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.