APA Insurance Jamii Plus Cover – Complete Guide

Jamii Plus is a comprehensive medical insurance product offered by APA Insurance in Kenya. It is designed for individuals and families seeking flexible, affordable healthcare coverage with the option to customize benefits based on needs and budget . The plan stands out for its high inpatient limits (up to KSh 10 million), coverage for pre-existing conditions, and extensive optional add-ons.

Overview

Key Benefits

Jamii Plus provides a range of inpatient benefits, with the option to add outpatient, maternity, dental, and optical coverage .

Inpatient Plans (Core Cover)

APA offers 5 inpatient plans with varying annual limits and bed options :

Outpatient Plans (Optional)

Outpatient cover can be added with 4 plan options :

Who Is Eligible?

Adults: Aged 18 years to 80 years 
Children: From Day 1 (full-term baby at 38 weeks) up to 17 years 

Waiting Periods

Exclusions (What’s NOT Covered)

Based on standard industry exclusions and policy wording, the following are typically not covered under Jamii Plus:

• Cosmetic Procedures – Plastic surgery not related to accidents or reconstructive necessity

• Alternative Medicine – Unless specifically endorsed (chiropractors and osteopaths are covered under outpatient on GP referral)

• Fertility Treatments – Assisted reproduction, IVF

• Weight Management – Bariatric surgery, weight loss programs

• Self-inflicted Injuries – Suicide attempts, intentional harm

• Substance Abuse – Conditions arising from alcohol or drug misuse

• Experimental Treatments – Unproven or investigational procedures

• War & Terrorism – Injuries from acts of war, terrorism, civil unrest

• Non-disclosed Pre-existing Conditions – Conditions not declared at policy inception

Silent Features (Value-Added Benefits)

These features add significant value but may not be prominently highlighted:

1. Pre-existing Conditions Covered – After 12 months, chronic conditions including HIV/AIDS, diabetes, hypertension, and cancer are covered up to generous limits .

2. Organ Transplant Coverage – Available from the 3rd year of cover for kidney, heart, liver, lung, and bone marrow transplants (excluding donor organ costs) .

3. Treatment in India – Overseas inpatient referrals to India are covered on a reimbursement basis when treatment is unavailable locally, including economy class airfare .

4. Post-hospitalisation Benefit – Covers treatment for 3 weeks after discharge, ensuring continuity of care .

5. Nursing at Home – Up to 30 days of home-based nursing care on doctor’s recommendation .

6. Parent Accommodation – When a child under 10 years is hospitalized, accommodation costs for one parent staying in the hospital are covered .

7. Funeral Expenses – Included as a standard benefit across all plans .

8. Free Personal Accident Benefit – Available for the principal member .

9. KEPI Vaccines for Children – Up to KSh 7,500 for recommended childhood vaccines for children up to 18 months .

10. Annual Health Check-up – From KSh 5,000 to KSh 10,000 depending on outpatient plan selected, for members aged 21 and above .

11. COVID-19 Cover – Free cover for COVID-19 and related expenses, with limits matching chronic/pre-existing condition limits .

12. Countrywide Provider Network – Access to a wide network of hospitals across Kenya .

Optional Add-ons

Jamii Plus allows you to customize your cover with these optional benefits :

Why Choose Jamii Plus?