Who are we?
ProHealth HMO Limited is a registered company and accredited by the National Health Insurance Authority (NHIA), as a national Health Maintenance Organization (HMO) to provide social and private managed care health insurance services for institutions, corporate organizations, groups, families and individuals.
ProHealth HMO Limited is a Public-Private driven enterprise established by the Nigeria Social Insurance Trust Fund (NSITF) with investment contribution from private individuals and organizations. Nigeria Social Insurance Trust Fund (NSITF) established the company as a special purpose vehicle (SPV) to meet its strategic objectives and plans in realizing its statutory mandate under the ILO convention No 102 of 1952 (Minimum Standards fulfilment of the Medicare requirement) of providing Social Security Insurance as it relates to health.
Value Statement
Mission
“To be a leader in giving clients financial access to healthcare services through innovative products and technologies in an efficient way”.
Core Values
Responsiveness
Integrity
Innovation
Passion
Excellence
Vision
“To be a world class Health Maintenance Organisation (HMO) that facilitates quality and affordable healthcare services in Nigeria and beyond”.
Meet our Board of Directors
Our Board comprise of seasoned professionals and technocrats. The quality of our leadership is fundamental to the growth and success of our business; hence our directors have been pulled from the public and private sectors to guarantee the right mix of capabilities and skills required to meet the performance of an ambitions Health Insurance Industry and address the health challenges of an emerging economy. Our directors are experts in their respective fields and have brought a wide range of business, financial and global perspectives to the Board by actively participate in governance and strategic planning of the Company.
Barr. Samaila Abdu, Chairman, Board of Directors
A seasoned legal professional with over a decade of experience in diverse areas of legal practice including corporate consultancy, litigation, election petitions, property, and commercial law. Born and raised in Kafur Local Government Area of Katsina State, his educational journey began at ECWA Primary School, Malumfashi, and continued through Federal Government College, Daura, Katsina State. He later attended the School of Basic and Remedial Studies in Funtua before earning his LL. B (Hons) from Ahmadu Bello University, Zaria in 2009. He proceeded to the Nigerian Law School, Kano, and was called to the Nigerian Bar in 2010.
His legal career began with pupilage roles at reputable firms including Gidado Chambers and Aysha Ahmad & Co. in Zaria, where he developed a strong foundation in legal research, litigation, and advisory services. He later founded Gold-Wig Solicitors in Kaduna, where he served as Principal Partner, earning a reputation for professional integrity, courtroom excellence, and unwavering commitment to justice.
Barr. Abdu's is presently the Executive Director, Administrations of the Nigeria Social Insurance Trust Fund (NSITF).
Our other Board Members
Our Trusted Team
These are the individuals who inspire our progress and lead us toward a brighter future. Together, they are shaping the path to continued success for ProHealth HMO.
Dr. Margaret Isabona
Managing Director/CE
Dr Margaret Otibho Isabona is a Seasoned Administrator and a Health Management Professional. She has spent nearly two decades driving Sales and Operations at ProHealth HMO Ltd before her appointment as the Managing Director/ Chief Executive. She is a Doctor of Optometry (OD) graduate from the University of Benin who bagged the prestigious ODORBN award for Best Graduating Student in her Class, She also has a master’s degree in health management (MHM) and practiced clinically in both the Public and Private sectors before taking up appointment in this Organization.
In addition to her Medical and management degrees, She has undertaken several professional Development Courses through on-line offerings of schools like; Johns Hopkins Bloomberg School of Public Health, University of Copenhagen, University of California, Pennsylvania State University and University of Manchester. She has also attended several courses on health insurance processes with professional certificates on Claims and medical Billings, Rating and underwriting health Insurance products and Utilization Review and management in health
nsurance and managed care and has attended International Health insurance Conferences as participant and Speaker.
Dr Isabona is a Member of the Health Initiative Working group under the Payment system.....
Some of our Clients
Our Products
PHIS
CBSHIP
SSHIP
TISHIP
USESHIS
RHIP
Formal Sector
PHIS
Private Health Insurance Scheme (PHIS)
These are health plan packages designed for corporate organizations, small-medium enterprise (SME) and private individuals. There are 4 main plans under PHIS. However, a plan may be customized based on request or demographic information. These plans, as well as all our other plans are designed to comply with NHIA guidelines.
They also have access to our wide range of health care providers (HCP) nationwide. Enrollees have access to all the HCPs on our network in line with their subscribed health plan.
CBSHIP
Community Based Social Health Insurance Scheme
CBSHIP is a health insurance programme for a cohesive group of households/individuals or homogenous occupation-based groups, formed on the basis of the ethics of mutual aid and collective pooling of health risks, in which members take part in its management.
