APA Insurance is set to replace CIC Insurance as the lead insurer of the multi-billion shillings medical scheme for police and prison officers amid complaints about the slow pace of processing of claims.
In changes announced by Medical Administrators Kenya Limited (MAKL), which oversees the medical schemes for police and prison officers in grades F to T, APA will take over the Sh8.67 billion scheme along with Britam and Jubilee for the next nine months of the remaining contract period.
It is not clear why CIC has been dropped with under a year left on the contract it had bagged as the lead consortium that also included Britam General Insurance Company and Old Mutual General Insurance.
There have been widespread complaints by police and prison officers over their cover, with many expressing frustration over declined claims or delays in the processing of accepted claims.
MAKL, in a March 30 letter to medical service providers, communicated the “significant transition” saying that police and prison officers will now be identified as being insured under APA Insurance. At the same time, claims management has been split between MAKL and Minet Kenya.
“MAKL will assume responsibility for managing Job groups A-K, while our esteemed partners at Minet Kenya will handle Job groups L-T. It's essential to note that despite this change, the treatment process remains consistent with the terms stipulated in the contract we have with your establishment,” said MAKL in the letter.
Job groups F to K include constables and assistant superintendents, while job groups L to T include superintendents up to the inspector-general of police.
The police scheme is a consortium of insurance companies initially led by CIC Insurance. The insurance company contracted MAKL to act as the capitation manager, charging up to seven percent of the tender amount as an administration fee. The premiums provided by the government were being paid directly to CIC.
The transition from CIC to APA took place on April 1, 2024. Police and prison officers will be hoping that there will be no hitches given the challenges they encountered in populating the system with their details and those of their dependents when they were switching from the National Health Insurance Fund to CIC.
“For admitted patients who will still be continuing with treatment, you will be required to discharge them on the old scheme and a new member verification code must be generated on the scheme period to ensure continuity of care,” noted MAKL in the letter.
In December last year, hospitals accused MAKL of delaying the processing of Sh5 billion capitation claims.
This is despite the government releasing Sh13.6 billion to the National Police Service Commission (NPSC) to cover police and prison officers in the current financial year.
