BENEFIT COVER

HEALTH PLAN/SERVICE DESCRIPTION BRONZE SILVER GOLD GOLD PLUS PLATINUM

REGISTRATION
 INCLUDING SUPPLY OF HMO ID CARDS COVERED COVERED COVERED COVERED COVERED

CONSULTATION
 GENERAL PRACTITIONER COVERED COVERED COVERED COVERED COVERED
 SPECIALIST CONSULTATION WHEN NECESSARY COVERED COVERED COVERED COVERED COVERED

SUPPLY OF DRUGS & CONSUMABLES

PRESCRIBED DRUGS COVERED COVERED COVERED COVERED COVERED
NECK COLLARS, BANDAGES (CREPE & COTTON BANDAGES) COVERED COVERED COVERED COVERED COVERED
SURGICAL CONSUMABLES COVERED COVERED COVERED COVERED COVERED

NON-INVASIVE CARE AT OPD (BASIC PATIENT CARE) COVERED COVERED COVERED COVERED COVERED
MANIPULATIONS COVERED COVERED COVERED COVERED COVERED
POP APPLICATION COVERED COVERED COVERED COVERED COVERED
INJECTIONS. COVERED COVERED COVERED COVERED COVERED
 SKILLED NURSING CARE COVERED COVERED COVERED COVERED COVERED
 WOUND DRESSINGS COVERED COVERED COVERED COVERED COVERED
INVASIVE CARE COVERED COVERED COVERED COVERED COVERED
 INCISION & DRAINAGES COVERED COVERED COVERED COVERED COVERED
 MEDIUM-LARGE ABSCESSES COVERED COVERED COVERED COVERED COVERED
 INSERTION OF CHEST TUBES COVERED COVERED COVERED COVERED COVERED
CATHETERISATION COVERED COVERED COVERED COVERED COVERED

