The following terms and conditions are true for the plans listed below:
- Minimum number of principals for Sapphire plan is 100
- Minimum number of principals for Emerald plan is 10
- Cover limit for both Corporate & Retail plans – 65 years.
- Family = Principal, Spouse and a maximum of 4 biological children under 18 years.
- Benefit limits are not transferable.
- Premium and benefits are subject to change.
- The Premium computed is payable once annually based on the populace.
- All pre-existing medical conditions are excluded for the initial one year of purchase for retail businesses.
Sapphire Plan Benefits
Emerald Plan Benefits
Ruby Plan Benefits
Pearl Plan benefits
Diamond Plan Benefits
Sapphire Plan Benefits
| Medical Benefits | Sapphire |
| Out-patient Services | |
| General Consultation | YES |
| Specialist Consultation/Care | YES |
| Routine Lab tests & Plain X-Ray (Chest, Limb & Joint) | |
| Basic | YES |
| Secondary | NO |
| Prescribed Drugs | YES |
| Physiotherapy (maximum sessions per annum) | NO |
| Management of Chronic Conditions (Group Policy only, Retail – After 12months) | |
| Hypertension | NO |
| Diabetes | NO |
| Sickle Anaemia | NO |
| Asthma | NO |
| Hospital Admission (21 Days) | |
| General ward | YES |
| Semi Private Ward | NO |
| Private Ward | NO |
| Maternity Services (Including Antenatal Care, Normal Delivery & Ceasarean Section) | ANC, Normal Delivery Only |
| Post Natal Care up to 6 weeks | NO |
| Family Planning Services (Family Plan only) | |
| Counselling only | NO |
| IUCDs | NO |
| Injectables | NO |
| Oral Contraception | NO |
| Implants | NO |
| Child Health Services (Family Plan only) | |
| Routine Immunization (NPI) | YES |
| Additional Childhood Immunization – Under 5 Years | |
| Rotavirus | NO |
| Varicella | NO |
| Pneumococal | NO |
| Meningitis | NO |
| Emergency Services | |
| Medical Emergencies | YES |
| Intensive Care/stabilization | NO |
| Local Evacuation to Hospital | NO |
| Accident & Emergency. | NO |
| Surgical Procedures – Minor, intermediate, Major | 50,000 |
| Advanced Radiological Services | |
| ECG | NO |
| Echocardiography | NO |
| Mammogram | NO |
| CT Scan | NO |
| MRI (1 session/annum) | NO |
| Optical Services | |
| Consultation & Refraction, visual acquity, Routine Examination | YES |
| Treatment of Simple Infection | YES |
| Provision of lenses :plain, bifocal& varifocal lenses subject to limit of coverage (1/year) | NO |
| Intraocular pressure test | NO |
| Eye Surgeries – Cataract | NO |
| Dental Services | |
| Dental Care (Including Consultation and Treatment, Investigations, Surgical Extraction, Scaling & Polishing, Extraction, Amalgam Filling) | Total Limit: 10,000 |
| Root Canal | NO |
| HIV/AIDS Support Services | |
| Education & VCT | YES |
| ARV treatment referral to diagnostic centres | YES |
| Additional Services | |
| Cancer –screening & investigation | NO |
| Fertility Treatment: basic investigation, non-hormonal drug treatment. | NO |
| Annual Basic Medical Examination (Principal Beneficiary Only) | NO |
| Comprehensive Medical Screening (Principal Beneficiary Only) | NO |
| Kidney dialysis (Principal Beneficiary Only) | NO |
| Mental Health Services | |
| Initial Psychiatric Evaluation | NO |
Emerald Plan Benefits
| Medical Benefits | Emerald |
| OUT-PATIENT SERVICES | |
| General Consultation | YES |
| Specialist Consultation /Care (On referral for initial consultation and subsequent follow up subject to covered diagnosis) | |
| Obstetrician | YES |
| Gynaecologist | YES |
| Pediatrician | YES |
| General Surgeon | YES |
| Cardiothoracic Surgeon | YES |
| Neurosurgeon | YES |
| ENT Surgeon (Otorhinolaryngologist) | YES |
| Urologist | YES |
| Orthopedic Surgeon | YES |
| Gastroenterologist | YES |
| Cardiologist | YES |
| Nephrologist | YES |
| Psychiatrist | YES |
| Neonatologist | YES |
| Dermatologist | YES |
| Pulmonologist/Respiratory Physician | YES |
| Hematologist | YES |
| Oncologist | YES |
| Endocrinologist | YES |
| Family Physician | YES |
| Oral and Maxillofacial Surgeon | YES |
| Pathologist | YES |
| Routine Laboratory tests | |
| Packed cell volume (PCV), Full blood count, | YES |
| White blood cell count(wbc) (Total & differential), Red blood count (rbc) | YES |
| Malaria parasites & Widal. | YES |
| Urinalysis | YES |
| Random blood Sugar | YES |
| PRESCRIBED MEDICATIONS | |
| Supply of drugs and medication as recommended in the course of treatment for covered services only. | YES |
| INPATIENT SERVICES (21 days Hospitalization) | |
| General ward | YES |
| Semi Private Ward | NO |
| Private Ward | NO |
| Skilled nursing care and inpatient medical services. General and Specialist medical review. | YES |
| Supply of drugs and Infusions, dressings, medical & surgical consumables for covered services only. | YES |
| Feeding on Admission | YES |
| PHYSIOTHERAPHY | |
| Basic physical therapy, massages, shortwave, infra-red radiation | 4 sessions/yr |
| Prescribed Physiotherapeutic Appliances: | |
| Cervical Collar | NO |
| Crutches | NO |
| Lumbar corset | NO |
| MANAGEMENT OF CHRONIC CONDITIONS (Group Policy only) | |
| Limit | 80,000 |
| Hypertension | YES |
| Diabetes mellitus | YES |
| Sickle Anaemia | YES |
| Chronic bronchitis | YES |
| Peptic ulcer | YES |
| Arthritis | YES |
| MATERNITY SERVICES (Family Plan only) | |
| Antenatal Services from conception to delivery including consultation, examinations and supply of drugs for all antenatal visits, Laboratory tests: haemoglobin estimation or packed cell volume evaluation, HIV 1 & 2 evaluation, blood group and genotype evaluation, Hepatitis B surface antigen, ultrasound scan examination (3 max) during pregnancy. | YES |
| Delivery services, Management of labour, Normal Delivery | YES |
| Induction of Labour and Assisted Delivery, forceps delivery | YES |
| Caesarian section C/S (Emergency & Medically Indicated Electives) | 100,000 |
| Hospitalization & skilled nursing care in connection with childbirth for the mother and the new born child(ren). | YES |
| Post Natal Care up to 6 weeks | YES |
| FAMILY PLANNING SERVICES (Family Plan only) | |
| Counselling | YES |
| Plain IUCDs / Copper T Intrauterine Device | YES |
| Oral Contraception | YES |
| Injectables | NO |
| Implants | NO |
| Tubal ligation, Vasectomy | NO |
| CHILD HEALTH SERVICES (Family Plan only) | |
| Childcare counselling | YES |
| Post Nantal Care of unregistered newborn within the first 6 weeks of life limited to routine primary health care | YES |
| treatment of minor infections | YES |
| puerperal infection | YES |
| hyper emesis gravid arum | YES |
| pre-eclampsia | YES |
| Circumcision of male infants | YES |
| Ear piercing for female infants | YES |
| Registration of newborn: Children born on the scheme should be registered on or before 6 weeks of birth | YES |
| Neonatal Care Services (Treatment of Mild or Moderate Neonatal Sepsis) | YES |
| Incubator Care | 24hrs |
