Download TSC Medical Claim Form for Teachers
In 2026, the medical landscape for teachers has undergone a significant shift. While the Minet (AON) Medical Scheme was the primary cover for years, most teachers have now transitioned to the Social Health Authority (SHA) under the Public Officers Medical Scheme Fund (POMSF).
Below is the download link for TSC Medical Claim Form for Teachers
TSC Medical Claim Form for Teachers
Above is the download link for TSC Medical Claim Form for Teachers
However, for expenses incurred under the previous structure, or for specific reimbursements that fall outside the “capitation” (direct payment) model, you still need the TSC Medical Claim Form (Revised). Filing this form correctly is the only way to get back money spent out-of-pocket during emergencies or at non-empanelled facilities.
FAQ: Navigating Medical Claims in 2026
Q: Which medical scheme covers teachers in 2026?
A: As of December 1, 2025, the Teachers Service Commission (TSC) moved from Minet to the Social Health Authority (SHA). You are now covered under the Public Officers Medical Scheme Fund. Claims for services after this date are mostly handled digitally through the SHA portal, but the manual TSC claim form is still used for “Reimbursement Claims” where digital systems weren’t used.
Q: Can I claim for treatment at a private hospital?
A: Generally, you must use “empanelled” (contracted) providers. However, if it was a life-threatening emergency and you had to pay at a private facility, you can file a claim. You will need to provide a “Letter of Emergency” from the attending doctor explaining why you couldn’t reach a contracted facility.
Q: What is the “14-day Rule” for claims?
A: In 2026, the strict deadline remains: you must notify the insurer (now SHA/POMSF) of an out-of-pocket expense within 24 hours and submit the formal claim form within 14 days of discharge. Late submissions are the #1 reason for rejected claims.
Q: Are my dependents still covered?
A: Yes. The 2026 scheme covers the principal member (teacher), one spouse, and up to five children. Children are covered until age 18, or 25 if they are still in full-time education (proof of schooling required).
Q: What is the “Co-pay” amount in 2026?
A: Under the current SHA framework for public officers, there is a standard co-payment of Ksh 100 for outpatient visits at specialized clinics. This is usually paid directly and is not reimbursable.
Q: Does the scheme cover overseas treatment? A: Yes, but only by referral. If a local medical board certifies that the treatment is unavailable in Kenya, the scheme can cover up to Ksh 1.1 million for surgery and Ksh 500,000 for other costs. You must get pre-authorization before traveling.
Checklist for a Successful Claim
To avoid your claim being returned, ensure you have attached:
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Original Receipts: Not photocopies. They must be stamped and signed by the hospital.
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Invoice/Statement of Account: Showing the breakdown of all costs and any NHIF/SHA rebates applied.
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The Claim Form: Must be signed by you and stamped by your Head of Institution (to prove you are currently in active service).
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Copy of Latest Payslip: To verify your TSC number and current job group.
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Discharge Summary: For inpatient claims, detailing the diagnosis and treatment given.
