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APA INSURANCE CO LTD: AFYA NAFUU PRODUCT: FOR MIDDLE INCOME FAMILIES


Choose from this options

Choose Father insurance


Minimum: 1 Maximum: 20






Minimum: 21 Maximum: 40






Minimum: 41 Maximum: 54






Minimum: 55 Maximum: 65






Minimum: 66 Maximum: 75





Choose Mother insurance


Minimum: 1 Maximum: 20






Minimum: 21 Maximum: 40






Minimum: 41 Maximum: 54






Minimum: 55 Maximum: 65






Minimum: 66 Maximum: 75





Choose Children insurance


Minimum: 1 Maximum: 19
Number of children:





TOTAL PREMIUM

see what is covered

Bed limits

For a limit of KES. 1,000,000: General ward bed is covered.

For a limit of KES. 750,000: General ward bed is covered.

For a limit of KES. 500,000: General ward bed is covered.

For a limit of KES. 300,000: General ward bed is covered.

For a limit of KES. 100,000: General ward bed is covered.

 

Prescription drugs and dressings (discharge drugs allowed up to a maximum of 14 days supply)

For all limits this benefit is covered in full.

 

Physicians, Specialist & Surgical fees, including anesthetists fees subject to APA panel rates

For all limits this benefit is covered in full.

 

Theatre charges, HDU & ICU

For all limits this benefit is covered in full.

 

Diagnostic tests

For all limits this benefit is covered in full.

 

Physiotherapy as part of treatment

For all limits this benefit is covered in full.

 

Pre-existing / chronic conditions/HIV/AIDS including psychiatry after 12 months of cover and on full disclosure at the time of joining. (Organ transplantation (3rd year) excluding cost of obtaining the donor organ. Covers operation costs for Kidney, Heart, Liver, Lung and Bone Marrow transplants)

For a limit of KES. 1,000,000: This benefit is covered up to a limit of KES. 250,000

For a limit of KES. 750,000: This benefit is covered up to a limit of KES. 150,000

For a limit of KES. 500,000: This benefit is covered up to a limit of KES. 125,000

For a limit of KES. 300,000: This benefit is covered up to a limit of KES. 100,000

For a limit of KES. 100,000: This benefit is covered up to a limit of KES. 50,000

 

In Patient Dental

For a limit of KES. 1,000,000: This benefit is covered up to a limit of KES. 40,000

For a limit of KES. 750,000: This benefit is covered up to a limit of KES. 30,000

For a limit of KES. 500,000: This benefit is covered up to a limit of KES. 30,000

For a limit of KES. 300,000: This benefit is covered up to a limit of KES. 20,000

For a limit of KES. 100,000: This benefit is covered up to a limit of KES. 10,000

 

Reconstructive surgery following an accident.

For all limits this benefit is covered in full.

 

Emergency dental / optical treatment following accident.

For all limits this benefit is covered in full.

 

Funeral expenses (No Exclusions).

For a limit of KES. 1,000,000: This benefit is covered up to a limit of KES. 40,000

For a limit of KES. 750,000: This benefit is covered up to a limit of KES. 30,000

For a limit of KES. 500,000: This benefit is covered up to a limit of KES. 30,000

For a limit of KES. 300,000: This benefit is covered up to a limit of KES. 20,000

For a limit of KES. 100,000: This benefit is covered up to a limit of KES. 10,000

 

Newly diagnosed chronic conditions

Diagnosis within 1st 6 months covered within pre-existing / Chronic sublimit. Diagnosis after 6 months covered to full limit.

 

Surgical appliances and internal prostheses

For all limits this benefit is covered in full.

 

Post Hospitalization Treatment- reimbursement only limited to the first 2 weeks after discharge.

For a limit of KES. 1,000,000: This benefit is covered up to a limit of KES. 20,000

For a limit of KES. 750,000: This benefit is covered up to a limit of KES. 15,000

For a limit of KES. 500,000: This benefit is covered up to a limit of KES. 10,000

For a limit of KES. 300,000: This benefit is covered up to a limit of KES. 10,000

For a limit of KES. 100,000: This benefit is covered up to a limit of KES. 7,500

 

Accommodation costs for 1 parent staying in hospital with insured child under 5 years

For all limits this benefit is covered in full.

 

Day Care Surgery under General anesthesia

For all limits this benefit is covered in full.

 

Home Nursing (on doctors recommendation)

All options are covered Up to a maximum of 30 days.

 

Local ambulance to hospital for emergency cases.

For all limits this benefit is covered in full.

 

CT, MRI and PET scans subject to pre authorization.

For all limits this benefit is covered in full.

 

Maternity related complications after being on cover for 10 months.

For a limit of KES. 1,000,000: This benefit is covered up to a limit of KES. 20,000

For a limit of KES. 750,000: This benefit is covered up to a limit of KES. 15,000

For a limit of KES. 500,000: This benefit is covered up to a limit of KES. 10,000

For a limit of KES. 300,000: This benefit is covered up to a limit of KES. 10,000

For a limit of KES. 100,000: This benefit is covered up to a limit of KES. 7,500

 

In Patient Ophthalmology: includes cost of cataract removal (after 24 months)

For a limit of KES. 1,000,000: This benefit is covered up to a limit of KES. 20,000

For a limit of KES. 750,000: This benefit is covered up to a limit of KES. 15,000

For a limit of KES. 500,000: This benefit is covered up to a limit of KES. 10,000

For a limit of KES. 300,000: This benefit is covered up to a limit of KES. 10,000

For a limit of KES. 100,000: This benefit is covered up to a limit of KES. 7,500

 

 

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 Haemorrhoids 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 Ayurvedic 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 hydros.

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

20.  Treatment outside Kenya and at non approved providers.



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