| Mild Neonatal Jaundice / Phototherapy | 24hrs |
| Peadiatric services. Out-patient & In-patient consultation and treatment for enrolled infants. Peadiatric Specialist consultation ( on referral) | YES |
| NPI IMMUNIZATION (0-5) | |
| BCG, DPT | YES |
| Hepatitis B | YES |
| Oral polio | YES |
| Measles | YES |
| Vitamins A supplementation, | YES |
| Yellow fever | YES |
| Rotavirus, MMR | NO |
| Pneumococal (PCV), Varicella (Chicken pox), Meningitis (Meningococcal) | NO |
| MEDICAL EMERGENCY SERVICES | |
| Accident & Medical Emergencies Stabilization, Emergency Drugs, Investigations, Resuscitative or lifesaving initial treatment | 24hrs |
| Blood Transfusion | 2 pints |
| Local Evacuation to Hospital | YES |
| Gunshot wounds | YES |
| Out of Station treatment | YES |
| SURGICAL PROCEDURES | |
| All surgical procedures are subject to cost limit and are restricted within the borders of the country, Nigeria | 100,000 |
| Minor Surgical procedures: Excision of breast lump, Ganglionectomy, Lipectomy, Marsupialisation (Bartholin’s cyst), Surgical drainage of abscess, Removal of in-growing toenail, Minor wound debridement, Evacuation of impacted faeces, Drainage of paronychia, Suturing of minor lacerations, Chest tube insertion, Uterine evacuation of incomplete abortion. | YES |
| Intermediate Surgical procedures: Appendicectomy, , Excision of intrascrotal mass, Haemorrhoidectomy (excluding 3rd degree haemorrhoids), Herniorrhaphies, Herniotomy, Hydrocoelectomy, Low fistulectomy, Varicolectomy, Bouginage, Cervical cerclage, Manual removal of placenta. | YES |
| Major Surgical procedures: Adenoidectomy / Tonsilectomy, Laparatomy, Ruptured ectopic gestation, Ovarian cyst, Ruptured Appendix, Myomectomy, Hysterectomy, Prostatectomy, Cholecystectomy. ENT Surgery. | NO |
| RADIOLOGICAL SERVICES | |
| Plain X-Ray (Chest / Thorax, upper & lower Limbs, & Joint). Digital X-Ray | YES |
| Vertebrae | NO |
| Abdomen, Skull series | NO |
| Lumbar, Cervical | NO |
| Electrocardiography ECG (resting) | YES |
| Spirometry | NO |
| Echocardiography, E.C.G (pre and post exercise/ stress), Electroencephalography (EEG), Mammogram | NO |
| CT Scan | NO |
| Endoscopies | NO |
| MRI (1 session/annum) | NO |
| Special Radiological Investigations: Barium meal, Barium swallow, HSG, MCUG, RCUG, Myelogram, Intravenous Urography (IVU) | NO |
| ULTRASOUND SCAN | |
| Obstetrics | YES |
| Abdominal scan | YES |
| Abdominopelvic, Pelvic | YES |
| Breast, Transvaginal | NO |
| Prostate | NO |
| Scrotum | NO |
| Tetis | NO |
| Thyroid | NO |
| Transfrontanellar | NO |
| Follicular tracking, Tissue. | NO |
| LABORATORY & DIAGNOSTIC SERVICES | |
| Laboratory investigations and diagnostic services will be carried out based on the clinician’s judgment for covered services only. | |
| HAEMATOLOGY. | |
| Basic / Primary investigations: | |
| Haemoglobin (Hb) | YES |
| Packed cell volume (PCV) | YES |
| Full blood count, White blood cell count(wbc) (Total & differential) | YES |
| Red blood count (rbc) | YES |
| Erythrocyte sedimentation rate (esr) | YES |
| Platelets count, Genotype, Blood group | YES |
| Malaria parasites | YES |
| Differential count (wbc) | YES |
| wester green, Cross matching | YES |
| Secondary investigations: | |
| Reticulocytes | NO |
| Mean corpuscular haemoglobin concentration (mchc), | NO |
| Mean corpuscular volume (mcv) | NO |
| Mean corpuscular haemoglobin (mch) | NO |
| Direct coomb’s test | NO |
| Indirect coomb’s test | NO |
| Bleeding time, Clotting time | NO |
| Prothrombin time (pt), Sickling test | NO |
| CLINICAL CHEMISTRY | |
| Basic / Primary investigations: | |
| Fasting blood sugar, Random blood sugar | YES |
| Urea | YES |
| Creatinine | YES |
| Electrolyte & urea | YES |
| Calcium, Phosphorus, Sodium, Potassium, Chloride, Bicarbonate | YES |
| Secondary investigations: | |
| 2 hrs. post prandial test | NO |
| Oral glucose tolerance test | NO |
| Total bilirubin, Direct bilirubin | NO |
| Indirect bilirubin, Uric acid | NO |
| cholesterol, HDL/LDL cholesterol | NO |
| Total protein, Albumin | NO |
| tryglyceride, Creatinine clearance | NO |
| Sgot & sgpt | NO |
| Alkaline phosphatase | NO |
| Liver function test (lft) | NO |
| Prostatic acid phosphotase | NO |
| Amylase, Csf glucose | NO |
| Csf protein, Csf chloride | NO |
| Protein electrophoresis + report | NO |
| Gamma gt, Ck amylase | NO |
| Total acid phosphotase | NO |
| Cardiac enzymes (troponin I,C, CKMB), Glycosylated Haemoglobin (HbA1c) | NO |
| MICROBIOLOGY | |
| Urinalysis, Pregnancy test – urine | YES |
| Stool occult blood | YES |
| Urine m/c/s | YES |
| Aspirate pus m/c/s | YES |
| Hvs m/c/s | YES |
| Urethral & wound m/c/s | YES |
| Stool m/c/s | YES |
| Sputum m/c/s | YES |
| Mantoux/heaf test | NO |
| Skin snip | NO |
| Helicobacter pylori assay | NO |
| Semen culture & sensitivity | NO |
| Microfilaria | NO |
| Skin scrapping for fungal elements | NO |
| Sputum AAFB for tuberculosis | NO |
| Blood culture | NO |
| CSF m/c/s | NO |
| Semen analysis | NO |
| Urea Breath test | NO |
| SEROLOGY | |
| Widal, HIV 1 & 2 screening, Pregnancy test hcg (blood) | YES |
| Hepatitis B. surface antigen, Clamydia screening, VDRL test. | YES |
| Aso titre, Rheumatoid factor, Confirmatory test for HIV 1 and 2. | NO |
| Viral load, Cd4 count | NO |
| IMMUNOLOGY HORMONES | |
| Cortisol | NO |
| Follicle Stimulating Hormone | NO |
| Growth Hormone (HGH) | NO |
| HCG level (Molar Pregnancy | NO |
| Insulin, Leutenizing Hormone (HTSH) | NO |
| Oestriol, Oestradiol | NO |
| Prolactin, Progesterone, Testosterone | NO |
| Thyroid hormones (T3 and T4) | NO |
| Thyroid Stimulating Hormone (TSH) | NO |
| Thyrotrophin | NO |
| HISTOPATHOLOGY | |
| Specimen from incisional biopsy, Specimen from excisional biopsy | NO |
| Pap smear, Prostatic specific assay (PSA) | NO |
| CONTRAST STUDIES: Ba meal, Ba enema, Hsg | NO |
| OPTICAL CARE SERVICES | |
| Consultation (Optometrist & Ophthalmologist) Refraction | YES |
| visual acquity assessment | YES |
| Routine & External Examination | YES |
| Ophthamoscopy | YES |
| Phoria tests | YES |
| Drug treatment of simple ocular infection & allergies e.g. Conjunctivitis, blepharitis, pinguecular, stye, etc. | YES |
| Foreign body removal | YES |
| Intraocular pressure test | NO |
| Visual field analysis | NO |
| Pterygium | NO |
| chalazion, Retinal photography | NO |
| Ocular scan (A & B scans)Surgical treatment of occular diseases e.g, pterygium excision | NO |
| Cataract extraction | NO |
| Provision of lenses :plain, bifocal& varifocal lenses subject to limit of coverage (once annually) | 10,000 |
| OCT scan | NO |
| DENTAL CARE SERVICES | |
| Consultation | YES |
| Routine dental examination | YES |
| Drug treatment of Simple Infection and oral pain | YES |
| Dental X-Ray | YES |
| Pain therapy | YES |
| Simple Extraction | YES |
| Scaling & Polishing (once per annum for adult) | YES |
| Amalgam Filing for caries | 2 teeth/yr |