FEEDING ON ADMISSION COVERED COVERED COVERED COVERED COVERED

LABORATORY INVESTIGATIONS
HEAMATOLOGY –
 HEAMOGLOBIN, COVERED COVERED COVERED COVERED COVERED
 PACKED CELL VOLUME, COVERED COVERED COVERED COVERED COVERED
 DIFFERENTIAL COUNT, FULL BLOOD COUNT, WHITE
COVERED COVERED COVERED COVERED COVERED
CELL COUNT, RED BLOOD COUNT,
 ESR WESTERGREEN, RETICULOCYTES, PLATELETS,
COVERED COVERED COVERED COVERED COVERED
HCHC, MCV, GENOTYPE, BLOOD GROUP,
  DIRECT COOMB’S TEST, INDIRECT COOMB’S TEST, COVERED COVERED COVERED COVERED COVERED
 MALARIA PARASITES, COVERED COVERED COVERED COVERED COVERED
 CLOTTING TIME, PROTHROMBIN TIME, PARTIAL
COVERED COVERED COVERED COVERED COVERED
THROMBOPLASTIN TIME,
 G-6-P-D SCREENING. COVERED COVERED COVERED COVERED COVERED
CLINICAL CHEMISTRY – COVERED COVERED
 FASTING BLOOD SUGAR, RANDOM BLOOD SUGAR,
COVERED COVERED COVERED COVERED COVERED
2HR POST PRANDIAL, GLUCOSE TOLERANCE TEST,
 TOTAL BILIRUBIN, DIRECT BILIRUBIN, INDIRECT
COVERED COVERED COVERED COVERED COVERED
BILIRUBIN
 SGOT & SGPT, ALKALINE PHOSPHATASE, LIVER
COVERED COVERED COVERED COVERED COVERED
FUNCTION TEST,
 TOTAL PROTEIN, ALBUMIN, UREA, CREATINE
COVERED COVERED COVERED COVERED COVERED
CLEARANCE,
 SODIUM, POTASSIUM, CHLORIDE BICARBONATE,
ELECTROLYTE AND UREA, URIC ACID, CALCIUM, COVERED COVERED COVERED COVERED COVERED
PHOSPHORUS AND PHOSPHATASE,
 TOTAL ACID PHOSPHATASE, AMYLASE, COVERED COVERED COVERED COVERED COVERED
 CHOLESTEROL, TRIGLYCERIDES, COVERED COVERED COVERED COVERED COVERED
 CHLORIDE, HDL/LDL CHOLESTEROL, GAMMA GT, CK
AMYLASE, OGTT, LIPID PROFILE, SERUM PROTEIN COVERED COVERED COVERED COVERED COVERED
ELECTROPHORESIS.
MICROBIOLOGY –
 OCCULT BLOOD, COVERED COVERED COVERED COVERED COVERED
 URINE MCS, COVERED COVERED COVERED COVERED COVERED
 MANTOUX TEST/ HEAF, COVERED COVERED COVERED COVERED COVERED
 URINE MICROSCOPY, URINALYSIS, COVERED COVERED COVERED COVERED COVERED
 SEMEN MCS, ASPIRATE PUS MCS, COVERED COVERED COVERED COVERED COVERED
 MICROFILARIA, COVERED COVERED COVERED COVERED COVERED
 HVS MCS, COVERED COVERED COVERED COVERED COVERED
 URETHRAL & AND WOUND MCS, COVERED COVERED COVERED COVERED COVERED
 SKIN SNIP, COVERED COVERED COVERED COVERED COVERED
 STOOL ANALYSIS, COVERED COVERED COVERED COVERED COVERED
 SKIN SCRAPPING FOR FUNGUS, COVERED COVERED COVERED COVERED COVERED
 SPUTUM AFB, SPUTUM MCS, COVERED COVERED COVERED COVERED COVERED
 BLOOD CULTURE, CSF MCS, COVERED COVERED COVERED COVERED COVERED
 BLOOD PREGNANCY TEST, URINE PREGNANCY
COVERED COVERED COVERED COVERED COVERED
TEST.
SEROLOGY –
 WIDAL, VDRL, ASO TITRE, COVERED COVERED COVERED COVERED COVERED
 BLOOD GROUP, COVERED COVERED COVERED COVERED COVERED
 HBSG/ HEPATITIS C, COVERED COVERED COVERED COVERED COVERED
  HIV SCREENING, CONFIRMATORY, HIV. COVERED COVERED COVERED COVERED COVERED
RADIO DIAGNOSTIC INVESTIGATIONS
