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DEFENCE FORCES MEDICAL INSURANCE SCHEME REGISTERED TRUSTEES

Background

Way back in 1996, the Kenyan Military leadership realised that their retirees were becoming vulnerable to ill health since their entitlement for healthcare ceased immediately upon retirement. This realization led to the introduction of the Kenya Defence Forces Medical Insurance Scheme (DFMIS) whose goal was to give a chance to the serving members to contribute a small portion of their basic salaries that would accumulate over a period of 15 years or so to be able to take care of their healthcare (together with their dependants) in their retirement.

Establishment and Nature of the Trust

The scheme was registered on 1st September 2001 as a Trust under the name The Kenya Defence Forces Medical Insurance Scheme Registered Trustees and there after issued with a certificate of incorporation on 31st January 2002 . The Trust is constituted under the Trustees (Perpetual Succession) Act Chapter 164 and all other enabling provisions of the Laws of Kenya and places the control of the scheme under a Board of Trustees to represent the stakeholders.

Objectives

The objective of the scheme remains to give a chance to the serving members of Defence Forces to participate while they are serving. Serving members would put aside a small amount of money (3.1% of ones basic salary), which would build up over a period of fifteen years or so (depending on the length of service of the contributor). The money so contributed would be used to provide members and their families with Medicare services after retirement, without further subscription .

Management of the Trust

The overall management of the Trust is vested on a Board of Trustees, which is the highest policy and decision-making organ of the Trust. It is composed of members of the Defence Council, Assistant Chief of Defence Forces, Personnel and Logistics (ACDF P&L), a retirees' representative and the Managing Director as shown here below:

  1. Cabinet Secretary for Defence- Chairman
  2. Chief of Defence Forces-Member
  3. Principal Secretary, MOD- Member
  4. Commander Kenya Army -Member
  5. Commander Kenya Air Force- Member
  6. Commander Kenya Navy- Member
  7. Retirees Representative- Member
  8. ACDF P&L- Secretary
  9. Managing Director Ex-Officio- Member

The day-to-day management of the Trust is vested on a Board of Management functioning under the general and special superintendence of the Board of Trustees. A Managing Director assisted by six professionals heads this Board. Currently a Personnel/Administration Manager and a Claims Manager are assisting the Managing Director.

Actuarial Recommendations

To facilitate a smooth take off, the actuarial consultant had recommended a minimum take up rate of 75% membership of the servicing strength. However, in June 2000 this was revised downwards to between 55% and 58%. The number of members ever recruited stands at 53.30% of the serving strength while the current number of contributors stands at 44.90% of the serving strength. The minimum take up rate of between 55% and 58% was critical were the scheme to be operational within the first six months from the date of commencement. This was however, overtaken by events and the scheme has since taken off smoothly financially.

Membership
  • Membership of the trust is voluntary for all serving members of the Kenya Defence Forces who were in service as at the commencement dates when the first contributions began to the end of Dec 2001.All other persons joining Defence Forces as as from Jan 02,the scheme membership is compulsory.
  • A serving member of the Kenya Defence Forces whether enlisted or commissioned shall, on taking the oath of allegiance, be automatically eligible for membership.
  • Former members of the Kenya Defence Forces who had retired honourably with a service gratuity and or a pension during the period of ten years immediately preceding the commencement date of this Trust are also eligible to become members of the Trust.
  • Every person who has become a member of the Trust shall in case of serving members of Defence Forces remain a member until he dies or retires.
  • In the event of death whether he was a fully paid up member or not, his membership will cease without affecting the rights of the dependants who shall continue to receive benefits as follows:
    • Spouse - covered for life.
    • Children - covered up to the age of 21, but can be extended up to the age of 25 provided the child has no income of his/her own and still living with the parents.
  • When a full paid up member retires, he and his dependants shall be entitled to all the benefits provided by the fund.
  • When a serving contributor retires prematurely, before making full contributions for a period of 15 years, he/she may:
    • Pay the determined lump sum at once, or
    • Pay 50% of determined lump sum and the balance within a period of not more than seven and a half years from the date of retirement.
  • Retired members of Defence Forces wishing to join may do so upon either full payment of the determined lump sum or pay 50% of the total premium payable for full membership and the balance within a period of not more than seven and a half years from the date of admission into the scheme. The delayed payment of 50% coupled with the extension of services to the members will however mean loss of interest. Consequently, to bring this member at par with a member who opts to pay 100% of the determined lump sum, the actuary determined loading factors as follows; 5 years 1.22, 6 yrs 1.26, 7 yrs 1.30 and 7 and a half yrs 1.32. This therefore means that the 50% balance will be multiplied by the factor corresponding to the chosen period, and then divided by the number of months over the said period to arrive at the monthly payments.
  • Opt for a refund without interest if he/she does not wish to contribute to a full membership
Dependants

- Every contributor shall be required to nominate one spouse and a maximum of four dependants.

- A contributor shall be allowed to declare and nominate his dependants only once. Under no circumstances will another person substitute a dependant.

- Every contributor shall at least six months before his retirement or if retired immediately upon being admitted to participate in the scheme furnish the Board of Management with particulars and details of self and his/her dependants.

- There shall be no lower age limits for the dependants under the trust.

- Where a contributor has more spouses or children, for whom he desires to provide cover under the Trust, he may be allowed to pay special rate of contribution as shall be determined by the Board of Trustees.

  • No dependant nominated by a contributor shall pay any contributions to the fund to qualify for benefits.
  • Except in specialized cases,a contributor shall benefit under the trust until he dies.
Benefits
  • In-Patients:For inpatients healthcare,the scheme shall pay 100% of the legitimate bills incured by a member or dependant during his hospitalisation save for specialized cases.
  • Outpatients:For outpatient healthcare,the scheme shall pay 75% of the legitimate bills incurred by a member or dependent save for specialized cases.The member shall be responsible for 25% of the total bill.

No benefits due to a member shall become available to him or payable until the day following the date of his retirement from the Defence Forces or if a member joins the Trust after his retirement on the date when he pays the required premium as laid down in the Trust.

The benefits promised under the Trust shall be available and obtainable only in the Republic of Kenya except in specialized cases where the Board of Trustees may have to approve in advance.

The 'Trust' is not a savings scheme or a cooperative society. The stated object of the Trust is that members and their dependants shall benefit from the fund by receiving healthcare and not cash refunds.

Procedure for obtaining benefits

Members may seek and obtain healthcare services only on prescribed facilities and not elsewhere. The Board of Management will provide members with updated list of the prescribed Healthcare facilities from time to time.

Positive identification of the members of the Trust shall be pre-requisite for admission to health care facilities.

If a member is admitted into a facility, the doctor/administrator responsible shall prepare a bill in respect of such admission and have the member endorse the bill upon discharge and the bill be sent to the Trust Headquarters for payment.

If a member is an outpatient, the doctor/administrator responsible shall require him to pay 25% of the bill and raise a bill for the remaining 75% and send it to the Trust Headquarters for payment.

Every claim for service/s rendered will have to be submitted to the Trust Headquarters within sixty days of rendering such services.

Withdrawal of Benefits

The benefits under the fund shall cease if:

  1. In case a contributor dies.
  2. Being a spouse, she dies or remarries, following the death of a contributor or divorces the contributor.
  3. Being a child, he/she dies, gets married, or attains the age of 21yrs PROVIDED any child who is under the age of 25 has no income of his/her own and still living with the contributor.
  4. The contributor ceases or fails to make contribution to the fund.
  5. The contributor is found guilty of gross miss-conduct warranting his expulsion from the Trust.
  6. If a member is convicted by a court of law for any offence against the Trust.

 

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