Benefits civil servants will enjoy in new fund, as other taxpayers deal with SHIF

Treasury CS John Mbadi has proposed a new medical scheme fund aimed at providing enhanced healthcare benefits for public officers.

According to the (Public Officers Medical Scheme Fund) Regulations, 2024, the new fund aims to expand healthcare coverage for civil servants, supplementing the newly unveiled Social Health Insurance Fund. 

Background and Structure of the Fund

The new regulations, if passed, will establish the Public Officers Medical Scheme Fund, a dedicated pool aimed at financing a medical scheme for public officers.

Unlike the social health insurance, this fund will act as an additional support system, helping bridge any gaps in coverage.

Public officers, including those appointed to serve in ministries, state departments, and various public service offices, will be eligible for these medical benefits.

The fund will receive its initial capital from Kenyan taxpayers through the National Assembly appropriations, with ongoing support from PSC contributions and any grants or donations from other sources.

Benefits for Public Officers

If passed, the proposed fund would provide public officers with an array of healthcare benefits:

• Expanded Medical Coverage: Public officers and their eligible dependents will enjoy expanded coverage beyond what the current social health insurance offers.
• Streamlined Claim Processes: A clear and defined process will manage medical claims, allowing public officers to access their healthcare benefits efficiently.
• Financial Safeguards: By maintaining a capped administrative cost of three percent of the approved budget, the scheme ensures that the majority of funds go directly towards healthcare services.
• Annual Performance Reviews: To ensure continued effectiveness, the board will conduct annual reviews to assess the fund’s performance and make adjustments to meet the needs of public officers.

Governance and Administration

Administration of the Public Officers Medical Scheme Fund will be handled by the Social Health Authority Board, constituted under the Social Health Insurance Act.

This board will oversee fund management and maintain accountability through an administrative structure, with responsibilities divided between the board and an appointed administrator.

The board will approve revenue and expenditure estimates, provide policy direction, and ensure that the fund operates within its budget.

The Chief Executive Officer of the Social Health Authority will act as the administrator, responsible for keeping accurate financial records, preparing non-financial performance reports, and maintaining all assets tied to the fund.

They will also prepare annual budget estimates and submit them to the board for approval.