| Gingival Curretage, Composite Filling, Surgical Extraction | NO |
| Root Canal treatment (Excluding Crowning) | NO |
| EAR, NOSE & THROAT | |
| Consultation with the ENT (on referral), Prescribed Drug, Ear Syringing | YES |
| Removal of foreign body | NO |
| Pure tone Audiometry, Tympanometry | NO |
| HIV/AIDS SUPPORT SERVICES | |
| Voluntary Counselling / education and Testing at designated diagnostic centres Treatment of Opportunistic Infections ARV treatment referral to diagnostic centres | YES |
| MENTAL HEALTH SERVICES | |
| Initial Psychiatric Evaluation 2-weeks Out-patient Psychiatric Treatment (1 consultation, 2 Follow-Up Care) | YES |
| CANCER CARE | |
| Physical Examination (breasts, prostate and cervix etc) | YES |
| Cancer –screening & investigation | NO |
| REPRODUCTION/FERTILITY HEALTH | |
| GYNAECOLOGICAL AND OBSTETRICAL PROCEDURE: EUA, cauterization, episiotomy, vaginal laceration. | NO |
| Fertility Treatment: basic investigation, non-hormonal drug treatment | NO |
| Fertility Investigation – Counseling, USS, SFA, HSG, Hormonal Assay | NO |
| ADDITIONAL SERVICES | |
| Medical examination / screening (Medically indicated) | |
| Physical examination | YES |
| BMI | YES |
| blood pressure | YES |
| FBS & Urinalysis | YES |
| PCV | NO |
| blood pressure | NO |
| blood sugar | NO |
| Chest x-ray | NO |
| Genotype | NO |
| serum cholesterol | NO |
| Liver function test (lft) | NO |
| Kidney functions( E/U/Cr) | NO |
| cervical smears every 2 years for women > 30 years | NO |
| Prostate-specific antigen (PSA) for men above 40 yrs | NO |
| Blood Cholesterol Check | NO |
| Visual Acuity Check (Using Snellen Chart) | NO |
| Pap Smear | NO |
| Mammography (For Women ≥ 40 years of age) | NO |
| Kidney dialysis (Principal) | NO |
| Gym Service | NO |
| Mortuary Services (Cleaning, Embalmment, Storage, Ambulance) | NO |
| Outdoor fitness activities (walk for health, aerobic) | YES |
| PREVENTIVE HEALTHCARE/ HEALTH PROMOTION | |
| Provision of periodic disease prevention and health promotion information, wellness program and materials | YES |
| On-Site Basic Health Check, health education/ counseling, Health Talks. | YES |
| Outdoor fitness activities (walk for health, aerobic) | YES |
Ruby Plan Benefits
| Medical Benefits | Ruby |
| OUT-PATIENT SERVICES | |
| General Consultation | YES |
| Specialist Consultation /Care (On referral for initial consultation and subsequent follow up subject to covered diagnosis) | |
| Obstetrician | YES |
| Gynaecologist | YES |
| Pediatrician | YES |
| General Surgeon | YES |
| Cardiothoracic Surgeon | YES |
| Neurosurgeon | YES |
| ENT Surgeon (Otorhinolaryngologist) | YES |
| Urologist | YES |
| Orthopedic Surgeon | YES |
| Gastroenterologist | YES |
| Cardiologist | YES |
| Nephrologist | YES |
| Psychiatrist | YES |
| Neonatologist | YES |
| Dermatologist | YES |
| Pulmonologist/Respiratory Physician | YES |
| Hematologist | YES |
| Oncologist | YES |
| Endocrinologist | YES |
| Family Physician | YES |
| Oral and Maxillofacial Surgeon | YES |
| Pathologist | YES |
| Routine Laboratory tests | |
| Packed cell volume (PCV), Full blood count, | YES |
| White blood cell count(wbc) (Total & differential), Red blood count (rbc) | YES |
| Malaria parasites & Widal. | YES |
| Urinalysis | YES |
| Random blood Sugar | YES |
| PRESCRIBED MEDICATIONS | |
| Supply of drugs and medication as recommended in the course of treatment for covered services only. | YES |
| INPATIENT SERVICES (21 days Hospitalization) | |
| General ward | YES |
| Semi Private Ward | YES |
| Private Ward | YES |
| Skilled nursing care and inpatient medical services. General and Specialist medical review. | YES |
| Supply of drugs and Infusions, dressings, medical & surgical consumables for covered services only. | YES |
| Feeding on Admission | YES |
| PHYSIOTHERAPHY | |
| Basic physical therapy, massages, shortwave, infra-red radiation | 6 sessions/yr |
| Prescribed Physiotherapeutic Appliances: | |
| Cervical Collar | YES |
| Crutches | YES |
| Lumbar corset | YES |
| MANAGEMENT OF CHRONIC CONDITIONS (Group Policy only) | |
| Limit | 100,000.00 |
| Hypertension | YES |
| Diabetes mellitus | YES |
| Sickle Anaemia | YES |
| Chronic bronchitis | YES |
| Peptic ulcer | YES |
| Arthritis | YES |
| MATERNITY SERVICES (Family Plan only) | |
| Antenatal Services from conception to delivery including consultation, examinations and supply of drugs for all antenatal visits, Laboratory tests: haemoglobin estimation or packed cell volume evaluation, HIV 1 & 2 evaluation, blood group and genotype evaluation, Hepatitis B surface antigen, ultrasound scan examination (3 max) during pregnancy. | YES |
| Delivery services, Management of labour, Normal Delivery | YES |
| Induction of Labour and Assisted Delivery, forceps delivery | YES |
| Caesarian section C/S (Emergency & Medically Indicated Electives) | 200,000 |
| Hospitalization & skilled nursing care in connection with childbirth for the mother and the new born child(ren). | YES |
| Post Natal Care up to 6 weeks | YES |
| FAMILY PLANNING SERVICES (Family Plan only) | |
| Counselling | YES |
| Plain IUCDs / Copper T Intrauterine Device | YES |
| Oral Contraception | YES |
| Injectables | YES |
| Implants | YES |
| Tubal ligation, Vasectomy | YES |
| CHILD HEALTH SERVICES (Family Plan only) | |
| Childcare counselling | YES |
| Post Nantal Care of unregistered newborn within the first 6 weeks of life limited to routine primary health care | YES |
| treatment of minor infections | YES |
| puerperal infection | YES |
| hyper emesis gravid arum | YES |
| pre-eclampsia | YES |
| Circumcision of male infants | YES |
| Ear piercing for female infants | YES |
| Registration of newborn: Children born on the scheme should be registered on or before 6 weeks of birth | YES |
| Neonatal Care Services (Treatment of Mild or Moderate Neonatal Sepsis) | YES |
| Incubator Care | 48hrs |
| Mild Neonatal Jaundice / Phototherapy | 3days |
| Peadiatric services. Out-patient & In-patient consultation and treatment for enrolled infants. Peadiatric Specialist consultation ( on referral) | YES |
| NPI IMMUNIZATION (0-5) | |
| BCG, DPT | YES |
| Hepatitis B | YES |
| Oral polio | YES |
| Measles | YES |
| Vitamins A supplementation, | YES |
| Yellow fever | YES |
| Rotavirus, MMR | YES |
| Pneumococal (PCV), Varicella (Chicken pox), Meningitis (Meningococcal) | YES |
| MEDICAL EMERGENCY SERVICES | |
| Accident & Medical Emergencies Stabilization, Emergency Drugs, Investigations, Resuscitative or lifesaving initial treatment | 24hrs |
| Blood Transfusion | 3 pints |
| Local Evacuation to Hospital | YES |
| Gunshot wounds | YES |
| Out of Station treatment | YES |
| SURGICAL PROCEDURES | |
| All surgical procedures are subject to cost limit and are restricted within the borders of the country, Nigeria | 200,000 |
