet the travel costs. The insured will need to call our assistance company CEGA who will advise where the nearest centre of excellence is to receive the required treatment. Our assistance company will also take into consideration the insured’s preference as the which country they travel to providing that there is not a huge differential in the travel costs. In the event of a medical emergency our assistance company it is not always able to evacuate the insured to their preferred country as it may not be medically viable.”

Home Country Treatment: Can a member elect to receive treatment anywhere in their geographical area (including home country) provided that they pay travel costs?
“Yes, treatment is available at the same level of benefit within their territorial scope of cover. Although please note the Return to Home Country ruling which will be applicable to American and Canadian members of the scheme: Cover can remain in force when an Insured Person returns to his/her Home Country except for USA and Canadian nationals, whose cover will automatically be cancelled following three consecutive months in the Home Country. Cover in the Home Country is only available if the relevant premium has been paid to include that Geographical Area.”

School sports/Outdoor activities: Is an accident arising from participation in normal school sports and outdoor activities covered?
“Yes, any accidents would be covered within the terms and benefit limits of the policy.”