RADIOLOGICAL –
 HAND/FINGER, COVERED COVERED COVERED COVERED COVERED
 WRIST, COVERED COVERED COVERED COVERED COVERED
 RADIUS/ULNA, COVERED COVERED COVERED COVERED COVERED
 ELBOW, COVERED COVERED COVERED COVERED COVERED
 HUMERUS, COVERED COVERED COVERED COVERED COVERED
 SHOULDER, COVERED COVERED COVERED COVERED COVERED
 CLAVICLE, COVERED COVERED COVERED COVERED COVERED
 FOOT/TOE, COVERED COVERED COVERED COVERED COVERED
 ANKLE, COVERED COVERED COVERED COVERED COVERED
 TIBIA/FIBULA, COVERED COVERED COVERED COVERED COVERED
 KNEE, COVERED COVERED COVERED COVERED COVERED
 THIGH/FEMUR, COVERED COVERED COVERED COVERED COVERED
 HIP, PELVIS(AP), PELVIS AP &LAT, PELVIS COVERED COVERED COVERED COVERED COVERED
 CHEST PA, CHEST PA & LATERAL, COVERED COVERED COVERED COVERED COVERED
 STERNUM, COVERED COVERED COVERED COVERED COVERED
 THORACIC INLET, COVERED COVERED COVERED COVERED COVERED
 LATERAL NECK, COVERED COVERED COVERED COVERED COVERED
 THORACIC SPINE, COVERED COVERED COVERED COVERED COVERED
 THORACO- LUMBAR SPINE, COVERED COVERED COVERED COVERED COVERED
 LUMBAR SPINE, COVERED COVERED COVERED COVERED COVERED
 LUMBO-SACRAL, COVERED COVERED COVERED COVERED COVERED
 SACRAL PA &LAT, COVERED COVERED COVERED COVERED COVERED
 COCCYX, COVERED COVERED COVERED COVERED COVERED
 SACRO-ILIAC JOINT, COVERED COVERED COVERED COVERED COVERED
 CERVICAL SPINE, COVERED COVERED COVERED COVERED COVERED
 PLAIN ABDOMINAL, ERECT + SUPINE, COVERED COVERED COVERED COVERED COVERED
 PELVIMETRY, COVERED COVERED COVERED COVERED COVERED
 POST NASAL SPACE, COVERED COVERED COVERED COVERED COVERED
 SKULL AP/LAT, COVERED COVERED COVERED COVERED COVERED
 MASTOID, SINUSES, COVERED COVERED COVERED COVERED COVERED
 MANDIBLES, TEMPEROMANDIBULAR JT. COVERED COVERED COVERED COVERED COVERED
ULTRASOUND & IMAGING
 ABDOMINAL, PELVIC, COVERED COVERED COVERED COVERED COVERED
 BREAST SCAN, COVERED COVERED COVERED COVERED COVERED
 FISTULOGRAM/SONOGRAM, NOT COVERED NOT COVERED COVERED COVERED COVERED
 MC-URETHROGRAM, NOT COVERED NOT COVERED COVERED COVERED COVERED
 OBSTETRIC SCAN. COVERED COVERED COVERED COVERED COVERED
  IVU-BARIUM MEAL, BARIUM MEAL & FOLLOW
NOT COVERED COVERED COVERED COVERED COVERED
THROUGH, BARIUM SWALLOW, BARIUM ENEMA,
 ECG COVERED COVERED COVERED COVERED COVERED
 EEG NOT COVERED NOT COVERED COVERED COVERED COVERED
 CT SCAN (EMERGENCY CASES ONLY) NOT COVERED NOT COVERED COVERED COVERED COVERED
PHYSIOTHERAPY
 BASIC PHYSICAL THERAPY, COVERED COVERED COVERED COVERED COVERED
 BASIC PHYSIOTHERAPEUTIC APPLIANCES : CERVICAL COLLAR COVERED COVERED COVERED COVERED COVERED
 SHORTWAVE DIATHERMY, COVERED COVERED COVERED COVERED COVERED
 INFRARED RADIATION, COVERED COVERED COVERED COVERED COVERED
 MASSAGES, COVERED COVERED COVERED COVERED COVERED
 WAX TREATMENT COVERED COVERED COVERED COVERED COVERED

