Photo: Lebu Ayiga, Wikimedia Commons, CC BY-SA 4.0APA Insurance medical cover in Kenya: Jamii Plus and Afya Nafuu plans, prices and hospitals
The two family medical covers APA lists
APA Insurance's website blocks automated readers, so we read its product pages and brochures through their Web Archive copies in September 2026: the Jamii Plus page (copy of February 2026), the Afya Nafuu page (copy of September 2025) and the two brochures. Everything below is APA's own statement, not a rating.
- Jamii Plus — APA's brochure calls it "a premium family health cover": five inpatient levels, a private room on the top three, treatment in India on referral when it is not available locally, and optional outpatient, maternity, dental and optical cover. Open from day 1 (a full-term baby at 38 weeks) to 80 years.
- Afya Nafuu — the "affordable" family cover: six inpatient levels on the current page, general ward bed on all of them, with optional outpatient and maternity. The brochure sets the ages at 1 month to 75 years (maximum joining age 75); the product page says 75 in one place and 80 in another, so confirm with APA.
Both are sold by APA Insurance Limited, a general insurer on the regulator's list — see the APA profile for the regulator's figures and complaint count. APA's menu also lists Femina Plus, an International Health Cover and a corporate health cover; this article is about the two family plans.
Jamii Plus: inpatient limits and sub-limits
The overall limit is per year; conditions that are already there when you join are paid only after 12 months of cover and if you disclosed them. From the Jamii Plus page and brochure, in Kenya shillings:
| Overall limit a year | Bed | Pre-existing, chronic, HIV/AIDS, congenital | Psychiatry | Organ transplant (3rd year) |
|---|---|---|---|---|
| 10,000,000 | Private room up to 25,000 | 1,000,000 | 500,000 | 500,000 |
| 5,000,000 | Ensuite up to 18,000 | 500,000 | 250,000 | 500,000 |
| 2,000,000 | Standard private room up to 12,500 | 400,000 | 200,000 | 300,000 |
| 1,000,000 | General ward | 300,000 | 150,000 | 200,000 |
| 500,000 | General ward | 200,000 | 100,000 | 100,000 |
- Outpatient (optional, per person): 50,000, 75,000, 100,000 or 150,000 a year, with a consultation limit of 2,000 to 3,000 per visit and a general check-up from age 21.
- Maternity (optional, female principal or spouse): 50,000, 100,000 or 150,000 a year, antenatal visits, normal delivery and elective caesarean covered after 12 months.
- Dental and optical (optional): 10,000, 20,000 or 30,000 a year each.
Afya Nafuu: limits and the premiums APA published
The current Afya Nafuu page lists six levels, general ward bed on all of them:
| Overall limit a year | Pre-existing, chronic, HIV/AIDS, congenital | Inpatient dental | Funeral expenses |
|---|---|---|---|
| 2,000,000 | 300,000 | 75,000 | 50,000 |
| 1,000,000 | 250,000 | 40,000 | 30,000 |
| 750,000 | 200,000 | 30,000 | 25,000 |
| 500,000 | 150,000 | 30,000 | 25,000 |
| 300,000 | 100,000 | 20,000 | 20,000 |
| 100,000 | 50,000 | 10,000 | 20,000 |
The Afya Nafuu brochure names five of these levels (Affluent, Executive, Standard, Select, Mwananchi) and prints the inpatient premium per person per year, based on age at next birthday:
| Age | 1,000,000 | 750,000 | 500,000 | 300,000 | 100,000 |
|---|---|---|---|---|---|
| 1 month – 20 years | 9,417 | 7,788 | 6,727 | 6,115 | 5,500 |
| 21 – 40 years | 16,300 | 13,480 | 11,643 | 10,584 | 8,900 |
| 41 – 54 years | 23,499 | 19,779 | 17,043 | 15,084 | 11,120 |
| 55 – 65 years | 31,552 | 26,804 | 23,066 | 20,128 | 16,543 |
| 66 – 75 years | 42,350 | 38,115 | 30,492 | 25,918 | 19,890 |
Optional outpatient runs from KES 6,700 to KES 26,200 a person a year depending on age and limit (30,000 to 100,000), and optional maternity costs KES 7,500, 10,000 or 15,000 before taxes for a limit of 50,000, 75,000 or 100,000.