| Minor Surgical procedures: Excision of breast lump, Ganglionectomy, Lipectomy, Marsupialisation (Bartholin’s cyst), Surgical drainage of abscess, Removal of in-growing toenail, Minor wound debridement, Evacuation of impacted faeces, Drainage of paronychia, Suturing of minor lacerations, Chest tube insertion, Uterine evacuation of incomplete abortion. | YES |
| Intermediate Surgical procedures: Appendicectomy, , Excision of intrascrotal mass, Haemorrhoidectomy (excluding 3rd degree haemorrhoids), Herniorrhaphies, Herniotomy, Hydrocoelectomy, Low fistulectomy, Varicolectomy, Bouginage, Cervical cerclage, Manual removal of placenta. | YES |
| Major Surgical procedures: Adenoidectomy / Tonsilectomy, Laparatomy, Ruptured ectopic gestation, Ovarian cyst, Ruptured Appendix, Myomectomy, Hysterectomy, Prostatectomy, Cholecystectomy. ENT Surgery. | YES |
| RADIOLOGICAL SERVICES | |
| Plain X-Ray (Chest / Thorax, upper & lower Limbs, & Joint). Digital X-Ray | YES |
| Vertebrae | YES |
| Abdomen, Skull series | YES |
| Lumbar, Cervical | YES |
| Electrocardiography ECG (resting) | YES |
| Spirometry | YES |
| Echocardiography, E.C.G (pre and post exercise/ stress), Electroencephalography (EEG), Mammogram | YES |
| CT Scan | YES |
| Endoscopies | YES |
| MRI (1 session/annum) | YES |
| Special Radiological Investigations: Barium meal, Barium swallow, HSG, MCUG, RCUG, Myelogram, Intravenous Urography (IVU) | YES |
| ULTRASOUND SCAN | |
| Obstetrics | YES |
| Abdominal scan | YES |
| Abdominopelvic, Pelvic | YES |
| Breast, Transvaginal | YES |
| Prostate | YES |
| Scrotum | YES |
| Tetis | YES |
| Thyroid | YES |
| Transfrontanellar | YES |
| Follicular tracking, Tissue. | YES |
| LABORATORY & DIAGNOSTIC SERVICES | |
| Laboratory investigations and diagnostic services will be carried out based on the clinician’s judgment for covered services only. | |
| HAEMATOLOGY. | |
| Basic / Primary investigations: | |
| Haemoglobin (Hb) | YES |
| Packed cell volume (PCV) | YES |
| Full blood count, White blood cell count(wbc) (Total & differential) | YES |
| Red blood count (rbc) | YES |
| Erythrocyte sedimentation rate (esr) | YES |
| Platelets count, Genotype, Blood group | YES |
| Malaria parasites | YES |
| Differential count (wbc) | YES |
| wester green, Cross matching | YES |
| Secondary investigations: | |
| Reticulocytes | YES |
| Mean corpuscular haemoglobin concentration (mchc), | YES |
| Mean corpuscular volume (mcv) | YES |
| Mean corpuscular haemoglobin (mch) | YES |
| Direct coomb’s test | YES |
| Indirect coomb’s test | YES |
| Bleeding time, Clotting time | YES |
| Prothrombin time (pt), Sickling test | YES |
| CLINICAL CHEMISTRY | |
| Basic / Primary investigations: | |
| Fasting blood sugar, Random blood sugar | YES |
| Urea | YES |
| Creatinine | YES |
| Electrolyte & urea | YES |
| Calcium, Phosphorus, Sodium, Potassium, Chloride, Bicarbonate | YES |
| Secondary investigations: | |
| 2 hrs. post prandial test | YES |
| Oral glucose tolerance test | YES |
| Total bilirubin, Direct bilirubin | YES |
| Indirect bilirubin, Uric acid | YES |
| cholesterol, HDL/LDL cholesterol | YES |
| Total protein, Albumin | YES |
| tryglyceride, Creatinine clearance | YES |
| Sgot & sgpt | YES |
| Alkaline phosphatase | YES |
| Liver function test (lft) | YES |
| Prostatic acid phosphotase | YES |
| Amylase, Csf glucose | YES |
| Csf protein, Csf chloride | YES |
| Protein electrophoresis + report | YES |
| Gamma gt, Ck amylase | YES |
| Total acid phosphotase | YES |
| Cardiac enzymes (troponin I,C, CKMB), Glycosylated Haemoglobin (HbA1c) | YES |
| MICROBIOLOGY | |
| Urinalysis, Pregnancy test – urine | YES |
| Stool occult blood | YES |
| Urine m/c/s | YES |
| Aspirate pus m/c/s | YES |
| Hvs m/c/s | YES |
| Urethral & wound m/c/s | YES |
| Stool m/c/s | YES |
| Sputum m/c/s | YES |
| Mantoux/heaf test | YES |
| Skin snip | YES |
| Helicobacter pylori assay | YES |
| Semen culture & sensitivity | YES |
| Microfilaria | YES |
| Skin scrapping for fungal elements | YES |
| Sputum AAFB for tuberculosis | YES |
| Blood culture | YES |
| CSF m/c/s | YES |
| Semen analysis | YES |
| Urea Breath test | YES |
| SEROLOGY | |
| Widal, HIV 1 & 2 screening, Pregnancy test hcg (blood) | YES |
| Hepatitis B. surface antigen, Clamydia screening, VDRL test. | YES |
| Aso titre, Rheumatoid factor, Confirmatory test for HIV 1 and 2. | YES |
| Viral load, Cd4 count | YES |
| IMMUNOLOGY HORMONES | |
| Cortisol | YES |
| Follicle Stimulating Hormone | YES |
| Growth Hormone (HGH) | YES |
| HCG level (Molar Pregnancy | YES |
| Insulin, Leutenizing Hormone (HTSH) | YES |
| Oestriol, Oestradiol | YES |
| Prolactin, Progesterone, Testosterone | YES |
| Thyroid hormones (T3 and T4) | YES |
| Thyroid Stimulating Hormone (TSH) | YES |
| Thyrotrophin | YES |
| HISTOPATHOLOGY | |
| Specimen from incisional biopsy, Specimen from excisional biopsy | YES |
| Pap smear, Prostatic specific assay (PSA) | YES |
| CONTRAST STUDIES: Ba meal, Ba enema, Hsg | YES |
| OPTICAL CARE SERVICES | |
| Consultation (Optometrist & Ophthalmologist) Refraction | YES |
| visual acquity assessment | YES |
| Routine & External Examination | YES |
| Ophthamoscopy | YES |
| Phoria tests | YES |
| Drug treatment of simple ocular infection & allergies e.g. Conjunctivitis, blepharitis, pinguecular, stye, etc. | YES |
| Foreign body removal | YES |
| Intraocular pressure test | YES |
| Visual field analysis | YES |
| Pterygium | YES |
| chalazion, Retinal photography | YES |
| Ocular scan (A & B scans)Surgical treatment of occular diseases e.g, pterygium excision | YES |
| Cataract extraction | YES |
| Provision of lenses :plain, bifocal& varifocal lenses subject to limit of coverage (once annually) | 20,000 |
| OCT scan | YES |
| DENTAL CARE SERVICES | |
| Consultation | YES |
| Routine dental examination | YES |
| Drug treatment of Simple Infection and oral pain | YES |
| Dental X-Ray | YES |
| Pain therapy | YES |
| Simple Extraction | YES |
| Scaling & Polishing (once per annum for adult) | YES |
| Amalgam Filing for caries | 2 teeth/yr |
| Gingival Curretage, Composite Filling, Surgical Extraction | YES |
| Root Canal treatment (Excluding Crowning) | YES |
| EAR, NOSE & THROAT | |
| Consultation with the ENT (on referral), Prescribed Drug, Ear Syringing | YES |
| Removal of foreign body | YES |
| Pure tone Audiometry, Tympanometry | YES |
| HIV/AIDS SUPPORT SERVICES | |
| Voluntary Counselling / education and Testing at designated diagnostic centres Treatment of Opportunistic Infections ARV treatment referral to diagnostic centres | YES |
| MENTAL HEALTH SERVICES | |
| Initial Psychiatric Evaluation 2-weeks Out-patient Psychiatric Treatment (1 consultation, 2 Follow-Up Care) | YES |
| CANCER CARE | |
| Physical Examination (breasts, prostate and cervix etc) | YES |
| Cancer –screening & investigation | YES |
| REPRODUCTION/FERTILITY HEALTH | |
| GYNAECOLOGICAL AND OBSTETRICAL PROCEDURE: EUA, cauterization, episiotomy, vaginal laceration. | YES |