SSHIP
Schools Social Health Insurance Programme
This is a health insurance programme designed for health coverage of primary and secondary school students while they are under the care and custody of their school.
TISHIP
Tertiary Institutions Social Health insurance Scheme
This product was designed by the NHIA to manage the health care needs of students in tertiary institutions.
The scheme is run through a joint committee for the management of the scheme, comprising of representatives of the school management, students' representatives, the HMO and NHIA.
USESHIS
Urban Self-Employed Social Health Insurance Scheme
This scheme is for the low income earners and self-employed entrepreneurs. The scheme provides the enablement for contribution by interested persons irrespective of their socio-economic background. The contribution is remitted to a designated account to guarantee coverage for the subsequent period of the policy.
RHIP
Retiree Health Insurance Programmed (RHIP)
This scheme is for the elderly in the society. The benefits are targeted at meeting health care needs peculiar to old age, best suited for people who have retired from active service.
Formal Sector
Formal Sector Health Insurance Scheme
This is the mandatory National Health Insurance Scheme for civil servants in the employ of Federal and State governments. There is a standard health benefit package for all beneficiaries on the scheme.
Our Health Plans (Private Health Insurance Scheme)
Diamond Plus Plan
| S/N | Medical Benefits | DIAMOND PLUS |
| 1 | OUT-PATIENT SERVICES | |
| a | General Consultation | Yes |
| b | Specialist Consultation /Care (On referral for initial consultation and subsequent follow up subject to covered diagnosis) | |
| c | Routine Laboratory tests | |
| i | Packed cell volume (PCV), Full blood count, | Yes |
| ii | White blood cell count(wbc) (Total & differential), Red blood count (rbc) | Yes |
| iii | Malaria parasites & Widal. | Yes |
| iv | Urinalysis | Yes |
| v | Random blood Sugar | Yes |
| 2 | PRESCRIBED MEDICATIONS | |
| a | Supply of drugs and medication as recommended in the course of treatment for covered services only. | Yes |
| 3 | INPATIENT SERVICES (21 days Hospitalization) | |
| a | General ward | Yes |
| b | Semi Private Ward | Yes |
| c | Private Ward | Yes |
| d | Skilled nursing care and inpatient medical services. General and Specialist medical review. | Yes |
| e | Feeding on Admission | Yes |
| 4 | PHYSIOTHERAPHY | |
| a | Basic physical therapy, massages, shortwave, infra-red radiation | 15 sessions/yr |
| b | Prescribed Physiotherapeutic Appliances: | |
| i | Cervical Collar | Yes |
| ii | Crutches | Yes |
| iii | Lumbar corset | Yes |
| 5 | MANAGEMENT OF CHRONIC CONDITIONS (Group Policy only) | |
| Limit | 500,000.00 | |
| i | Hypertension | Yes |
| ii | Diabetes mellitus | Yes |
| iii | Sickle Anaemia | Yes |
| iv | Chronic bronchitis | Yes |
| v | Peptic ulcer | Yes |
| vi | Arthritis | Yes |
| 6 | MATERNITY SERVICES (Family Plan for Group policy only) | |
| a | Antenatal Care | Yes |
| b | Delivery services, Management of labour, Normal Delivery | Yes |
| c | Induction of Labour and Assisted Delivery, forceps delivery | Yes |
| d | Caesarian section C/S (Emergency & Medically Indicated Electives) | 1,000,000 |
| e | Hospitalization & skilled nursing care in connection with childbirth for the mother and the new born child(ren). | Yes |
| f | Post Natal Care up to 6 weeks | Yes |
| 7 | FAMILY PLANNING SERVICES (Family Plan only) | |
| a | Counselling | Yes |
| b | Plain IUCDs / Copper T Intrauterine Device | Yes |
| c | Oral Contraception | Yes |
| d | Injectables | Yes |
| e | Implants | Yes |
| f | Tubal ligation, Vasectomy | Yes |
| 8 | CHILD HEALTH SERVICES (Family Plan only) | |
| i | Childcare counselling | Yes |
| ii | Post Nantal Care of unregistered newborn within the first 6 weeks of life limited to routine primary health care | Yes |
| iii | treatment of minor infections | Yes |
| iv | puerperal infection | Yes |
| v | hyper emesis gravid arum | Yes |
| vi | pre-eclampsia | Yes |
| vii | Circumcision of male infants | Yes |
| viii | Ear piercing for female infants | Yes |
