must be paid in full before commencement of cover
Reimbursement for services sought outside the approved APA Panel.
admissions must be reported to APA Insurance with at least 48 hours notice. Member must await APA preauthorization before
admissions the hospitals will contact APA within 48 hours of admission.
periods are subject to continuous renewal with no break in cover. Where there
is a break in cover the waiting periods will apply afresh.
Fibroids, Hernias, Adenoidectomy and Haemorrhoids
shall be subject to a waiting period of 12 months.
produce their medical cards to enable them access treatment at the accredited
panel of providers.
calculated based on the members age at next birthday.
Period 30 days for illness & 90 days for surgical procedures, waived for
10. Age Limits: 1 months 75 years (Maximum joining age 75 years). All
renewals are subject to claims experience and underwriting guidelines.
11. 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.
12. Medical Report for all members joining who are 55 years and above
will be required.
13. Cover outside Kenya up to 6 weeks for business or leisure travel
on reimbursement basis
14. Geographical limit Kenya.
15. Time bar at ninety (90) days from the day of ailment for
16. No return premium for deleted individuals after six (6) months of
cover or where claims have been incurred.
17. Cancellation notice of 14 days by either party.
& chronic conditions occurring within the first 12 months.
related ailments occurring within the first 12 months of cover whether newly
diagnosed or not.
unless caused by accident.
Normal deliveries, pre & post-natal expenses.
operation within the first 24 months of cover Senility.
(present at birth) conditions.
planning or Infertility related conditions.
10. Treatment other than by registered medical practitioner.
11. Acupuncturist, Herbalists and Ayurvedic
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
20. Treatment outside Kenya and at non approved providers.