Medical cover guide
APA Jamii Plus — limits, benefits and options
APA Jamii Plus covers individuals and families on a per-family inpatient limit with optional outpatient, maternity, dental and optical benefits.
Cover typeIndividual and family
Inpatient limitsKSh 500,000 to KSh 10,000,000
Plans available7
Medical examinationApplicants aged 60 and above
APA Jamii Plus — inpatient limits
| Inpatient limit | Bed entitlement | Plan |
|---|---|---|
| KSh 500,000 | General Ward Bed | Jamii Plus 500K |
| KSh 1,000,000 | General Ward Bed | Jamii Plus 1M |
| KSh 2,000,000 | Standard Private Room up to KSh 12,500/day net of SHIF | Jamii Plus 2M |
| KSh 3,000,000 | Standard Private Room up to KSh 15,000/day net of SHIF | Jamii Plus 3M |
| KSh 5,000,000 | Ensuite Room up to KSh 18,000/day net of SHIF | Jamii Plus 5M |
| KSh 7,500,000 | Ensuite Room up to KSh 20,000/day net of SHIF | Jamii Plus 7.5M |
| KSh 10,000,000 | Private Ensuite Room up to KSh 25,000/day net of SHIF | Jamii Plus 10M |
Premiums depend on the members covered and their ages, so the price for a limit is confirmed in your quotation.
Optional benefits you can add
Depending on the plan you choose, the following can be added to the inpatient cover:
- Outpatient: KSh 50,000, KSh 75,000, KSh 100,000, KSh 150,000, KSh 200,000, KSh 250,000, KSh 300,000
- Maternity: KSh 50,000, KSh 60,000, KSh 75,000, KSh 80,000, KSh 100,000, KSh 120,000, KSh 150,000, KSh 175,000, KSh 200,000, KSh 250,000, KSh 300,000
- Dental: KSh 5,000, KSh 7,500, KSh 10,000, KSh 15,000, KSh 20,000, KSh 30,000, KSh 40,000, KSh 50,000
- Optical: KSh 5,000, KSh 7,500, KSh 10,000, KSh 15,000, KSh 20,000, KSh 30,000, KSh 40,000, KSh 50,000
What the cover includes
- Inpatient treatment for illness and accidents, including prescribed medicines, specialists, surgery, theatre, HDU/ICU and diagnostics
- Pre-existing, chronic, congenital and HIV/AIDS conditions after 12 months and full disclosure
- Newly diagnosed chronic conditions after 3 months
- Prematurity and neonatal conditions subject to the published waiting period and sub-limits
- Organ transplantation subject to a 2-year waiting period
- Psychiatry and psychotherapy within published sub-limits
- Post-hospitalisation treatment, home nursing, local ambulance and emergency air evacuation
- First emergency C-section / maternity complications within inpatient sub-limit after 10 months
- Inpatient accidental and non-accidental dental/ophthalmology benefits
- APA Femina Plus cancer diagnosis cash benefit
- Optional outpatient, maternity, dental and optical benefits
Benefit sub-limits (pre-existing conditions, chronic conditions, maternity, psychiatric care, last expense and so on) are printed on every quotation we issue and are listed in the insurer's brochure.
Waiting periods
- 30 days acute illness
- 90 days non-chronic surgical procedures
- 3 months newly diagnosed chronic conditions
- 10 months pregnancy/maternity
- 12 months pre-existing/chronic/congenital conditions and specified surgeries
- 2 years organ transplant
- No waiting period for accidental cases
Co-payment, where it applies
- KSh 1,500 at Aga Khan University Hospital, Nairobi Hospital, Premier Hospital, Nyali Children’s Hospital, Diani Beach Hospital, Maimooni Hospital, Mombasa Hospital, Mater Hospital and MP Shah Hospital
- KSh 500 at Gertrude’s Children’s Hospital, Avenue Hospital, Pandya Hospital, Eldoret Hospital, Nairobi West Hospital, Metropolitan Hospital, Oasis Doctors Plaza, Jocham Hospital, Palm Beach Hospital, Oasis Health Care Group and AAR Healthcare/Hospital
- All other providers: No Copayment
APA Jamii Plus — frequently asked questions
What inpatient limits are available on APA Jamii Plus?
The limits we quote are KSh 500,000 to KSh 10,000,000 per year. Each limit is a separate plan with its own benefits schedule, so the premium and the sub-limits change with the limit you pick.
Can I add outpatient, maternity, dental or optical cover?
Yes. Depending on the plan, optional benefits can be added at the amounts listed above. Outpatient cover is normally required before dental or optical benefits can be selected.
Who can be covered?
This product covers a principal member, and can include a spouse and children on the same policy.
How is the premium paid?
Premiums are paid directly to APA using the payment details printed on your quotation. Now Insurance Agency does not receive or handle client payments.
How long does cover take to start?
Cover is typically confirmed within 1 to 5 working days after payment or IPF settlement and receipt of complete documents, subject to the insurer's underwriting and acceptance.
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