Are you an SME, SACCO, Chama, microfinance group, or a registered self-help group looking for an affordable, comprehensive health insurance cover? Britam Afya Tele is an affordable, comprehensive medical cover designed for registered groups like the one you are in.
Afya Tele medical policy covers all members of a group, both individuals and families. The group members with a family, the cover features shared family benefits for inpatient and outpatient care combined with a built-in individual last expense (funeral) benefit.
In this write-up, I will take you through the salient features of Britam Afya Tele medical cover including benefits and cover limits, eligibility and age limits, waiting periods, and the claim process.
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What is Britam Afya Tele Medical Cover?
Britam Afya Tele is a medical policy designed specifically for the medical needs of groups including SMEs, Chamas, SACCOs, Microfinance Institutions, Religious Groups, and Registered Self-Help Groups.
The cover requires your group, in whichever form it is in, to be a registered group with a minimum of 10 members.
The key benefits of Afya Tele to a group is that it offers single policy convenience, cost efficiency as compared to individual plans, and built-in last expense cover.
Key Benefits and Cover Limits Breakdown
The basis of Britam Afya Tele medical insurance cover is inpatient and outpatient covers.
The policy has 4 options (Option I, Option II, Option III, and Option IV) available to members for both inpatient and outpatient covers depending on their medical needs and budget.
The inpatient main benefit limit ranges from KES 200,000 to KES 750,000. Option I had the lowest inpatient limits and Option IV has the highest inpatient limits.
Some of the conditions covered under inpatient cover include pre-existing and chronic conditions, psychiatric cases, maternity, congenital conditions, ambulance, radiology, dental, optical, and a funeral expense. Each of these conditions is subjected to sub limits with the inpatient man benefit limit.
For instance, pre-existing and chronic conditions and psychiatric cases sub-limit within inpatient is KES 100,000 in Option I upto KES 375,000 in Option IV.
Normal delivery maternity cover ranges from KES 20,000 to KES 60,000 while Maternity C-section ranges from KES 40,000 to KES 80,000, both within the inpatient cover.
Here is a table summarising the inpatient coverage in Britam Afya Tele
| Afya Tele Inpatient Cover | ||||
| Benefit Description | Option I (KES) | Option II (KES) | Option III (KES) | Option IV (KES) |
| Inpatient Cover Limit (Main Benefit) | 200,000 | 300,000 | 500,000 | 750,000 |
| Chronic / Pre-existing / Psychiatric Cases | 100,000 | 150,000 | 250,000 | 375,000 |
| Maternity Normal Delivery Limit (Within Inpatient) | 20,000 | 30,000 | 50,000 | 60,000 |
| Maternity C-Section (CS) Limit (Within Inpatient) | 40,000 | 50,000 | 70,000 | 80,000 |
| Congenital Conditions (25% of IP Limit) | 50,000 | 75,000 | 125,000 | 187,500 |
| Ambulance Services | 15,000 | 15,000 | 15,000 | 15,000 |
| Radiology (Once per year per person) | 20,000 | 25,000 | 30,000 | 40,000 |
| COVID-19 Treatment (50% of IP Limit) | 100,000 | 150,000 | 250,000 | 375,000 |
| Dental within Inpatient Limit | 50,000 | 75,000 | 125,000 | 187,500 |
| Optical within Inpatient Limit | 50,000 | 75,000 | 125,000 | 187,500 |
| Funeral/Last Expense Benefit | 50,000 | 50,000 | 50,000 | 75,000 |
| Maximum Outpatient Offered with Option | 50,000 | 50,000 | 75,000 | 75,000 |
The outpatient main benefit ranges from KES 30,000 in Option I to KES 75,000 in Option IV.
Within the outpatient main benefit, there exists some sub-limits depending on the conditions covered. The conditions with sub-limits within the main outpatient benefits include pre-existing and chronic conditions, psychiatric cases, dental and optical covers.
Dental and optical covers range from KES 5,000 in Option I to KES 10,000 in Option IV each within the outpatient limit.
Here is a table summary the outpatient coverage in Afya Tele
| Afya Tele Outpatient Cover | |||
| Benefit Description | Option I (KES) | Option II (KES) | Option III (KES) |
| 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 Outpatient Limit | 5,000 | 7,500 | 10,000 |
| Optical within Outpatient Limit | 5,000 | 7,500 | 10,000 |
Britam Afya Tele Medical Insurance Cover Eligibility and Age Limits
- The principal members and their spouses must be between the age of 18 and 65 years.
- Children under the cover should be between the age of 30 days and 18 years. Children between the age of 18 years and 24 years must prove full-time schooling/college enrollment to be included in the cover.
- The maximum age on cover for the principal is 70 years. Therefore, the cover renews yearly up to the age of 70 years for the main/principal member.
- Your group must have a minimum group size of 10 principal members.
Waiting Periods You Should Know Before Joining
Before joining Britam Afya Tele group medical cover, please note the following waiting periods.
- General illnesses have a 1 month waiting period. However, treatment as a result of accidental causes are covered from commencement date.
- Death as a result of natural causes has a waiting period of 1 month in order for the family to benefit from the last expense payout. Death as a result of any accident is covered from commencement date.
- Maternity and pregnancy related treatments are subject to a 9-month waiting period.
- Surgical treatment has a 1 year waiting period, unless surgery is as a result of an accident.
How Claims Work and Hospital Network Access
- If you visit any hospital in the Britam Panel, there shall be a direct billing. You just need to have your smart card or app for identification.
- Emergency admissions to non-panel hospitals requires you to notify Britam within 24 hours.
- For last expense claim, the following documents are required: claim form, ID copies, Death Certificate/Burial Permit, and police abstract if accidental.
How To Apply To Britam Afya Tele
In order to enroll your group in Britam Afya Tele Medical Cover, you will need the following:
- Fill in the application form
- Provide recently taken passport size photos of principal members and their dependants that they want insured
- Copy of IDs of principal members and their spouses (if applicable).
To start the process of onboarding members to Britam Afya Tele medical policy, please fill the form above or chat with me and I will get to you in no time.
Thank you for being here.
