Living a healthy stress-free life is every person's dream. A healthy family is a happy family. This is why we have medical insurance products designed to cover individuals and families. Our main products include: Inpatient cover is the core cover. With this, one is covered for; Pre-existing, Chronic, Congenital, HIV/AIDS-related conditions, cancer treatment, organ transplant, lodger fees, accidental dental/reconstructive surgery among many more others.
Covid-19 cover limit extended to match the limits offered limits offered under chronic / pre-existing conditions limit
Including all accommodation expenses net of NHIF during your stay in the hospital. Whether in the Wards, HDU or ICU.
All prescribed drugs and dressings through our designated partners.
Any doctor related charges including those of physicians, surgeons, anesthetists, and specialists for visits and consultations.
All prescribed laboratory tests, X-rays, Ultrasounds, MRI and CT Scans.
Inpatient cover is the core cover.
Inpatient cover is the core cover.
|Overall maximum benefit per year||10,000,000||5,000,000||2,000,000||1,000,000||500,000|
|Bed limits net of NHIF||Private room up to Kshs 25,000||Ensuite up to Kshs. 18,000||SPR up to Kshs 12,500||General Ward Bed||General Ward Bed|
|Prescription drugs and dressings - discharge drugs allowed up to a maximum of 30 days supply||Covered||Covered||Covered||Covered||Covered|
|Physicians, Specialist & Surgical fees, including anesthetist fees subject to APA panel rates||Covered||Covered||Covered||Covered||Covered|
|Theatre charges, HDU & ICU||Covered||Covered||Covered||Covered||Covered|
|Physiotherapy as part of treatment||Covered||Covered||Covered||Covered||Covered|
|Pre-existing / chronic conditions/HIV/AIDS/ Congenital conditions after 12 months of cover and on full disclosure at the time of joining||1,000,000||500,000||400,000||300,000||200,000|
|Organ transplantation (3rd year) excluding thecost of obtaining the donor organ. Covers operation costs for Kidney, Heart, Liver, Lung and Bone Marrow transplants||500,000||500,000||300,000||200,000||100,000|
|Psychiatry and psychotherapy conditions after 12 months of cover and on full disclosure at the time of joining||500,000||250,000||200,000||150,000||100,000|
|Post-hospitalisation Treatment- reimbursement only limited to the first 3 weeks after discharge||Covered||Covered||Covered||Covered||Covered|
|Accommodation costs for 1 parent staying in the hospital with insured child under 10 years||Covered||Covered||Covered||Covered||Covered|
|Day Care Surgery under General anesthesia||Covered||Covered||Covered||Covered||Covered|
|Nursing at home (on doctor’s recommendation)||30 Days||30 Days||30 Days||30 Days||30 Days|
|Local ambulance to hospital for emergency cases||Covered||Covered||Covered||Covered||Covered|
|Treatment outside East Africa RESTRICTED TO INDIA where treatment is not locally available (Pre-authorisation required) On reimbursement basis. Airfare Costs for ethpatient only on a scheduled flight in Economy Class||Covered||Covered||Covered||Covered||Covered|
|CT, MRI, and PET scans subject to pre-authorisation||Covered||Covered||Covered||Covered||Covered|
|1st ever emergency C-section &/or maternity-related complications after being on cover for 12 months.||100,000||100,000||75,000||50,000||50,000|
|In-Patient non-accidental Ophthalmology : includes cost of cataract-removal (1 year waiting period)||100,000||75,000||75,000||50,000||50,000|
|In-Patient non-accidental Dental (1 year waiting period)||100,000||75,000||75,000||50,000||50,000|
|Reconstructive surgery following an accident||Covered||Covered||Covered||Covered||Covered|
|Emergency dental / optical treatment following accident||Covered||Covered||Covered||Covered||Covered|
|Annual Limits Per Person||50,000||75,000||100,000||150,000|
|Maximum Consultation Limit per visit||2,000||2,500||3,000||3,000|
|Physicians consultation fees||Covered||Covered||Covered||Covered|
|Prescription drugs up to a maximum of 30 days||Covered||Covered||Covered||Covered|
|Specialists fees (strictly on referral by a GP)||Covered up to 3,000||Covered up to 3,000||Covered up to 3,500||Covered up to 4,000|
|X-Ray, MRI’s, CT and other diagnostic tests||Covered||Covered||Covered||Covered|
|Physiotherapy prescribed by a GP||Covered||Covered||Covered||Covered|
|Treatment by chiropractors and osteopaths if on referral by a GP||Covered||Covered||Covered||Covered|
|Pre-existing/ Chronic conditions/ HIV AIDS/ Congenital Conditions after 12 months of cover & full disclosure at the time of joining||Covered||Covered||Covered||Covered|
|KEPI recommended vaccines covered for children up to 18 months||7,500||7,500||7,500||7,500|
|General Health Check-up for members from Age 21 and above||5,000||7,500||10,000||10,000|
If you are interested in learning how much this insurance product would cost you, or if you are interested in purchasing this insurance product, please click Get Cover.
If you would like further explanation or assistance about this insurance product, please click I Need Assistance.
Download forms will give you access to any relevant documents for this insurance product, such as the claim form, proposal form, etc.
While we all adjust to the new normal; an uncertain and challenging time brought about by Covid-19, we wish to remind you that we are still here and ready to help in whatever way we can.
As the first Insurer to cover Covid-19 from the beginning of the pandemic, and even as we face the threat of the new variant entering the Country, we wish to assure you that all our medical products continue to provide coverage for covid19. We have so far paid over KES 120mn for covid19 cases.
Your respective policies specify the limits covered, and overall, all policies renewing or starting in 2021 have the limits indicated in your policy while those that were running from 2020 did not have the indication and as such, for those policies, we are committed to settling covid19 to the policy overall limits. The usual process on preauthorization for tests and admissions apply. Our family Covers such as Jamii Plus, Afya Nafuu and Simba Products have the covid19 cover limit extended to match the limits offered for chronic and pre-existing conditions. You are therefore covered for covid19 under all our health products.
In support of our partners and communities, through the Apollo Foundation, we have so far donated funds, care packages and PPES of up to KES 15mn to support those highly impacted in the society.
Our branches and offices remain open while observing Covid19 prevention protocols. Please rest assured that we are doing our very best to maintain exceptional customer service during this time. Our services are also available online including drug deliveries. We encourage you reach out to us for any concerns.