Frequently Asked Questions
What is apre-existing condition ?
Are conditions for which symptoms have been shown at some pointduring the 3 years prior to commencement of cover, irrespective of whether anymedical treatment or advice was sought.
Any such condition or related condition about which you, knew orcould reasonably have been assumed to have known, will deemed to bepre-existing.
What isachroniccondition?
A chronic condition is one that requires regular medical attentionand goes on for a long time and for which there is no cure. For example;Arthritis, Cancer, Hypertension, Diabetes & Asthma
Am Icovered if I get sick while out of the country?
APA will cover you for a period of SIX weeks while you are out ofthe country on business or holiday. Pay the bill, get a letter from the doctorand forward this with a claim form to APA and you will be refunded the bill.
It isrecommended that you consider taking the International travel cover wheneveryou travel as this provides comprehensive coverage.
Am Icovered if I go overseas for treatment?
If the medical treatment you require is not available in Kenya anddoctors recommend that you go abroad, APA will pay the costs of a scheduled airticket for yourself and your medical bills up to the limit of cover. APA mustbe advised prior to travelling abroad per treatment, to grant necessaryapproval.
What do Ido when I have a scheduled hospital admission?
Complete the pre-authorization form and submit it to APA beforethe admission date, take the APA letter of undertaking with you to theHospital. Show your APA medical card, National I.D or Employee / dependant I.Dcard. At the time of discharge, fill and sign the APA claim form .The Hospitalwill forward the claim form and bills to APA for payment.
Can Ichoose my own doctors?
APA has a panel of well qualified, recognized doctors to treat youon credit basis, if you have to visit your own doctor, you will have to pay andseek reimbursement.
APA has negotiated discounted rated with the panel doctors. Thisensures that your benefit is used in a cost efficient manner and does not runout before the cover period expires.
Whathappens when I reached my insured limit ?
APA Health will inform the insured person in the event of such anincident. You will receive Quarterly member statements. It is important thatyou keep track of your benefit utilisation. APA will require you to pay backany amounts incurred in excess of your insured limits.
Can my relatives, dependent, or even my frienduse my inpatient benefits ?
No, the insurance cover is for insured Person on the Policydocument per insured year. In the event of an incident APA Health willterminate the contract with the insured Person and delete it from the coverwith immediate effect and No premium refund.
APA reserves the right to institute legal proceedings where amember is found to be involved in fraudulent activities with regard to theinsurance covers issued.