| Fertility Treatment: basic investigation, non-hormonal drug treatment | YES |
| Fertility Investigation – Counseling, USS, SFA, HSG, Hormonal Assay | YES |
| ADDITIONAL SERVICES | |
| Medical examination / screening (Medically indicated) | |
| Physical examination | YES |
| BMI | YES |
| blood pressure | YES |
| FBS & Urinalysis | YES |
| PCV | YES |
| blood pressure | YES |
| blood sugar | YES |
| Chest x-ray | YES |
| Genotype | YES |
| serum cholesterol | YES |
| Liver function test (lft) | YES |
| Kidney functions( E/U/Cr) | YES |
| cervical smears every 2 years for women > 30 years | YES |
| Prostate-specific antigen (PSA) for men above 40 yrs | YES |
| Blood Cholesterol Check | YES |
| Visual Acuity Check (Using Snellen Chart) | YES |
| Pap Smear | YES |
| Mammography (For Women ≥ 40 years of age) | YES |
| Kidney dialysis (Principal) | YES |
| Gym Service | YES |
| Mortuary Services (Cleaning, Embalmment, Storage, Ambulance) | NO30,000 |
| Outdoor fitness activities (walk for health, aerobic) | YES |
| PREVENTIVE HEALTHCARE/ HEALTH PROMOTION | |
| Provision of periodic disease prevention and health promotion information, wellness program and materials | YES |
| On-Site Basic Health Check, health education/ counseling, Health Talks. | YES |
| Outdoor fitness activities (walk for health, aerobic) | YES |
Pearl Plan benefits
| Medical Benefits | Pearl |
| OUT-PATIENT SERVICES | |
| General Consultation | YES |
| Specialist Consultation /Care (On referral for initial consultation and subsequent follow up subject to covered diagnosis) | |
| Obstetrician | YES |
| Gynaecologist | YES |
| Pediatrician | YES |
| General Surgeon | YES |
| Cardiothoracic Surgeon | YES |
| Neurosurgeon | YES |
| ENT Surgeon (Otorhinolaryngologist) | YES |
| Urologist | YES |
| Orthopedic Surgeon | YES |
| Gastroenterologist | YES |
| Cardiologist | YES |
| Nephrologist | YES |
| Psychiatrist | YES |
| Neonatologist | YES |
| Dermatologist | YES |
| Pulmonologist/Respiratory Physician | YES |
| Hematologist | YES |
| Oncologist | YES |
| Endocrinologist | YES |
| Family Physician | YES |
| Oral and Maxillofacial Surgeon | YES |
| Pathologist | YES |
| Routine Laboratory tests | |
| Packed cell volume (PCV), Full blood count, | YES |
| White blood cell count(wbc) (Total & differential), Red blood count (rbc) | YES |
| Malaria parasites & Widal. | YES |
| Urinalysis | YES |
| Random blood Sugar | YES |
| PRESCRIBED MEDICATIONS | |
| Supply of drugs and medication as recommended in the course of treatment for covered services only. | YES |
| INPATIENT SERVICES (21 days Hospitalization) | |
| General ward | YES |
| Semi Private Ward | YES |
| Private Ward | YES |
| Skilled nursing care and inpatient medical services. General and Specialist medical review. | YES |
| Supply of drugs and Infusions, dressings, medical & surgical consumables for covered services only. | YES |
| Feeding on Admission | YES |
| PHYSIOTHERAPHY | |
| Basic physical therapy, massages, shortwave, infra-red radiation | 8 sessions/yr |
| Prescribed Physiotherapeutic Appliances: | |
| Cervical Collar | YES |
| Crutches | YES |
| Lumbar corset | YES |
| MANAGEMENT OF CHRONIC CONDITIONS (Group Policy only) | |
| Limit | 150,000.00 |
| Hypertension | YES |
| Diabetes mellitus | YES |
| Sickle Anaemia | YES |
| Chronic bronchitis | YES |
| Peptic ulcer | YES |
| Arthritis | YES |
| MATERNITY SERVICES (Family Plan only) | |
| Antenatal Services from conception to delivery including consultation, examinations and supply of drugs for all antenatal visits, Laboratory tests: haemoglobin estimation or packed cell volume evaluation, HIV 1 & 2 evaluation, blood group and genotype evaluation, Hepatitis B surface antigen, ultrasound scan examination (3 max) during pregnancy. | YES |
| Delivery services, Management of labour, Normal Delivery | YES |
| Induction of Labour and Assisted Delivery, forceps delivery | YES |
| Caesarian section C/S (Emergency & Medically Indicated Electives) | 250,000 |
| Hospitalization & skilled nursing care in connection with childbirth for the mother and the new born child(ren). | YES |
| Post Natal Care up to 6 weeks | YES |
| FAMILY PLANNING SERVICES (Family Plan only) | |
| Counselling | YES |
| Plain IUCDs / Copper T Intrauterine Device | YES |
| Oral Contraception | YES |
| Injectables | YES |
| Implants | NO |
| Tubal ligation, Vasectomy | YES |
| CHILD HEALTH SERVICES (Family Plan only) | |
| Childcare counselling | YES |
| Post Nantal Care of unregistered newborn within the first 6 weeks of life limited to routine primary health care | YES |
| treatment of minor infections | YES |
| puerperal infection | YES |
| hyper emesis gravid arum | YES |
| pre-eclampsia | YES |
| Circumcision of male infants | YES |
| Ear piercing for female infants | YES |
| Registration of newborn: Children born on the scheme should be registered on or before 6 weeks of birth | YES |
| Neonatal Care Services (Treatment of Mild or Moderate Neonatal Sepsis) | YES |
| Incubator Care | 72hrs |
| Mild Neonatal Jaundice / Phototherapy | 4days |
| Peadiatric services. Out-patient & In-patient consultation and treatment for enrolled infants. Peadiatric Specialist consultation ( on referral) | YES |
| NPI IMMUNIZATION (0-5) | |
| BCG, DPT | YES |
| Hepatitis B | YES |
| Oral polio | YES |
| Measles | YES |
| Vitamins A supplementation, | YES |
| Yellow fever | YES |
| Rotavirus, MMR | YES |
| Pneumococal (PCV), Varicella (Chicken pox), Meningitis (Meningococcal) | NO |
| MEDICAL EMERGENCY SERVICES | |
| Accident & Medical Emergencies Stabilization, Emergency Drugs, Investigations, Resuscitative or lifesaving initial treatment | 48hrs |
| Blood Transfusion | 4 pints |
| Local Evacuation to Hospital | YES |
| Gunshot wounds | YES |
| Out of Station treatment | YES |
| SURGICAL PROCEDURES | |
| All surgical procedures are subject to cost limit and are restricted within the borders of the country, Nigeria | 250,000 |
| Minor Surgical procedures: Excision of breast lump, Ganglionectomy, Lipectomy, Marsupialisation (Bartholin’s cyst), Surgical drainage of abscess, Removal of in-growing toenail, Minor wound debridement, Evacuation of impacted faeces, Drainage of paronychia, Suturing of minor lacerations, Chest tube insertion, Uterine evacuation of incomplete abortion. | YES |
| Intermediate Surgical procedures: Appendicectomy, , Excision of intrascrotal mass, Haemorrhoidectomy (excluding 3rd degree haemorrhoids), Herniorrhaphies, Herniotomy, Hydrocoelectomy, Low fistulectomy, Varicolectomy, Bouginage, Cervical cerclage, Manual removal of placenta. | YES |
| Major Surgical procedures: Adenoidectomy / Tonsilectomy, Laparatomy, Ruptured ectopic gestation, Ovarian cyst, Ruptured Appendix, Myomectomy, Hysterectomy, Prostatectomy, Cholecystectomy. ENT Surgery. | YES |
| RADIOLOGICAL SERVICES | |
