What is a
pre-existing condition ?
Are conditions for which symptoms have been shown at some point
during the 3 years prior to commencement of cover, irrespective of whether any
medical treatment or advice was sought.
Any such condition or related condition about which you, knew or
could reasonably have been assumed to have known, will deemed to be
pre-existing.
What is a
chronic condition?
A chronic condition is one that requires regular medical attention
and goes on for a long time and for which there is no cure. For example;
Arthritis, Cancer, Hypertension, Diabetes & Asthma
Am I
covered if I get sick while out of the country?
APA will cover you for a period of SIX weeks while you are out of
the country on business or holiday. Pay the bill, get a letter from the doctor
and forward this with a claim form to APA and you will be refunded the bill.
It is
recommended that you consider taking the International travel cover whenever
you travel as this provides comprehensive coverage.
Am I
covered if I go overseas for treatment?
If the medical treatment you require is not available in Kenya and
doctors recommend that you go abroad, APA will pay the costs of a scheduled air
ticket for yourself and your medical bills up to the limit of cover. APA must
be advised prior to travelling abroad per treatment, to grant necessary
approval.
What do I
do when I have a scheduled hospital admission?
Complete the pre-authorization form and submit it to APA before
the admission date, take the APA letter of undertaking with you to the
Hospital. Show your APA medical card, National I.D or Employee / dependant I.D
card. At the time of discharge, fill and sign the APA claim form .The Hospital
will forward the claim form and bills to APA for payment.
Can I
choose my own doctors?
APA has a panel of well qualified, recognized doctors to treat you
on credit basis, if you have to visit your own doctor, you will have to pay and
seek reimbursement.
APA has negotiated discounted rated with the panel doctors. This
ensures that your benefit is used in a cost efficient manner and does not run
out before the cover period expires.
What
happens when I reached my insured limit ?
APA Health will inform the insured person in the event of such an
incident. You will receive Quarterly member statements. It is important that
you keep track of your benefit utilisation. APA will require you to pay back
any amounts incurred in excess of your insured limits.
Can my relatives, dependent, or even my friend
use my inpatient benefits ?
No, the insurance cover is for insured Person on the Policy
document per insured year. In the event of an incident APA Health will
terminate the contract with the insured Person and delete it from the cover
with immediate effect and No premium refund.
APA reserves the right to institute legal proceedings where a
member is found to be involved in fraudulent activities with regard to the
insurance covers issued.
