BRITAM AFYA TELE GROUP MEDICAL COVER

This is a unique comprehensive group medical insurance that covers for inpatient, outpatient and a funeral cover. This policy is available to registered groups within;

-SMEs  -Micro finance institutions -Sacco’s -Chama’s -Self help groups

-Government institutions -Education Institutions -Religious Groups

Benefits of the Cover

Inpatient Cover

This is a health care plan to manage unforeseen illness or injuries that lead to hospitalization. Some of the  benefits are:

– Maternity	– Radiology	– Covid cover
– Congenital	– Dental	– Funeral Expense
– Ambulance	– Optical	– Chronic/pre-existing /psychiatric condition – 50%

Outpatient Cover

This pays for outpatient treatments which includes reasonable costs incurred at duly  appointed hospitals and doctors’ clinics. Some of the benefits are:

-Dental

-Optical

-Chronic/pre-existing /psychiatric condition – 50%

-Copay – 500/=

Last Expense

This cover provides support to cover funeral expenses following the death of the insured.

Inpatient cover options

INPATIENT
BENEFIT	Option I	Option II	Option III	Option IV
Inpatient Cover Limit (Main Benefit)	200,000	300,000	500,000	750,000
Chronic/ Pre-existing/ Psychiatric cases within IP Limit	100,000	150,000	250,000	375,000
Maternity C Limit (Within Inpatient)	20,000	30,000	50,000	60,000
Maternity CS	40,000	50,000	70,000	80,000
Congenital	50,000	75,000	125,000	187,500
Ambulance	15,000	15,000	15,000	15,000
Radiology	20,000	25,000	30,000	40,000
Covid (50% of IP Limit)	100,000	150,000	250,000	375,000
Dental within IP Limit	50,000	75,000	125,000	187,500
Optical within IP Limit	50,000	75,000	125,000	187,500
Funeral Expense	50,000	50,000	50,000	75,000
Maximum OP to be offered	50,000	50,000	75,000	75,000

Outpatient cover options

OUTPATIENT
	Option I	Option II	Option III
Outpatient Cover Limit (Optional Benefit)	30,000	50,000	75,000
Chronic/ Pre-existing/ Psychiatric cases within OP Limit	15,000	25,000	37,500
Dental within OP Limit	5,000	7,500	10,000
Optical within OP Limit	5,000	7,500	10,000

Who can get the cover

•Minimum principals – 10 members

•Applicant & spouse – (18  –  65) years at entry.

•Maximum Age on cover – 70 years

•Children – 0 – 18 years. Or Up to 24 years with Proof of schooling

Waiting Periods

•Accident cases – No waiting period for treatment or last expense cover

•1 month waiting period for all illnesses

•1 month waiting period on death as a result of natural causes.

•9 months’ waiting period for maternity and pregnancy related treatments.

•1 year waiting period for surgical treatment unless surgery is as a result of an  accident

Last Expense Claim Process

The claimant should get a claim form from Britam offices and have it completed, attach certified copies

of the Following documents and send to Britam Head Office,

•Certified copy of ID (/Birth Certificate for children/dependents)

•

•Burial permit,

•

•ID copy of claimant Principal

If death is as a result of an accident, a police abstract should also be attached  for death claims. NB: Any

additional documents deemed necessary may be requested.

Exclusions

In-Patient and Outpatient

i)Expenditure incurred arising from any illegal or criminal act.

ii)Operations, treatments and/or procedures of own choice for purely cosmetic purposes or obesity, and any  complications that may arise from such operations, treatment and/or procedures.

iii)General health examination or checkup.

iv)Services arising from an accident or event of which the Policyholder or dependants has received, or is likely to  receive compensation from any source whatsoever including National Hospital Insurance Fund (NHIF) and  employer liability insurance

v)Treatment for infertility/ Impotence and family planning.

vi)Dialysis

** A complete list of the exclusions will be provided on the policy document

Product Brochure: https://cutt.ly/jCiH86t

For More Infor on how to sign up;

Contact Gallin Wekesa: FA@Britam

0712-870-447 gwwekesa@britam.com