| Plain X-Ray (Chest / Thorax, upper & lower Limbs, & Joint). Digital X-Ray | YES |
| Vertebrae | YES |
| Abdomen, Skull series | YES |
| Lumbar, Cervical | YES |
| Electrocardiography ECG (resting) | YES |
| Spirometry | YES |
| Echocardiography, E.C.G (pre and post exercise/ stress), Electroencephalography (EEG), Mammogram | YES |
| CT Scan | YES |
| Endoscopies | YES |
| MRI (1 session/annum) | YES |
| Special Radiological Investigations: Barium meal, Barium swallow, HSG, MCUG, RCUG, Myelogram, Intravenous Urography (IVU) | NO |
| ULTRASOUND SCAN | |
| Obstetrics | YES |
| Abdominal scan | YES |
| Abdominopelvic, Pelvic | YES |
| Breast, Transvaginal | YES |
| Prostate | YES |
| Scrotum | YES |
| Tetis | YES |
| Thyroid | YES |
| Transfrontanellar | YES |
| Follicular tracking, Tissue. | YES |
| LABORATORY & DIAGNOSTIC SERVICES | |
| Laboratory investigations and diagnostic services will be carried out based on the clinician’s judgment for covered services only. | |
| HAEMATOLOGY. | |
| Basic / Primary investigations: | |
| Haemoglobin (Hb) | YES |
| Packed cell volume (PCV) | YES |
| Full blood count, White blood cell count(wbc) (Total & differential) | YES |
| Red blood count (rbc) | YES |
| Erythrocyte sedimentation rate (esr) | YES |
| Platelets count, Genotype, Blood group | YES |
| Malaria parasites | YES |
| Differential count (wbc) | YES |
| wester green, Cross matching | YES |
| Secondary investigations: | |
| Reticulocytes | YES |
| Mean corpuscular haemoglobin concentration (mchc), | YES |
| Mean corpuscular volume (mcv) | YES |
| Mean corpuscular haemoglobin (mch) | YES |
| Direct coomb’s test | YES |
| Indirect coomb’s test | YES |
| Bleeding time, Clotting time | YES |
| Prothrombin time (pt), Sickling test | YES |
| CLINICAL CHEMISTRY | |
| Basic / Primary investigations: | |
| Fasting blood sugar, Random blood sugar | YES |
| Urea | YES |
| Creatinine | YES |
| Electrolyte & urea | YES |
| Calcium, Phosphorus, Sodium, Potassium, Chloride, Bicarbonate | YES |
| Secondary investigations: | |
| 2 hrs. post prandial test | YES |
| Oral glucose tolerance test | YES |
| Total bilirubin, Direct bilirubin | YES |
| Indirect bilirubin, Uric acid | YES |
| cholesterol, HDL/LDL cholesterol | YES |
| Total protein, Albumin | YES |
| tryglyceride, Creatinine clearance | YES |
| Sgot & sgpt | YES |
| Alkaline phosphatase | YES |
| Liver function test (lft) | YES |
| Prostatic acid phosphotase | YES |
| Amylase, Csf glucose | YES |
| Csf protein, Csf chloride | YES |
| Protein electrophoresis + report | YES |
| Gamma gt, Ck amylase | YES |
| Total acid phosphotase | YES |
| Cardiac enzymes (troponin I,C, CKMB), Glycosylated Haemoglobin (HbA1c) | YES |
| MICROBIOLOGY | |
| Urinalysis, Pregnancy test – urine | YES |
| Stool occult blood | YES |
| Urine m/c/s | YES |
| Aspirate pus m/c/s | YES |
| Hvs m/c/s | YES |
| Urethral & wound m/c/s | YES |
| Stool m/c/s | YES |
| Sputum m/c/s | YES |
| Mantoux/heaf test | YES |
| Skin snip | YES |
| Helicobacter pylori assay | YES |
| Semen culture & sensitivity | YES |
| Microfilaria | YES |
| Skin scrapping for fungal elements | YES |
| Sputum AAFB for tuberculosis | YES |
| Blood culture | YES |
| CSF m/c/s | YES |
| Semen analysis | YES |
| Urea Breath test | YES |
| SEROLOGY | |
| Widal, HIV 1 & 2 screening, Pregnancy test hcg (blood) | YES |
| Hepatitis B. surface antigen, Clamydia screening, VDRL test. | YES |
| Aso titre, Rheumatoid factor, Confirmatory test for HIV 1 and 2. | YES |
| Viral load, Cd4 count | YES |
| IMMUNOLOGY HORMONES | |
| Cortisol | YES |
| Follicle Stimulating Hormone | YES |
| Growth Hormone (HGH) | YES |
| HCG level (Molar Pregnancy | YES |
| Insulin, Leutenizing Hormone (HTSH) | YES |
| Oestriol, Oestradiol | YES |
| Prolactin, Progesterone, Testosterone | YES |
| Thyroid hormones (T3 and T4) | YES |
| Thyroid Stimulating Hormone (TSH) | YES |
| Thyrotrophin | YES |
| HISTOPATHOLOGY | |
| Specimen from incisional biopsy, Specimen from excisional biopsy | YES |
| Pap smear, Prostatic specific assay (PSA) | YES |
| CONTRAST STUDIES: Ba meal, Ba enema, Hsg | YES |
| OPTICAL CARE SERVICES | |
| Consultation (Optometrist & Ophthalmologist) Refraction | YES |
| visual acquity assessment | YES |
| Routine & External Examination | YES |
| Ophthamoscopy | YES |
| Phoria tests | YES |
| Drug treatment of simple ocular infection & allergies e.g. Conjunctivitis, blepharitis, pinguecular, stye, etc. | YES |
| Foreign body removal | YES |
| Intraocular pressure test | YES |
| Visual field analysis | YES |
| Pterygium | YES |
| chalazion, Retinal photography | YES |
| Ocular scan (A & B scans)Surgical treatment of occular diseases e.g, pterygium excision | YES |
| Cataract extraction | YES |
| Provision of lenses :plain, bifocal& varifocal lenses subject to limit of coverage (once annually) | 25,000 |
| OCT scan | NO |
| DENTAL CARE SERVICES | |
| Consultation | YES |
| Routine dental examination | YES |
| Drug treatment of Simple Infection and oral pain | YES |
| Dental X-Ray | YES |
| Pain therapy | YES |
| Simple Extraction | YES |
| Scaling & Polishing (once per annum for adult) | YES |
| Amalgam Filing for caries | 2 teeth/yr |
| Gingival Curretage, Composite Filling, Surgical Extraction | 2 teeth/yr |
| Root Canal treatment (Excluding Crowning) | NO |
| EAR, NOSE & THROAT | |
| Consultation with the ENT (on referral), Prescribed Drug, Ear Syringing | YES |
| Removal of foreign body | YES |
| Pure tone Audiometry, Tympanometry | YES |
| HIV/AIDS SUPPORT SERVICES | |
| Voluntary Counselling / education and Testing at designated diagnostic centres Treatment of Opportunistic Infections ARV treatment referral to diagnostic centres | YES |
| MENTAL HEALTH SERVICES | |
| Initial Psychiatric Evaluation 2-weeks Out-patient Psychiatric Treatment (1 consultation, 2 Follow-Up Care) | YES |
| CANCER CARE | |
| Physical Examination (breasts, prostate and cervix etc) | YES |
| Cancer –screening & investigation | YES |
| REPRODUCTION/FERTILITY HEALTH | |
| GYNAECOLOGICAL AND OBSTETRICAL PROCEDURE: EUA, cauterization, episiotomy, vaginal laceration. | YES |
| Fertility Treatment: basic investigation, non-hormonal drug treatment | YES |
| Fertility Investigation – Counseling, USS, SFA, HSG, Hormonal Assay | |
| ADDITIONAL SERVICES | |
| Medical examination / screening (Medically indicated) | |
| Physical examination | YES |
| BMI | YES |
| blood pressure | YES |
| FBS & Urinalysis | YES |
| PCV | YES |
| blood pressure | YES |
| blood sugar | YES |
| Chest x-ray | YES |
| Genotype | YES |
| serum cholesterol | YES |
| Liver function test (lft) | YES |
| Kidney functions( E/U/Cr) | YES |
| cervical smears every 2 years for women > 30 years | YES |
| Prostate-specific antigen (PSA) for men above 40 yrs | YES |
| Blood Cholesterol Check | YES |
| Visual Acuity Check (Using Snellen Chart) | YES |
| Pap Smear | YES |
| Mammography (For Women ≥ 40 years of age) | NO |
