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APA INSURANCE AFYA NAFUU


OPTIONS

Father insurance


Minimum: 1 Maximum: 20






Minimum: 21 Maximum: 40






Minimum: 41 Maximum: 60






Minimum: 61 Maximum: 75





Mother insurance


Minimum: 1 Maximum: 20






Minimum: 21 Maximum: 40






Minimum: 41 Maximum: 60






Minimum: 61 Maximum: 75





Children insurance


Minimum: 1 Maximum: 20
Number of children:





TOTAL PREMIUM

INFORMATION

Special Conditions

1.       All Premiums must be paid in full before commencement of cover.

2.       All In-Patient Bills will be paid net of National Hospital Insurance Fund (NHIF).

3.       No Reimbursement for services sought outside the approved APA Panel.

4.       All scheduled admissions must be reported to APA Insurance with at least 48 hours notice. Member must await APA preauthorization before proceeding.

5.       For emergency admissions the hospitals will contact APA within 48 hours of admission.

6.       All waiting periods are subject to continuous renewal with no break in cover. Where there is a break in cover the waiting periods will apply afresh.

7.       Treatment for Fibroids, Hernias, Adenoidectomy and Hemorrhoids shall be subject to a waiting period of 12 months.

8.       Members must produce their medical cards to enable them access treatment at the accredited panel of providers.

9.       Premiums are calculated based on the members age at next birthday.

10.   Waiting Period 30 days for illness & 90 days for surgical procedures, waived for accident cases.

11.   Age Limits: 1 months 75 years (Maximum joining age 75 years). All renewals are subject to claims experience and underwriting guidelines.

12.   Benefits may not be payable if there is non-disclosure of any material facts that could influence our assessment and acceptance of this application. APA reserves the right to decline an application or renewal.

13.   Medical Report for all members joining who are 55 years and above will be required.

14.   Cover outside Kenya up to 6 weeks for business or leisure travel on reimbursement basis.

15.   Geographical limit Kenya.

16.   Time bar at ninety (90) days from the day of ailment for reimbursement claims.

17.   No return premium for deleted individuals after six (6) months of cover or where claims have been incurred.

18.   Cancellation notice of 14 days by either party.

 

Main Exclusions

1.       General Health check-ups.

2.       Pre-existing & chronic conditions occurring within the first 12 months.

3.       War and Kindred risks.

4.       HIV/AIDS and related ailments occurring within the first 12 months of cover whether newly diagnosed or not.

5.       Cosmetic surgery unless caused by accident.

6.       Maternity- Normal deliveries, pre & post-natal expenses.

7.       Cataract operation within the first 24 months of cover Senility.

8.       Congenital (present at birth) conditions.

9.       Family planning or Infertility related conditions.

10.   Treatment other than by registered medical practitioner.

11.   Acupuncturist, Herbalists and Ayurveda treatment.

12.   Intentional self-injury, drunkenness, drug abuse addiction.

13.   Naval, Military or Air force operations.

14.   Hearing aids.

15.   Eye glasses/lenses, eye testing except for Inpatient Ophthalmology as specified above.

16.   Dental treatment unless for Inpatient Cases as specified above.

17.   Expenses recoverable under any other insurance.

18.   Beauty treatment in nature cure clinics or health hydro.

19.   Contamination by radio activity from nuclear fuel, waste or fission.

20.   Treatment outside Kenya and at non approved providers.

 

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