Fresh audit queries on civil servants’ medical plan

The medical scheme for civil servants and members of the disciplined forces has drawn fresh audit queries as insurance figures fail to tally with returns from contracted health facilities.

The Auditor-General Edward Ouko has questioned the expenditure of the Sh3.5 billion by then Public Service ministry.

The ministry was allocated a total of Sh4.32 billion in 2012/13 for the scheme but only disbursed Sh3.5 billion to the the National Hospital Insurance Fund (NHIF).

“However, reconciliations from the ministry on the number of beneficiaries covered in the insurance scheme and accountability returns from health facilities on the number of civil servants and disciplined forces attended to have not been made available for audit review,” Mr Ouko said in his qualified audit opinion of the NHIF.

In the report currently before the National Assembly, Mr Ouko said it has not been possible to confirm the propriety of the expenditure of Sh3.5 billion included in the benefit-expenses of Sh8.23 billion in the NHIF statement of comprehensive income for the year under review.

“In the circumstances, it has not been possible to confirm that the ministry, civil servants and disciplined services obtained value for money on the medical scheme,” he said.

In January 2012, civil servants and the disciplined services started accessing a comprehensive health cover under a medical scheme implemented by the NHIF.

READ: Medical cover for public servants unveiled

Then Public Service Minister Dalmas Otieno announced that the medical scheme would cover more than 220,000 civil servants at Sh4.3 billion in the first year.

The medical scheme included unlimited inpatient and outpatient cover in accredited hospitals, with the exception of the higher job groups N to T who were given a specified ceiling.

The civil servants and members of the armed forces were also given life insurance and allowed a mandatory annual check-up.

The financing of the scheme was obtained from the monthly medical allowances payable to employees while the government covered the difference to ensure quality was comparable to medical covers applicable to other public servants.

Previously, civil servants got as low as Sh375 per month as medical allowance while the highest earners got Sh2,940.

The cover caters for the principal member, spouse and three children under 18 years and up to a maximum of 25 years if still a full time student.

Those with additional members are allowed to pay extra premiums directly to the NHIF to get them covered.