Per Person  

This plan is designed for individuals and provides comprehensive healthcare coverage for one person. The plan covers all healthcare services from consultations with doctors to prescription fulfillment and major medical procedures. The cost of the plan is $55 per year for one person, and additional family members can be added. The cost for an additional adult is $49.5 per year, while children are covered at a cost of $22 per year. The plan covers individuals between the ages of 0 (newborn babies) and 60 and provides coverage for up to 12 months.

 

This plan offers a variety of benefits, including coverage for prescription care, doctor visits, hospitalization, and telemedicine.

• The Tiva Health Scheme plan can cover up to 6 individuals, typically structured either as a principal individual, a principal adult with spouse and child dependents, or a principal adult with spouse, child dependents, and parents or in-laws.
• Care is covered at all healthcare facilities nationwide that are in the Tiva Network, except in places where Tiva has no network. In those cases, permission must be requested.
• Maximum age for elder policyholders is 60; 
• Minimum age to add a child by buying a new insurance package is 1 day.
  

 

 

Inpatient services are typically provided to patients who require hospitalization for more serious medical conditions.  Tiva Afya Yangu Health Scheme covers several basic inpatient services, including:

·       Hospital room and board: This includes the cost of a hospital bed and nursing care.

·       Medical procedures and treatments: This may include surgeries, anesthesia, diagnostic tests, and imaging tests such as CT scans and MRI.

·       Medications: Inpatient services usually cover the cost of prescription drugs and other medications required during the hospital stay.

·       Rehabilitation services: This includes physiotherapy and other forms of rehabilitation to help patients recover from injuries or illnesses.

·       Intensive care: Patients who require critical care may be admitted to the intensive care unit (ICU) where they receive close monitoring and specialized care.

·       Specialist consultations: Patients may require consultations with medical specialists such as cardiologists, neurologists, or oncologists, depending on their medical condition.

·       Emergency care: In the event of a medical emergency, Tiva Afya Yangu Health Scheme covers the cost of emergency.

·       Maximum Benefit Ceiling: $1,000 per year

What is not covered

·       Psychiatric hospitalization

·       Chronic diseases, chronic medication

·       Cosmetic surgeries

·       Dental treatments

·       Vision

·       Pregnancy-related conditions etc...

More specifically, outpatient services may include the following:

• General consultations with a physician or specialist for illnesses, injuries, or preventive care
• Diagnostic tests such as blood tests, X-rays, ultrasounds, and ECGs
• Laboratory services such as blood and urine analysis
• Prescription medications for common illnesses and chronic conditions
• Basic medical procedures such as wound dressing, injections, and minor surgeries
• Physiotherapy sessions for rehabilitation after injuries or surgeries

·       Maximum Benefit Ceiling: $250 per year

Exclusions:

•        Pre-existing conditions

•        Cosmetic surgeries

•        Dental treatments

•        Pregnancy-related expenses

•        Vision

·        Inpatient services typically cover the cost of prescription drugs and other medications required during a beneficiary's hospital stay, with the following exceptions: pre-existing conditions, cosmetic surgeries, dental treatments, and pregnancy and delivery-related treatments.

·        Tiva has a network of pharmacies throughout the entire country, which are located in various street locations. This program specifically covers medication benefits that are within the outpatients’ limit.

·        Each individual with Tiva Afya Yangu Health Scheme package has access to medication benefits as explained above.

·       The outpatient services component offers a wide range of diagnostic tests such as blood tests, X-rays, Ultrasounds, and ECGs, laboratory services such as blood and urine analysis, basic medical procedures such as wound dressing, injections, and minor surgeries, as well as physiotherapy sessions for rehabilitation after injuries or surgeries.

·       Tiva Afya Yangu Health Scheme examination and investigation includes pathology (tissue lab tests, blood, urine); and basic imaging like X-ray, PET scan if a beneficiary (subscriber) is inpatient.

·       CT scan, MRI are covered under Tiva Afya Yangu Health Scheme if a patient is administered while under admission and a medical motivation is required.

The Tiva Afya Yangu Health Scheme offers comprehensive coverage for a wide range of surgical procedures, operation theatre costs, operation fees, it covers pre-operative consultations, post-operative care, rehabilitation services as required and anesthetics facilities. 

·        The Tiva Afya Yangu Health Scheme provides coverage for emergencies and accidents, as well as medical treatments, hospitalization, and operation procedures, ensuring comprehensive and affordable access to high-quality healthcare.

