In-Patient Claims

a)     Scheduled admission

• The member will inform APA Insurance Ltd.  Before the date of admission.  The attending/referring doctor will fully complete the APA Pre-authorization, which will be submitted to APA by the member. Based on this, the member will obtain a letter of undertaking from APA authorizing the admission. If private doctors’ fees are not indicated, then the undertaking to pay given by APA will be only for the hospital and resident doctor’s bills.
• The  member  will  identify  himself  properly  to  the  hospital  using  the  APA  medical  card/National Identity Card/Employment Card and will present the letter of undertaking to the hospital.
• Before discharge, or latest at the time of discharge, the attending doctor will complete the form and member will fill in the membership number, verify the final bill and sign the APA claim form.
• The claim form should be completed meticulously with each expense shown separately, with the nature of illness clearly indicated and with drugs prescribed given.
• The  hospital  will  forward  the  completed  claim  form  together  with  the  detailed  bill(s)  to  APA Insurance Ltd for settlement of the claim
• APA  does  not  cover  the  National  Hospital  Insurance  Fund  (NHIF)  expenses. To  benefit  from  NHIF subsidies,  the  member  must  present  his  NHIF  card  to  the  hospital  before  discharge  or  settle  the NHIF  amount  with  the  hospital  before  the  claim  documents  and  bills  are  submitted  to  APA.  This NHIF amount can then be claimed separately from NHIF if the card and paid bills are presented to NHIF.

b)   Emergency admission 

• The  member  will  identify  himself  properly  to  the  Hospital  using  the  APA  medical  card  and/or  other satisfactory identification. A Guardian may identify the member.
• The attending doctor will complete the APA Pre-authorisation form (available at the hospital) during such an admission. The Pre-authorisation form will be forwarded by the Hospital to APA Insurance Ltd within 48 hours of the admission.
• A  letter  of  undertaking  will  be  faxed  from  APA  Insurance  Ltd  within  48  hours  of  receipt  of  the questionnaire from the Hospital.
• Before discharge, or latest at the time of discharge, the member will sign the APA claim form and the attending doctor will complete it.
• The  hospital  will  forward  the  completed  claim  form  together  with  the  detailed  bill(s)  to  APA Insurance Ltd for settlement of the claim
• APA does not cover the National Hospital Insurance Fund (NHIF) expenses
• Please note that it shall be responsibility of the member to avail their NHIF cards which must be produced at the hospital for all admission cases