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Our Health Plans

PLANS

Pearl

Sapphire

Emerald

Ruby

Diamond

1

MEDICAL SERVICES

General consultation

Covered

Covered

Covered

Covered

Covered

Specialist consultation (Pediatric, Internal medicine, Obstetrics & Gynecology General surgery, Orthopedics & ENT

Covered excluding Orthopedics & ENT. Two consultation per policy year

Covered excluding Orthopedics & ENT. Three consultation per policy year

Covered to a limit of N100,000

Covered

Covered

Annual Routine Medical Screening. Including annual physical examination (General Physical Examination, BP Check, BMI, Respiratory rate, Complete Hemogram)

Covered

Covered

Covered

Covered

Covered

Annual Comprehensive Medical Screening Physical Examination, testing for organ function and Cancer screening (For Principal only)

Not Covered

Not Covered

Limited to 2 organs only

Limited to 3 organs only

Limited to 4 organs only

Routine laboratory investigation such as hematology, microbiology, serology and clinical chemistry & prescribed drugs

Covered

Covered

Covered

Covered

Covered

Adult Immunization: HBsAg (For Principal only)

Covered

Covered

Covered

Covered

Covered

2

IN-PATIENT CARE

Hospital Admission

Standard ward (10 days only)

Standard ward (15 days only)

Semi-Private ward (21 days only)

Private Ward (Covered)

Private Ward (Covered)

Nursing care

Covered

Covered

Covered

Covered

Covered

Intensive Care Unit

Not covered

Not covered

24 hours

48 hours

72 hours

3

ACCIDENT & EMERGENCY

Accident & Emergency nationwide cover including local evacuation within scope of benefit & subject to overall limit

Covered up to N100,000

Covered up to N120,000

Covered up to N150,000

Covered up to N200,000

Covered up to N250,000

Emergency drugs and investigation within the scope of benefit

Covered

Covered

Covered

Covered

Covered

4

RADIOLOGICAL & SPECIALIZED INVESTIGATIONS

Plain X-rays (Chest, Upper limb, lower limbs, Abdominal, Spine, Hip joints)

Covered

Covered

Covered

Covered

Covered

Ultrasound scans

Covered (Abdominal ultrasound only)

Covered

Covered

Covered

Covered

Electrocardiogram (ECG), Echocardiography, Electroencephalogram

Not covered

Not covered

Covered ECG only

Covered

Covered

Computed Tomography - CT Scan

Not covered

Not covered

Covered (Limited to 1 session only with 50% copayment)

Covered (Limited to 1 session only)

Covered (Limited to 2 sessions only

MRI

Not covered

Not covered

Not covered

Covered

Covered up to 2 sessions

Myelogram

Not covered

Not covered

Not covered

Not covered

Covered

Mammogram

Not covered

Not covered

Covered

Covered

Covered

5

MINOR SURGERIES

Suturing of lacerations, Incision & drainage, debridement of wounds, Evacuation of Impacted Faeces

Covered

Covered

Covered

Covered

Covered

Circumcision and Ear Piercing (Infants only)

Covered

Covered

Covered

Covered

Covered

Appendectomy, Herniorrhaphy, Excision Biopsy, Fistulectomy, Tonsillectomy, Surgical drainage of abscesses, Herniotomy, Hemorrhoidectomy, Surgical Excision of Soft Tissue Tumor, Closed Reduction of Fractures

Not Covered

Covered up to N100,000

Covered up to N200,000

Covered up to N300,000

Covered up N400,000

Hysterectomy, Myomectomy, Prostatectomy, Thyroidectomy, Open Reduced and Internal Fixation of Fractures (ORIF), Laparotomy, Intestinal Resection, Colostomy, Orchidectomy, Thoracotomy

Not covered

Covered up to N150,000

Covered up to N200,000

Covered up to N350,000

Covered up to N500,000

8

MATERNITY CARE (Family plan only)

Antenatal

Covered

Covered

Covered

Covered

Covered

Normal delivery

Covered

Covered

Covered

Covered

Covered

Assisted delivery

Not Covered

Covered

Covered

Covered

Covered

Caesarean section

Not Covered

Not Covered

Covered (Limit as in Major Surgery)

Covered (Limit as in Major Surgery)

Covered (Limit as in Major Surgery)

Post-natal care (Up to 6 weeks) Including Post-natal primary care/emergency care for newborn)

Covered

Covered

Covered

Covered

Covered

Preterm delivery

Not covered

Not covered

Not Covered

Covered

Covered

Family planning (IUCDs, Injectable, Oral Contraceptives, Norplant, BTL)

