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callREACH US ON : O20 286 2000

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Health Corporate

APA Insurance offers flexible tailor made corporate products for groups with ten (10) or more employees. The main benefit is a fully insured in-patient scheme.

Optional Riders:

  • A fully insured outpatient scheme
  • A fully insured Dental and optical cover
  • A fully insured Maternity Cover
  • Last/Funeral expense cover
  • Excess of Loss Cover

Enhanced benefits:

  • Cover for Pre-existing and chronic conditions
  • Opportunistic infections of HIV conditions

Other benefits offered at a fee:

Fund management / Scheme administration only

Structure of Cover

Cover can be either on a:

  • Per Family /shared limit. The family shares the cover on a first come first to claim basis until the limit is exhausted.
  • Per person basis. Each member has own limit.

Scheme Membership:

  1. All Permanent Employees, aged between 18 to 65 years.
  2. One Legal Spouse per principle member.
  3. Own or legally adopted child from 0 months (a term baby) to 18 years (or 23 Years for a child who is a fulltime school or college students).

Scope of Cover

Inpatient Cover: Minimum Kshs.100, 000 to a maximum 5,000,000

Inpatient cover provides for medically necessary hospital bed charges, doctor’s bills, anesthetist’s bills, operating theatre fees, ICU expenses, day surgery, physiotherapy pharmacy, laboratory and investigations reasonably incurred by an insured member. Local road and air evacuation is also included. This cover will be on credit facility with our providers.

Outpatient: Limit of cover offered: Kshs. 30,000 to 300,000

Outpatient cover provides for medically necessary consultation fees, investigatory procedures (laboratory & radiology), and referral to specialists, pharmacy and dressings Cover will be on credit facility basis with our providers and on 80% re-imbursement.

Dental: Limit of cover offered: Kshs. 10,000 to 30,000

This provides for: Cost of fillings, X-rays, Extractions including surgical extraction together with anesthetics fees

Optical: Limit of cover offered: Kshs. 10,000 to 30,000

This provides for the cost of eyeglasses and eye testing.

Maternity

This benefit shall cover Delivery fees, consultation and treatment for both mother and child only during the period of confinement in hospital.

Costs for miscarriages and abortions may be covered, provided they are certified by a gynecologist as being necessary to save the life of the mother.

This benefit is only available to staff/spouse

At APA Health, we:

  1. Guarantee confidentiality of member data and medical information.
  2. Provide clear communication of scope of cover to employer/members.
  3. Maintain access to all the accredited hospitals.
  4. Audit of bills and the utilization of the scheme by members.
  5. Ensure prompt settlement of claims.
  6. Issue policy document and photo cards promptly.
  7. Issue quarterly expenditure statement and call for review meeting.
  8. Observe the principal of Utmost Good Faith.
  9. Issue policy document and photo cards promptly.