ACCIDENTS AND EMERGENCIES

 FIRST AID, COVERED COVERED COVERED COVERED COVERED
 STABILIZATION, COVERED COVERED COVERED COVERED COVERED
 ROAD TRAFFIC ACCIDENTS COVERED COVERED COVERED COVERED COVERED
 EVACUATION FROM SITE TO HOSPITAL (BY ROAD) COVERED COVERED COVERED COVERED COVERED
ANTENATAL + DELIVERY
 ANTENATAL CARE SERVICES, COVERED COVERED COVERED COVERED COVERED
 CONSULTATION, COVERED COVERED COVERED COVERED COVERED
 ULTRASOUND SCANS, COVERED COVERED COVERED COVERED COVERED
 LABORATORY TESTS COVERED COVERED COVERED COVERED COVERED
 MANAGEMENT of COMPLICATIONS IN PREGNANCY COVERED COVERED COVERED COVERED COVERED
 DELIVERY ROOM SERVICES COVERED COVERED COVERED COVERED COVERED
 MANAGEMENT OF LABOUR COVERED COVERED COVERED COVERED COVERED
 NORMAL PAR VAGINUM DELIVERY COVERED COVERED COVERED COVERED COVERED
 CAESAREAN SECTION DELIVERY COVERED COVERED COVERED COVERED COVERED
 ASSISTED DELIVERY (VACCUM, FORCEPS) COVERED COVERED COVERED COVERED COVERED