Waiting periods and main exclusions
| What | Jamii Plus | Afya Nafuu |
|---|---|---|
| Illness | 30 days | 30 days |
| Surgical procedures | 90 days | 90 days |
| Accidents | No waiting period | No waiting period |
| Pre-existing, chronic, HIV/AIDS, congenital | 12 months | 12 months |
| Fibroids, hernias, adenoidectomy, haemorrhoids | Up to 12 months (tonsillectomy too) | 12 months |
| Maternity (if bought) | 12 months | 10 months |
| Organ transplant | From the 3rd year | From the 3rd year |
Waiting periods run only with continuous renewal: after a break in cover they start again. Members joining at 55 or above must send a medical report, and APA says benefits may not be paid if a material fact was not disclosed. Exclusions in both brochures include cosmetic surgery (unless after an accident), family planning and infertility, herbal and Ayurvedic treatment, and expenses recoverable under another insurance.
Hospitals: the APA panel and the co-payment
Both covers work through APA's panel of accredited providers: you show your medical card (Jamii Plus outpatient runs on a smart card) at a panel hospital or clinic. APA's pages describe a "countrywide provider network"; ask APA for the current panel list for your county before choosing a plan.
- Afya Nafuu: no reimbursement for services outside the APA panel; cover limited to Kenya, plus up to 6 weeks abroad for travel, on reimbursement.
- Jamii Plus: doctors' fees paid at 100% on the panel; up to 85% of an out-of-panel doctor's fee can be claimed, at APA's panel rates. Cover within East Africa, and India for treatment not available locally, with pre-authorisation.
- Co-payment (Jamii Plus brochure): KES 500 at Gertrude's Children's Hospital, Aga Khan University Hospital, MP Shah, AAR, Nairobi Hospital and Mater Hospital and their satellite clinics; no co-payment elsewhere on the panel.
How to buy APA medical cover and make a claim
- Choose the inpatient limit for the family, then the options (outpatient, maternity, dental, optical).
- Fill in and sign the application form, with a passport photo of each member and a copy of your ID and KRA PIN (Afya Nafuu brochure), through an agent, a broker or an APA office.
- Pay the full premium: cover starts only once it is received. The brochure asks for payment directly to APA Insurance; APA's page gives paybill 511600.
- Receive the medical cards and policy document, and read the policy itself — the brochures are marketing summaries.
- Planned admission: tell APA at least 48 hours ahead and wait for pre-authorisation. Emergency: the hospital contacts APA within 48 hours of admission.
- Reimbursement claims (for example abroad): send them within 90 days of the date of the illness.
Either side can cancel with 14 days' notice. If APA refuses a claim, the steps are in our guide to complaining about an insurer. To compare APA's plans with other licensed insurers, read our health insurance guide or ask for quotes.
What would you like to do now?
Frequently asked questions
What medical covers does APA Insurance offer in Kenya?
For individuals and families, APA lists two family plans: Jamii Plus, with an inpatient limit from KES 500,000 to KES 10,000,000 a year, and Afya Nafuu, from KES 100,000 to KES 2,000,000. Outpatient, maternity and, on Jamii Plus, dental and optical are optional.
How much is APA Afya Nafuu per year?
APA's Afya Nafuu brochure, with rates "as at June 2017", lists inpatient premiums per person per year from KES 5,500 (limit 100,000, age up to 20) to KES 42,350 (limit 1,000,000, age 66 to 75). APA says rates can change without notice: ask for a current quote.
Does APA medical cover pay for pre-existing and chronic conditions?
Yes, on both plans, after 12 months of cover and only if the condition was disclosed when you joined, within a sub-limit: from KES 200,000 to KES 1,000,000 on Jamii Plus and from KES 50,000 to KES 300,000 on Afya Nafuu.
What is the waiting period on APA medical cover?
30 days for illness and 90 days for surgical procedures, none for accidents; 12 months for pre-existing and chronic conditions; for maternity, 12 months on Jamii Plus and 10 months on Afya Nafuu.
Can I use APA medical cover in any hospital?
Afya Nafuu pays only within APA's panel and does not reimburse outside it. Jamii Plus pays panel doctors in full and reimburses up to 85% of an out-of-panel doctor's fee at panel rates, with a KES 500 co-payment at a few named Nairobi hospitals.
Sources
- APA Insurance — Jamii Plus product page (insurer's own page, Web Archive copy of 23 February 2026)
- APA Insurance — Jamii Plus Health Cover brochure, "rates as at July 2019" (insurer's own document, Web Archive copy)
- APA Insurance — Afya Nafuu product page (insurer's own page, Web Archive copy of 5 September 2025)
- APA Insurance — Afya Nafuu brochure with premium rates "as at June 2017" (insurer's own document, Web Archive copy)