Not covered

Not covered

Covered (IUCD & Oral contraceptive)

Covered (Excluding BTL)

Covered

9

CHILD CARE AND PEDIATRIC SERVICES (Family Plan Only)

Neonatal Intensive Care Unit

Not covered

Not covered

Covered for the first 24hrs of life

Covered for the first 3 days of life

Covered for the first 5 days of life

Phototherapy

Not covered

Covered for 24hrs

Covered for 48hrs

Covered up to 3 days

Covered up to 5 days

Exchange Blood Transfusion (EBT)

Not covered

Not covered

Not covered

Covered

Covered

Routine Immunizations (NPI)

Covered

Covered

Covered

Covered

Covered

Additional immunizations (Rota virus, Pneumococcal, MMR, Meningococcal Meningitis)

Not covered

Not covered

Not covered

Pneumococcal, HIB, Rota Virus only

Covered

10

OPTICAL / OPHTHALMOLOGICAL SERVICES

Consultation

Covered

Covered

Covered

Covered

Covered

Provision of lenses and frames (once every 2 years)

Not covered

Covered up to N10,000

Covered up to N15,000

Covered up to N20,000

Covered up to N25,000

Optical Care

Not covered

Limits N15,000

Limits N20,000

Limit N25,000

Limits N30,000

Other Eye test (Tonometry, Ophthalmoscopy/Fundoscopy, Slit Lamp Examination, Visual Field)

Not covered

Covered

Covered

Covered

Covered

Ophthalmic Surgery such as Pterygium Excision, Cataract Extraction and Glaucoma

Not covered

Covered within limits

Covered within limits

Covered within limits

Covered within limits

11

DENTAL SERVICES

Up to a limit of N10,000

Up to limit of N25,000

Up to limit of N30,000

Up to limit of N40,000

Consultation, Pain Relief Therapy

Not covered

Covered

Covered

Covered

Covered

Fillings - Amalgam/ Composite (per annum)

Not Covered

Not Covered

Covered

Covered

Covered

Scaling & Polishing (only when medically prescribed)

Not covered

Not covered

Covered (Principals only)

Covered (Principals only)

Covered (Principals only)

Simple Extraction

Not covered

Covered

Covered

Covered

Covered

Surgical Extraction/Root Canal Therapy

Not covered

Not covered

Not covered

Covered

Covered

12

MANAGEMENT OF CHRONIC ILLNESS

Hypertension

Not covered

Not covered

Covered

Covered

Covered

Diabetes

Not covered

Not covered

Covered

Covered

Covered

Dialysis for Acute Renal Failure

Not covered

Not covered

Not covered

Covered for 1 session only

Covered for 2 sessions only

13

ADDITIONAL SERVICES

Physiotherapy

Not Covered

Not Covered

Covered (Max. of 3 sessions)

Covered (Max. of 5 sessions)

Covered (Max. of 7 sessions)

Orthotics e.g. Neck collar, Knee braces

Not Covered

Not Covered

Covered

Covered

Covered

Psychiatric illness assessment and treatment of acute phase not more than 2weeks

Not covered

Not covered

Covered

Covered

Covered

14

WELLNESS AND FITNESS

Counselling

Covered

Covered

Covered

Covered

Covered

Gymnasium

Not covered

Not covered

Not covered

Not covered

Covered

Spa

Not covered

Not covered

Not covered

Not covered

Covered

Swimming

Not covered

Not covered

Not covered

Not covered

Covered

Hiking

Not covered

Not covered

Not covered

Not covered

Covered

15

TELEMEDICINE

Telemedicine

Not covered

Not covered

Not covered

Covered

Covered

Maximum Benefit Limit per enrollee

N200,000.00

N350,000.00

N700,000.00

N1,000,000.00

N1,500,000.00

GENERAL EXCLUSION (applicable to local plans)

  • Artificial limbs & dental prostheses
  • Specific treatment for aids/hiv positive patients
  • Complex surgery (organ transplant, etc.)
  • Cosmetic plastic surgery
  • Tertiary radiological investigations such as ct scan etc.
  • Definitive treatment infertility: Intrauterineinsemination (iui) & in vitro fertilization (ivf).
  • Cytotoxic (anti-cancer) drugs and radiotherapy.
  • Screening and comprehensive health assessment.
  • Chronic renal dialysis.
  • Embalmment and autopsies
  • Management of sickle cell disease, tb, hiv, spinal cord injuries
  • Occupational hazard, epidemic, natural disaster.
  • Infertility treatment
  • Domestic violence/ self inflicted injury, injury resulting from riots.
  • Management of drug abuse and suicide related illnesses.
  • Injuries from dangerous sports.