What is not covered:

• Ambulance services related costs.
• Any emergency transportation including air evacuation, cross border transportation is not included.

If need hospital transfer coverages; discover Tiva-Patient Transfer Package – Basic $5/year/person

·       The Tiva Afya Yangu Health Scheme does not include coverage for dental care, such as routine dental examinations, cleanings, fillings, extractions, or any other dental treatments.

·         Individuals seeking dental care may need to explore alternative options, such as purchasing additional dental insurance plan or paying for dental services out of pocket.

Pay $15/month /person for Tiva Dental Executive Plan

·       You can purchase Tiva Dental CARE EXECUTIVE PLAN to be included in your Tiva Afya Yangu Health Scheme.

·        All dental care services under the plan are covered when you add dental care plan

·       Consultations and basic treatment are included – see the list of treatment here.

·       Surgeries and procedures: Scaling, polishing, root canal, basic extraction subject to dental is included    

·       Waiting time for the dental insurance is 6 months.

Click here for more information. 

·       The Tiva Afya Yangu Health Scheme does not provide coverage for vision care, including routine eye examinations, corrective eyewear, or any other vision-related treatments.

·       Patients requiring vision care may need to consider alternative options, such as purchasing vision insurance or paying for services out of pocket.

Pay $19/month /person                   

You can purchase a VISION CARE PLAN to be included in your Tiva Afya Yangu Health Scheme.

The optical care plans include. 

• Eye Consultation, treatment of eye conditions, diagnostics procedures and glasses are all covered under this vision plan.
• Eye operations and surgeries are all covered.
• Waiting time for the vision package is 6 months to kick in.

Click here for more information. 

·        The Tiva Afya Yangu Health Scheme does not cover maternity care

·        The Tiva Afya Yangu Health Scheme does not provide coverage for maternity care, including pregnancy-related conditions, childbirth, and postnatal care.

·        Patients requiring maternity care may need to consider alternative options, such as purchasing maternity insurance or paying for services out of pocket if they are enrolled in this scheme.

·        It is important for patients to carefully review the coverage options and limitations of their healthcare plans to ensure that they have access to the medical care they need when they need it.

Pay $110/year/person

You can purchase a MATERNITY CARE PLAN to be included in your Tiva Afya Yangu Health Scheme.

 The maternity care plan includes:

• Imaging, medications and Antenatal care.
• Delivery also is included and postnatal care of the mother and the new baby.

·        The TIVA MATERNITY CARE package includes Neonatal care, circumcision, and all other necessary procedures.

•  Waiting time is 4 months.

The TIVA MATERNITY CARE plan offers a comprehensive range of services to support expectant mothers and their babies throughout the pregnancy and after delivery. This plan covers antenatal care, imaging, medications, delivery, and postnatal care for both the mother and the baby. Additionally, the package includes neonatal care, circumcision, and all other necessary procedures to ensure the well-being of the newborn.

With the TIVA MATERNITY CARE plan, expectant mothers can have peace of mind knowing that they will have access to the medical care they need throughout their pregnancy and after delivery.

The TIVA MATERNITY CARE plan provides comprehensive care for expectant mothers and their babies, covering antenatal care, delivery, postnatal care, neonatal care, circumcision, and necessary procedures.

Click here for more information. 

General Prohibitions to all Tiva health schemes users:

The Tiva health schemes have several general prohibitions that apply to all users, including using the scheme for fraudulent or illegal purposes, providing false information, sharing benefits with unauthorized individuals, failing to follow prescribed treatment plans, engaging in risky behaviors, using the scheme for elective or cosmetic procedures, receiving care from unauthorized providers, making false claims, and violating the code of conduct or ethics policy.

It is important for all Tiva health Scheme users to understand and comply with these prohibitions and restrictions to ensure that they receive the appropriate level of care and to avoid any negative consequences, such as loss of coverage or legal penalties.

Tiva is committed to maintaining ethical and legal practices, which includes the right to deny sales of health schemes to individuals with a history of malicious or criminal acts, forgeries, or fraudulent activities related to Tiva health scheme. To verify eligibility, background checks or additional documentation may be required. This ensures quality services, affordable healthcare coverage, and allocation of resources towards genuine health needs.

Tiva reserves the right to refuse the sale of the Tiva Afya Yangu Health Scheme to individuals who have committed malicious acts, criminal offenses, or related offenses. Additionally, the company reserves the right to cancel a subscriber's coverage if they are found to be involved in a conspiracy to defraud the company.