The Teachers Service Commission (TSC) has announced a major boost to teachers’ healthcare benefits after unveiling In-Vitro Fertilization (IVF) services under the Social Health Authority (SHA) Mwalimu Comprehensive Cover.

In a statement on Thursday, April 30, TSC confirmed that IVF services have now been formally activated under the SHA scheme and are available to eligible teachers under the cover.

“The Teachers Service Commission (TSC) is pleased to inform all eligible members that the Social Health Authority (SHA) has formally activated In-Vitro Fertilization (IVF) services under the SHA,” the statement read.

TSC announced that the service will initially be offered at The Nairobi Hospital, making it clear that access has already begun.

“This benefit is now accessible at The Nairobi West Hospital, a contracted and accredited healthcare provider under the scheme, with immediate effect,” the statement added.

According to SHA, access to IVF services will be strictly limited to SHA-POMSF beneficiaries, including principal members and their lawfully declared spouses.

Applicants must meet strict medical requirements, including documented infertility defined as failure to conceive after 12 months of regular unprotected intercourse or as determined by a qualified specialist. 

All cases must also be supported by a clinical diagnosis and a written recommendation from a registered specialist.

The commission has also outlined usage limits, including the maximum number of attempts allowed per beneficiary, as well as strict age restrictions for the female partner seeking treatment.

Each beneficiary will be allowed a maximum of two IVF attempts over their lifetime, while the female partner must be aged 41 years or below at the start of the treatment cycle.

Both primary and secondary infertility cases qualify, although couples seeking treatment for secondary infertility must not have any living child at the time of application.

The IVF benefit will be covered within the existing inpatient limits of the Mwalimu Comprehensive Cover, meaning all costs will be drawn from the allocated inpatient cover.

This includes procedures such as Frozen Embryo Transfer (FET) cycles, which fall within the same benefit cap.

In cases where treatment is cancelled or unsuccessful due to medical factors such as poor ovarian response, failure to retrieve viable oocytes, failed fertilization, absence of viable embryos, or failed implantation, the costs incurred will still be deducted from the inpatient limit. 

Treatment may continue until the limit is exhausted or the two-attempt maximum is reached.

TSC noted that all IVF procedures must strictly follow national medical guidelines and that reimbursement will only apply to services offered at SHA-approved facilities with prior authorization.

“All treatment must strictly follow national clinical guidelines and SHA pre-authorization procedures. Only services provided at SHA-contracted and accredited facilities will be eligible for reimbursement,” the statement further read.