POST-DELIVERY CARE
 NEO NATAL CARE SIX WEEKS FOR REGISTRATION TO BE
COVERED COVERED COVERED COVERED COVERED
EFFECTED
 POST NATAL FOLLOW-UP COVERED COVERED COVERED COVERED COVERED
FAMILY PLANNING - IUCD, INJECTABLES COVERED COVERED COVERED COVERED COVERED
CHILD WELFARE CLINIC
 CIRCUMCISION COVERED COVERED COVERED COVERED COVERED
 EAR PIERCING COVERED COVERED COVERED COVERED COVERED
 IMMUNIZATIONS –
 BCG, MEASLES, COVERED COVERED COVERED COVERED COVERED
  ORAL POLIO, COVERED COVERED COVERED COVERED COVERED
 VITAMIN A, COVERED COVERED COVERED COVERED COVERED
 PENTAVALENT (DPT,HIB,HEP B) COVERED COVERED COVERED COVERED COVERED
 MMR, ROTAVIRUS NOT COVERED NOT COVERED COVERED COVERED COVERED
 PNEUMOCOCCAL CONJUGATE NOT COVERED NOT COVERED NOT COVERED NOT COVERED COVERED
MINOR SURGERY
 PRIMARY SUTURING, COVERED COVERED COVERED COVERED COVERED
 LORD’S PROCEDURE, PTERYGIUM, MEIBOMIAN CYST COVERED COVERED COVERED COVERED COVERED
 LIPOMA EXCISION, COVERED COVERED COVERED COVERED COVERED
 GANGLION EXCISION, COVERED COVERED COVERED COVERED COVERED
 INCISION AND DRAINAGE, COVERED COVERED COVERED COVERED COVERED
 KELOIDS EXCISION, COVERED COVERED COVERED COVERED COVERED
 MINOR BURNS WOUND DEBRIDEMENT COVERED COVERED COVERED COVERED COVERED
 MINOR SUTURING, POLYSYNDACTYLY COVERED COVERED COVERED COVERED COVERED
 RELEASE OF CHORDAE, COVERED COVERED COVERED COVERED COVERED
 SMALL CYST EXCISION, COVERED COVERED COVERED COVERED COVERED
 BREAST LUMP EXCISION COVERED COVERED COVERED COVERED COVERED
MAJOR SURGERY
 HERNIORAPHY, COVERED COVERED COVERED COVERED COVERED
 LAPAROTOMY, NOT COVERED COVERED COVERED COVERED COVERED
 DIAPHRAGMATIC HERNIA NOT COVERED NOT COVERED NOT COVERED NOT COVERED COVERED
 CYSTECTOMY, NOT COVERED NOT COVERED COVERED COVERED COVERED
 ADRENALECTOMY, NOT COVERED NOTCOVERED COVERED COVERED COVERED
 APPENDECTOMY COVERED COVERED COVERED COVERED COVERED
 FIBROID NOT COVERED COVERED COVERED COVERED COVERED
 OVARIAN CYST NOT COVERED NOT COVERED COVERED COVERED COVERED
 GUN SHOT WOUND COVERED COVERED COVERED COVERED COVERED
SEMI-PRIVATE
ADMISSION STANDARD WARD PRIVATE WARD PRIVATE WARD PRIVATE WARD
WARD
EYE CARE
 FOREIGN BODY REMOVAL, COVERED COVERED COVERED COVERED COVERED
 STYE INCISION, NOT COVERED NOT COVERED COVERED COVERED COVERED
 ENTROPION AND ECTOPION REPAIRS, NOT COVERED NOT COVERED COVERED COVERED COVERED
 CHALAZION INCISION, NOT COVERED COVERED COVERED COVERED COVERED
 SYRINGING AND PROBING, COVERED COVERED COVERED COVERED COVERED
 ROUTINE EYE EXAMINATION, REFRACTION, COVERED COVERED COVERED COVERED COVERED
 CONDITIONS – ALLERGIES, CONJUNCTIVITIS, COVERED COVERED COVERED COVERED COVERED
 CATARACT EXTRACTION, NOT COVERED NOT COVERED COVERED COVERED COVERED
 GLASSES / FRAMES NOT COVERED NOT COVERED 10,000 20,000 25,000
DENTAL CARE
 ROUTINE EXAMINATION OF DENTITION, COVERED COVERED COVERED COVERED COVERED
  X-RAYS, COVERED COVERED COVERED COVERED COVERED
 PERI-APICAL, COVERED COVERED COVERED COVERED COVERED
 BITE WINGS, COVERED COVERED COVERED COVERED COVERED
 SIMPLE EXTRACTION, COVERED COVERED COVERED COVERED COVERED
 AMALGAM FILLING, COVERED COVERED COVERED COVERED COVERED
 SURGICAL EXTRACTION, NOT COVERED NOT COVERED COVERED COVERED COVERED
GYNAECOLOGICAL AND OBSTETRICAL CARE
 LAP/RUPTURE REPAIR, COVERED COVERED COVERED COVERED COVERED
 EVACUATION UNDER ANAESTHESIA, COVERED COVERED COVERED COVERED COVERED
 BILATERAL TUBAL LIGATION, NOTCOVERED NOT COVERED COVERED COVERED COVERED
 CAUTERIZATION, NOTCOVERED COVERED COVERED COVERED COVERED
 MASUPIALIZATION, COVERED COVERED COVERED COVERED COVERED
 CERVICAL POLYPECTOMY, NOTCOVERED COVERED COVERED COVERED COVERED
 EPISIOTOMY, COVERED COVERED COVERED COVERED COVERED
 VAGINAL LACERATION, COVERED COVERED COVERED COVERED COVERED
 CERVICAL CERCLAGE, COVERED COVERED COVERED COVERED COVERED
 OVARIAN BIOPSY, NOT COVERED NOT COVERED COVERED COVERED COVERED
 INVESTIGATION FOR INFERTILITY(SFA, HSG. HORMONAL
NOT COVERED NOT COVERED COVERED COVERED COVERED
PROFILE)
ORTHOPAEDIC CARE
 BONE GRAFTING, NOT COVERED NOT COVERED NOT COVERED COVERED COVERED
 CLOSED REDUCTION AND CAST APPLICATION, COVERED COVERED COVERED COVERED COVERED
 SKIN TRACTION, POP APPLICATION, EXOSTECTOMY, COVERED COVERED COVERED COVERED COVERED
 JOINT EFFUSION TAP, COVERED COVERED COVERED COVERED COVERED
 SEQUESTRECTOMY, NOT COVERED NOT COVERED COVERED COVERED COVERED
 SKELETAL GRAFTING, NOT COVERED NOT COVERED COVERED COVERED COVERED
 ORIF NOT COVERED NOT COVERED COVERED COVERED COVERED
 SAUCERISATION, NOT COVERED NOT COVERED COVERED COVERED COVERED
COMPLEX CASE MANAGEMENT
 KIDNEY CARE (INCLUDING DIALYSIS) NOT COVERED NOT COVERED UP TO 150,000 UP TO N250,000 UP TO N500,000
 CANCER CARE NOT COVERED NOT COVERED DIAGNOSTIC ONLY UP TO N250,000 UP TO N500,000
 PROSTATECTOMY/BPH NOT COVERED NOT COVERED NOT COVERED NOT COVERED COVERED
 CHOLECYSTECTOMY NOT COVERED NOT COVERED COVERED COVERED COVERED
PREMIUM
SINGLE N25,000 N35,000 N50,000 N70,000 N100,000
FAMILY (P+S+D4) N100,000 N135,000 N225,000 N315,000 N450,000