Jipay Afya Medical Insurance Cover

Jipay Afya is a medical insurance cover offered in partnership with Birdview Microinsurance Limited, giving Jipay members access to affordable inpatient and outpatient medical cover, alongside last expense and personal accident benefits.

Birdview is licensed by the Insurance Regulatory Authority (IRA) as a Microinsurance underwriter. Birdview's aim is to offer value-added insurance solutions to clients at affordable prices. Their micro insurance products include Medical, Last Expense, Personal Accident, Hospital Cash, and Evacuation and Repatriation cover.

The following waiting periods apply to all individuals:

• 30 days general waiting period for inpatient and outpatient illness
• 6 months waiting period for maternity and pregnancy-related complications
• 6 months waiting period for chronic and pre-existing (and related) conditions
• 6 months waiting period for inpatient dental and optical non-accidental treatment
• 6 months waiting period for pre-maturity and congenital conditions

• Cover for pre-existing, chronic, psychiatric, and congenital conditions, and HIV/AIDS including related conditions
• Last expense benefit
• Coverage within East Africa, including when travelling

• Minimum entry age of 18 years and maximum entry age of 70 years for adults; from birth (term baby of 37 weeks) and up to 25 years for children covered as dependants if residing with their parents and enrolled full-time in a recognized post-secondary institution
• New entrants observe a general waiting period of 30 days for illness claims; no waiting period applies to accident-related treatments
• Pre-authorization is necessary for MRI, CT, and PET scans
• A 6-month waiting period applies to pre-existing conditions, chronic conditions, congenital conditions, organ transplants, cancer, HIV/AIDS-related treatment, maternity and related complications, inpatient non-accidental ophthalmology, dental surgery, fibroids, all gynaecological illnesses and treatments, adenoidectomy, haemorrhoidectomy, hernias, tonsillectomy, and thyroidectomy procedures
• No medical examinations required
• Confirmation of coverage in writing and payment of premiums in advance and in full to Birdview Microinsurance is required for benefits to take effect
• Scheduled admissions must be pre-authorized at least 48 hours before admission. For emergency admissions, the hospital must contact Birdview Microinsurance within 48 hours
• Members must complete and sign a claim form, confirming access to the correct services by signing the provider's invoice
• Members travelling abroad are eligible for accident and emergency medical benefits for up to six (6) weeks per trip. Medical expenses are reimbursed based on reasonable and customary rates and policy terms, excluding accommodation and travel costs
• Eligible reimbursement claims are paid up to 100% within the panel and 100% outside the panel, subject to reasonable and customary rates as per the Micro panel

Please refer to the policy documents for the full list of exclusions.

• Treatment resulting from non-compliance, failure, or refusal to comply with medical advice
• Alternative treatments such as herbal medicine, acupuncture, and chiropractic care
• Beauty treatments, massages, and stays in sanatoria or old age homes
• Genetic disorders, genetic testing, and related conditions
• Cosmetic or plastic surgery, unless necessitated by an accidental injury during the coverage period
• Transportation other than licensed ambulances, under inpatient cover
• Nutritional supplements, vitamins, and replacements, whether prescribed or not
• Injuries or illnesses arising from Navy, Military, or air force operations, insurrection, war, civil commotion, terrorism, riots, and strikes
• Optical treatments such as eyeglasses and contact lenses, unless optical cover is purchased
• Dental treatments including extractions, fillings, and scaling, unless dental cover is purchased
• Acute or chronic alcoholism and drug addiction treatments
• Expenses recoverable under other insurance such as Workmen's Compensation or Personal Accident cover
• Reimbursement claims apply only if members exceed the outpatient benefit utilization limit
• Services primarily for weight reduction, obesity treatment, or slimming operations
• Epidemics, pandemics, or unknown diseases, except COVID-19