Kenya Armed Forces Medical Insurance Scheme Registered Trustees

KENYA ARMED 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 Armed Forces Medical Insurance Scheme (KAFMIS) 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 Armed 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 the Armed 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 the General Staff, Personnel and Logistics (ACGS P&L), a retirees' representative and the Managing Director as shown here below:

a. Minister of Defence- Chairman

b. Chief of the General Staff -Member

c. Permanent Secretary, DOD- Member

d. Commander Kenya Army -Member

e. Commander Kenya Air Force- Member

f. Commander Kenya Navy- Member

g. Retirees Representative- Member

h. ACGS P&L- Secretary

i. Managing Director Ex-Officio- Member

5. 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

6. 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 Armed 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 the Armed Forces as as from Jan 02,the scheme membership is compulsory.
A serving member of the Kenya Armed Forces whether enlisted or commissioned shall, on taking the oath of allegiance, be automatically eligible for membership.
Former members of the Kenya Armed 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 the Armed 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 the Armed 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 Armed 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:

• In case a contributor dies.

• Being a spouse, she dies or remarries, following the death of a contributor or divorces the contributor.

• 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.

• The contributor ceases or fails to make contribution to the fund.

• The contributor is found guilty of gross miss-conduct warranting his expulsion from the Trust.

• If a member is convicted by a court of law for any offence against the Trust.

Authorised Healthcare Facilities

The prescribed and authorized hospitals and facilities, which the members gets treatment, are as follows:

Phase1- (Already operational) Contracted Government, Private and Mission Medicare Institutions.

Phase 2 –This phase shall be implemented after establishment of Veterans hospital/s.

Excluded Matters

No (Benefits) payments shall be made from the fund in the following situations:

• Treatment Abroad unless certified by the Medical Advisory Board and sanctioned by the Board of Trustees.

• Self induced or inflicted conditions or injuries.

• Cosmetic or plastic surgery unless certified by a Doctor to be medically beneficial and approved by the Board of Trustees.

• General routine check-ups.

• Funeral and Testamentary expenses in respect of a deceased member.

• Injuries sustained in furtherance of a crime.

• Use of hospitals and healthcare facilities as old peoples home, hospice, sanatorium or a place of recovery or convalesce of invalids or as hotel or residence with a view to getting comfort.

• Refund of a member contribution or part of it in lieu of medical services or Loans whatsoever.

Treatment Cards

• Cards for retired and fully paid up members are prepared and issued to them as need arises.

Current Status

Since its inception way back in 1996,the Kenya Armed Forces Medical Insurance Scheme has grown from bound to bound.The scheme is now fully operational and the current status are as follows:

Membership

Number ever recruited 14,981
Currently contributing 12,552
Number lost through normal attrition 2,429
Receiving treatment 211 fully paid-up members &121 families of deceased members-332

Medicare Facilities

So far the scheme has entered into contract with a total of 95 Medical institutions countrywide as follows:

Nairobi - Nairobi Hospital , Mater Hospital , M P Shah Hospital , Nairobi West Hospital , Menelink Hospital , Metropolitan Hospital , Gertrude's Children's Hospital, Nairobi Women Hospital , Prime care Hospital, St James Hospital, Professional Eye Care, Dr Susan Maina Dental Surgeon, Diagnostic Centre, Optica Ltd. ( Moi Avenue , Mobil Plaza , Jubilee Insurance House, Warwick Centre, Westland 's, The Junction Shopping Mall)

Kiambu- Kijabe Mission Hospital , Nazareth Hospital , PCEA Kikuyu Eye Hospital .

Mombasa- H H The Aga Khan Hospital , Pandya Memorial Hospital , Mary Immaculate Hospital, Optica Ltd.

Kilifi- St Luke Hospital Kaloleni, Kwa Chalo Wamae Medical Centre, Pwani Maternity and Nursing Home.

Kwale- Diani Beach Hospital .

Malindi- Star Hospital , Sea Breeze Medical Centre .