| Kidney dialysis (Principal) | 2 sessions |
| Gym Service | YES |
| Mortuary Services (Cleaning, Embalmment, Storage, Ambulance) | N50,000 |
| Outdoor fitness activities (walk for health, aerobic) | YES |
| PREVENTIVE HEALTHCARE/ HEALTH PROMOTION | |
| Provision of periodic disease prevention and health promotion information, wellness program and materials | YES |
| On-Site Basic Health Check, health education/ counseling, Health Talks. | YES |
| Outdoor fitness activities (walk for health, aerobic) | YES |
Diamond Plan Benefits
| Medical Benefits | Diamond |
| OUT-PATIENT SERVICES | |
| General Consultation | YES |
| Specialist Consultation /Care (On referral for initial consultation and subsequent follow up subject to covered diagnosis) | |
| Obstetrician | YES |
| Gynaecologist | YES |
| Pediatrician | YES |
| General Surgeon | YES |
| Cardiothoracic Surgeon | YES |
| Neurosurgeon | YES |
| ENT Surgeon (Otorhinolaryngologist) | YES |
| Urologist | YES |
| Orthopedic Surgeon | YES |
| Gastroenterologist | YES |
| Cardiologist | YES |
| Nephrologist | YES |
| Psychiatrist | YES |
| Neonatologist | YES |
| Dermatologist | YES |
| Pulmonologist/Respiratory Physician | YES |
| Hematologist | YES |
| Oncologist | YES |
| Endocrinologist | YES |
| Family Physician | YES |
| Oral and Maxillofacial Surgeon | YES |
| Pathologist | YES |
| Routine Laboratory tests | |
| Packed cell volume (PCV), Full blood count, | YES |
| White blood cell count(wbc) (Total & differential), Red blood count (rbc) | YES |
| Malaria parasites & Widal. | YES |
| Urinalysis | YES |
| Random blood Sugar | YES |
| PRESCRIBED MEDICATIONS | |
| Supply of drugs and medication as recommended in the course of treatment for covered services only. | YES |
| INPATIENT SERVICES (21 days Hospitalization) | |
| General ward | YES |
| Semi Private Ward | YES |
| Private Ward | YES |
| Skilled nursing care and inpatient medical services. General and Specialist medical review. | YES |
| Supply of drugs and Infusions, dressings, medical & surgical consumables for covered services only. | YES |
| Feeding on Admission | YES |
| PHYSIOTHERAPHY | |
| Basic physical therapy, massages, shortwave, infra-red radiation | 10 sessions/yr |
| Prescribed Physiotherapeutic Appliances: | |
| Cervical Collar | YES |
| Crutches | YES |
| Lumbar corset | YES |
| MANAGEMENT OF CHRONIC CONDITIONS (Group Policy only) | |
| Limit | 200,000.00 |
| Hypertension | YES |
| Diabetes mellitus | YES |
| Sickle Anaemia | YES |
| Chronic bronchitis | YES |
| Peptic ulcer | YES |
| Arthritis | YES |
| MATERNITY SERVICES (Family Plan only) | |
| Antenatal Services from conception to delivery including consultation, examinations and supply of drugs for all antenatal visits, Laboratory tests: haemoglobin estimation or packed cell volume evaluation, HIV 1 & 2 evaluation, blood group and genotype evaluation, Hepatitis B surface antigen, ultrasound scan examination (3 max) during pregnancy. | YES |
| Delivery services, Management of labour, Normal Delivery | YES |
| Induction of Labour and Assisted Delivery, forceps delivery | YES |
| Caesarian section C/S (Emergency & Medically Indicated Electives) | 400,000 |
| Hospitalization & skilled nursing care in connection with childbirth for the mother and the new born child(ren). | YES |
| Post Natal Care up to 6 weeks | YES |
| FAMILY PLANNING SERVICES (Family Plan only) | |
| Counselling | YES |
| Plain IUCDs / Copper T Intrauterine Device | YES |
| Oral Contraception | YES |
| Injectables | YES |
| Implants | YES |
| Tubal ligation, Vasectomy | YES |
| CHILD HEALTH SERVICES (Family Plan only) | |
| Childcare counselling | YES |
| Post Nantal Care of unregistered newborn within the first 6 weeks of life limited to routine primary health care | YES |
| treatment of minor infections | YES |
| puerperal infection | YES |
| hyper emesis gravid arum | YES |
| pre-eclampsia | YES |
| Circumcision of male infants | YES |
| Ear piercing for female infants | YES |
| Registration of newborn: Children born on the scheme should be registered on or before 6 weeks of birth | YES |
| Neonatal Care Services (Treatment of Mild or Moderate Neonatal Sepsis) | YES |
| Incubator Care | 5days |
| Mild Neonatal Jaundice / Phototherapy | 5days |
| Peadiatric services. Out-patient & In-patient consultation and treatment for enrolled infants. Peadiatric Specialist consultation ( on referral) | YES |
| NPI IMMUNIZATION (0-5) | |
| BCG, DPT | YES |
| Hepatitis B | YES |
| Oral polio | YES |
| Measles | YES |
| Vitamins A supplementation, | YES |
| Yellow fever | YES |
| Rotavirus, MMR | YES |
| Pneumococal (PCV), Varicella (Chicken pox), Meningitis (Meningococcal) | YES |
| MEDICAL EMERGENCY SERVICES | |
| Accident & Medical Emergencies Stabilization, Emergency Drugs, Investigations, Resuscitative or lifesaving initial treatment | 72hrs |
| Blood Transfusion | 4 pints |
| Local Evacuation to Hospital | YES |
| Gunshot wounds | YES |
| Out of Station treatment | YES |
| SURGICAL PROCEDURES | |
| All surgical procedures are subject to cost limit and are restricted within the borders of the country, Nigeria | 400,000 |
| Minor Surgical procedures: Excision of breast lump, Ganglionectomy, Lipectomy, Marsupialisation (Bartholin’s cyst), Surgical drainage of abscess, Removal of in-growing toenail, Minor wound debridement, Evacuation of impacted faeces, Drainage of paronychia, Suturing of minor lacerations, Chest tube insertion, Uterine evacuation of incomplete abortion. | YES |
| Intermediate Surgical procedures: Appendicectomy, , Excision of intrascrotal mass, Haemorrhoidectomy (excluding 3rd degree haemorrhoids), Herniorrhaphies, Herniotomy, Hydrocoelectomy, Low fistulectomy, Varicolectomy, Bouginage, Cervical cerclage, Manual removal of placenta. | YES |
| Major Surgical procedures: Adenoidectomy / Tonsilectomy, Laparatomy, Ruptured ectopic gestation, Ovarian cyst, Ruptured Appendix, Myomectomy, Hysterectomy, Prostatectomy, Cholecystectomy. ENT Surgery. | YES |
| RADIOLOGICAL SERVICES | |
| Plain X-Ray (Chest / Thorax, upper & lower Limbs, & Joint). Digital X-Ray | YES |
| Vertebrae | YES |
| Abdomen, Skull series | YES |
| Lumbar, Cervical | YES |
| Electrocardiography ECG (resting) | YES |
| Spirometry | YES |
| Echocardiography, E.C.G (pre and post exercise/ stress), Electroencephalography (EEG), Mammogram | YES |
| CT Scan | YES |
| Endoscopies | YES |
| MRI (1 session/annum) | YES |
| Special Radiological Investigations: Barium meal, Barium swallow, HSG, MCUG, RCUG, Myelogram, Intravenous Urography (IVU) | YES |
| ULTRASOUND SCAN | |
| Obstetrics | YES |
| Abdominal scan | YES |
| Abdominopelvic, Pelvic | YES |
| Breast, Transvaginal | YES |
| Prostate | YES |
| Scrotum | YES |
| Tetis | YES |
| Thyroid | YES |
| Transfrontanellar | YES |
| Follicular tracking, Tissue. | YES |
| LABORATORY & DIAGNOSTIC SERVICES | |