Tana River- Bakalcha Medical Centre.

Mtito Andei- Suleman Farooq Memorial Medical Centre, Dr Dino Kyalo Clinic.

Lamu- Maria Teressa Nuzzo (Mpeketoni).

Voi-Mount View Maternity & Nursing Home .

Machakos- Bishop Urbana's Kioko Mission Hospital , Matuu Nursing Home, Kikoko Mission Hospital (Nunguni).

Marsabit- Marsabit Medical Clinic.

Nakuru- Valley Hospital, Baraka Maternity &Nursing Hospital, Nakuru Nursing &Maternity Hospital, Crater Medical Center, Evans Sunrise Medical Centre, Nakuru War Memorial Hospital, Optica Ltd, Ol-Jorai Health Centre.

Eldoret- Plateau Hospital , Elgon View Hospital , Moi Referral University Hospital .

Kitale-Moi's Bridge Hospital , Kitale Nursing Home. Mount Elgon Hospital .

Kapenguria- Ortum Mission Hospital .

Nyahururu- Good Hope Medical Center , Kinangop Mission Hospital.

Nyeri- Consolata Hospital , Outspan Hospital, Optica Ltd, PCEA Tumutumu Hospital, Mary Immaculate Hospital (Mweiga), Jamii Hospital (Karatina).

Nanyuki- Nanyuki Cottage hospital, Nanyuki Nursing & Maternity Home.

Meru- Consolata Hospital Nkubu, P. C. E A. Hospital Chogoria, Milimani maternity & Nursing Home, St John of God Mission Hospital (Tigania) Consolata Mission Hospital (Chuka).

Embu- Consolata Mission Hospital Runyenjes, Joy Kim Nursing Home .

Kerugoya Kutus- ACK Mount Kenya Hospital , Mweya Mission Hospital .

Koibatek – Mercy Mission Hospital ( El-Dama Ravine).

Baringo – Barnet Memorial Hospital , Kipsaraman Mission Hospital.

Kapsabet – Kapsabet Health Centre.

Narok – Maasai Nursing Home, A.I.C Siapei Dispensary.

Kericho -St Leonard's Hospital, Kericho Nursing Home.

Sotik- Kaplong Mission hospital.

Bomet- Tenwek Hospital .

Litein- Litein AIC Hospital.

Kisii- Tabaka Mission Hospital, Christa Marianne Hospital, Ram Memorial Hospital, Optica Ltd.

Migori-St Joseph 's Mission Hospital .

Kilgoris - St Joseph's Mission Hospital.

Nyamira – Nyamira Maternity & Nursing Home.

Oyugis - Masogo Nursing Home.

Sondu- St Joseph's Mission Hospital.

Kisumu- Nightingale, Jalaram Nursing Home, St Monica Catholic Hospital, Optica Ltd.

Bondo- St Elizabeth Lwak Hospital, Bondo Medical Clinic .

Homa Bay- St Paul's Mission Hospital.

Maseno- Maseno Hospital.

Kaimosi- Friends Hospital Kaimosi.

Kakamega -St Elizabeth Hospital Mukumu, Nala Maternity & Nursing Home, Kakamega Central Maternity & Nursing Home .

Bungoma - Elgon View Medical Cottage, Lumboka Memorial Hospital.

Mumias- St Mary's Hospital.

Siaya- Bama Nursing Home.

Funyula- Holy Family Hospital Nagina.

Busia- Tanaka Nursing Home.

Webuye- Misikhu Mission Hospital , Lugulu Mission Hospital.

Mwingi- Mwingi Baraka Nursing Home .

Garissa - Garissa Nursing Home.

Wajir- Plaza Maternity & Nursing Home.

Isiolo- Waso Medical Services & Nursing Home .

Summary

The scheme has continued to perform smoothly both financially and operationally. The Management Board looks forward to continue contracting more Medicare institutions countrywide and thus taking services nearer to the members.

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