| Laboratory investigations and diagnostic services will be carried out based on the clinician’s judgment for covered services only. | |
| HAEMATOLOGY. | |
| Basic / Primary investigations: | |
| Haemoglobin (Hb) | YES |
| Packed cell volume (PCV) | YES |
| Full blood count, White blood cell count(wbc) (Total & differential) | YES |
| Red blood count (rbc) | YES |
| Erythrocyte sedimentation rate (esr) | YES |
| Platelets count, Genotype, Blood group | YES |
| Malaria parasites | YES |
| Differential count (wbc) | YES |
| wester green, Cross matching | YES |
| Secondary investigations: | |
| Reticulocytes | YES |
| Mean corpuscular haemoglobin concentration (mchc), | YES |
| Mean corpuscular volume (mcv) | YES |
| Mean corpuscular haemoglobin (mch) | YES |
| Direct coomb’s test | YES |
| Indirect coomb’s test | YES |
| Bleeding time, Clotting time | YES |
| Prothrombin time (pt), Sickling test | YES |
| CLINICAL CHEMISTRY | |
| Basic / Primary investigations: | |
| Fasting blood sugar, Random blood sugar | YES |
| Urea | YES |
| Creatinine | YES |
| Electrolyte & urea | YES |
| Calcium, Phosphorus, Sodium, Potassium, Chloride, Bicarbonate | YES |
| Secondary investigations: | |
| 2 hrs. post prandial test | YES |
| Oral glucose tolerance test | YES |
| Total bilirubin, Direct bilirubin | YES |
| Indirect bilirubin, Uric acid | YES |
| cholesterol, HDL/LDL cholesterol | YES |
| Total protein, Albumin | YES |
| tryglyceride, Creatinine clearance | YES |
| Sgot & sgpt | YES |
| Alkaline phosphatase | YES |
| Liver function test (lft) | YES |
| Prostatic acid phosphotase | YES |
| Amylase, Csf glucose | YES |
| Csf protein, Csf chloride | YES |
| Protein electrophoresis + report | YES |
| Gamma gt, Ck amylase | YES |
| Total acid phosphotase | YES |
| Cardiac enzymes (troponin I,C, CKMB), Glycosylated Haemoglobin (HbA1c) | YES |
| MICROBIOLOGY | |
| Urinalysis, Pregnancy test – urine | YES |
| Stool occult blood | YES |
| Urine m/c/s | YES |
| Aspirate pus m/c/s | YES |
| Hvs m/c/s | YES |
| Urethral & wound m/c/s | YES |
| Stool m/c/s | YES |
| Sputum m/c/s | YES |
| Mantoux/heaf test | YES |
| Skin snip | YES |
| Helicobacter pylori assay | YES |
| Semen culture & sensitivity | YES |
| Microfilaria | YES |
| Skin scrapping for fungal elements | YES |
| Sputum AAFB for tuberculosis | YES |
| Blood culture | YES |
| CSF m/c/s | YES |
| Semen analysis | YES |
| Urea Breath test | YES |
| SEROLOGY | |
| Widal, HIV 1 & 2 screening, Pregnancy test hcg (blood) | YES |
| Hepatitis B. surface antigen, Clamydia screening, VDRL test. | YES |
| Aso titre, Rheumatoid factor, Confirmatory test for HIV 1 and 2. | YES |
| Viral load, Cd4 count | YES |
| IMMUNOLOGY HORMONES | |
| Cortisol | YES |
| Follicle Stimulating Hormone | YES |
| Growth Hormone (HGH) | YES |
| HCG level (Molar Pregnancy | YES |
| Insulin, Leutenizing Hormone (HTSH) | YES |
| Oestriol, Oestradiol | YES |
| Prolactin, Progesterone, Testosterone | YES |
| Thyroid hormones (T3 and T4) | YES |
| Thyroid Stimulating Hormone (TSH) | YES |
| Thyrotrophin | YES |
| HISTOPATHOLOGY | |
| Specimen from incisional biopsy, Specimen from excisional biopsy | YES |
| Pap smear, Prostatic specific assay (PSA) | YES |
| CONTRAST STUDIES: Ba meal, Ba enema, Hsg | YES |
| OPTICAL CARE SERVICES | |
| Consultation (Optometrist & Ophthalmologist) Refraction | YES |
| visual acquity assessment | YES |
| Routine & External Examination | YES |
| Ophthamoscopy | YES |
| Phoria tests | YES |
| Drug treatment of simple ocular infection & allergies e.g. Conjunctivitis, blepharitis, pinguecular, stye, etc. | YES |
| Foreign body removal | YES |
| Intraocular pressure test | YES |
| Visual field analysis | YES |
| Pterygium | YES |
| chalazion, Retinal photography | YES |
| Ocular scan (A & B scans)Surgical treatment of occular diseases e.g, pterygium excision | YES |
| Cataract extraction | YES |
| Provision of lenses :plain, bifocal& varifocal lenses subject to limit of coverage (once annually) | 30,000 |
| OCT scan | YES |
| DENTAL CARE SERVICES | |
| Consultation | YES |
| Routine dental examination | YES |
| Drug treatment of Simple Infection and oral pain | YES |
| Dental X-Ray | YES |
| Pain therapy | YES |
| Simple Extraction | YES |
| Scaling & Polishing (once per annum for adult) | YES |
| Amalgam Filing for caries | 2 teeth/yr |
| Gingival Curretage, Composite Filling, Surgical Extraction | 4 teeth/yr |
| Root Canal treatment (Excluding Crowning) | YES |
| EAR, NOSE & THROAT | |
| Consultation with the ENT (on referral), Prescribed Drug, Ear Syringing | YES |
| Removal of foreign body | YES |
| Pure tone Audiometry, Tympanometry | YES |
| HIV/AIDS SUPPORT SERVICES | |
| Voluntary Counselling / education and Testing at designated diagnostic centres Treatment of Opportunistic Infections ARV treatment referral to diagnostic centres | YES |
| MENTAL HEALTH SERVICES | |
| Initial Psychiatric Evaluation 2-weeks Out-patient Psychiatric Treatment (1 consultation, 2 Follow-Up Care) | YES |
| CANCER CARE | |
| Physical Examination (breasts, prostate and cervix etc) | YES |
| Cancer –screening & investigation | YES |
| REPRODUCTION/FERTILITY HEALTH | |
| GYNAECOLOGICAL AND OBSTETRICAL PROCEDURE: EUA, cauterization, episiotomy, vaginal laceration. | YES |
| Fertility Treatment: basic investigation, non-hormonal drug treatment | YES |
| Fertility Investigation – Counseling, USS, SFA, HSG, Hormonal Assay | YES |
| ADDITIONAL SERVICES | |
| Medical examination / screening (Medically indicated) | |
| Kidney dialysis (Principal) | 3 sessions |
| Gym Service | YES |
| Mortuary Services (Cleaning, Embalmment, Storage, Ambulance) | N75,000 |
| Outdoor fitness activities (walk for health, aerobic) | YES |
| PREVENTIVE HEALTHCARE/ HEALTH PROMOTION | |
| Provision of periodic disease prevention and health promotion information, wellness program and materials | YES |
| On-Site Basic Health Check, health education/ counseling, Health Talks. | YES |
| Outdoor fitness activities (walk for health, aerobic) | YES |
General Exclusions
- Services not covered by the subscribed plan.
- Advanced conservative restorations
- orthodontic and associated treatment
- Artificial limbs
- Tuberculosis
- Liver and Kidney Transplant
- Supply of physiotherapeutic appliances
- Incubator care and use of oxygen support in cases of premature rupture of membrane
- Dialysis (Dependant)
- Cosmetic/Plastic surgeries
- Prosthesis and other fitting
- Denture and special dental procedures
- Cytotoxic treatment
- Chronic Conditions end stage diseases including renal failure, kidney failure, liver failure
- Certain injuries, – old sport injuries, self-inflicted injuries
- Overseas treatment and transplant surgery
- The following neonatal care and services will not be covered for newborn; Severe Neonatal Jaundice, Exchange Blood Transfusion, severe infections, Neonatal Sepsis and Congenital abnormalities requiring medical or surgical intervention