| ix | Registration of newborn: Children born on the scheme should be registered on or before 6 weeks of birth | Yes |
| b | Neonatal Care Services (Treatment of Mild or Moderate Neonatal Sepsis) | Yes |
| c | Incubator Care | 8days |
| d | Mild Neonatal Jaundice / Phototherapy | 8days |
| e | Peadiatric services. Out-patient & In-patient consultation and treatment for enrolled infants. Peadiatric Specialist consultation ( on referral) | Yes |
| f | NPI IMMUNIZATION (0-5) | |
| i | BCG, DPT | Yes |
| ii | Hepatitis B | Yes |
| iii | Oral polio | Yes |
| v | Measles | Yes |
| vi | Vitamins A supplementation, | Yes |
| vii | Yellow fever | Yes |
| viii | Rotavirus, MMR | Yes |
| ix | Pneumococal (PCV), Varicella (Chicken pox), Meningitis (Meningococcal) | Yes |
| 9 | MEDICAL EMERGENCY SERVICES | |
| a | Accident & Medical Emergencies Stabilization, Emergency Drugs, Investigations, Resuscitative or lifesaving initial treatment | 96hrs |
| b | Blood Transfusion | 6 pints |
| c | Local Evacuation to Hospital | Yes |
| d | Gunshot wounds | Yes |
| e | Out of Station treatment | Yes |
| 10 | SURGICAL PROCEDURES | |
| All surgical procedures are subject to cost limit and are restricted within the borders of the country, Nigeria | 1,000,000 | |
| a | 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 |
| b | 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 |
| c | Major Surgical procedures: Adenoidectomy / Tonsilectomy, Laparatomy, Ruptured ectopic gestation, Ovarian cyst, Ruptured Appendix, Myomectomy, Hysterectomy, Prostatectomy, Cholecystectomy. ENT Surgery. | Yes |
| 11 | RADIOLOGICAL SERVICES | |
| a | Plain X-Ray (Chest / Thorax, upper & lower Limbs, & Joint). Digital X-Ray | Yes |
| b | Vertebrae | Yes |
| c | Abdomen, Skull series | Yes |
| d | Lumbar, Cervical | Yes |
| e | Electrocardiography ECG (resting) | Yes |
| f | Spirometry | Yes |
| g | Echocardiography, E.C.G (pre and post exercise/ stress), Electroencephalography (EEG), Mammogram | Yes |
| h | CT Scan | Yes |
| i | Endoscopies | Yes |
| j | Intravenous Urography (IVU) | Yes |
| k | Hysterosalpingoscopy (HSG) | Yes |
| l | MRI (1 session/annum) | Yes |
| m | Special Radiological Investigations: Barium meal, Barium swallow, MCUG, RCUG, Myelogram | Yes |
| 12 | ULTRASOUND SCAN | |
| a | Obstetrics | Yes |
| b | Abdominal scan | Yes |
| c | Abdominopelvic, Pelvic | Yes |
| d | Breast, Transvaginal | Yes |
| c | Prostate | Yes |
| d | Scrotum | Yes |
| e | Tetis | Yes |
| f | Thyroid | Yes |
| g | Transfrontanellar | Yes |
| h | Follicular tracking, Tissue. | Yes |
| 13 | LABORATORY & DIAGNOSTIC SERVICES | |
| Laboratory investigations and diagnostic services will be carried out based on the clinician’s judgment for covered services only. | ||
| HAEMATOLOGY. | ||
| a | Basic / Primary investigations: | |
| i | Haemoglobin (Hb) | Yes |
| ii | Packed cell volume (PCV) | Yes |
| iii | Full blood count, White blood cell count(wbc) (Total & differential) | Yes |
| iv | Red blood count (rbc) | Yes |
| v | Erythrocyte sedimentation rate (esr) | Yes |
| vi | Platelets count, Genotype, Blood group | Yes |
| vii | Malaria parasites | Yes |
| viii | Differential count (wbc) | Yes |
| ix | wester green, Cross matching | Yes |
| b | Secondary investigations: | |
| i | Reticulocytes | Yes |
| ii | Mean corpuscular haemoglobin concentration (mchc), | Yes |
| iii | Mean corpuscular volume (mcv) | Yes |
| iv | Mean corpuscular haemoglobin (mch) | Yes |
| v | Direct coomb’s test | Yes |
| vi | Indirect coomb’s test | Yes |
| vii | Bleeding time, Clotting time | Yes |
| viii | Prothrombin time (pt), Sickling test | Yes |
| a | CLINICAL CHEMISTRY | |
| Basic / Primary investigations: | ||
| i | Fasting blood sugar, Random blood sugar | Yes |
| ii | Urea | Yes |
| iii | Creatinine | Yes |
| iv | Electrolyte & urea | Yes |
| v | Calcium, Phosphorus, Sodium, Potassium, Chloride, Bicarbonate | Yes |
| b | Secondary investigations: | |
| i | 2 hrs. post prandial test | Yes |
| ii | Oral glucose tolerance test | Yes |
| iii | Total bilirubin, Direct bilirubin | Yes |
| iv | Indirect bilirubin, Uric acid | Yes |
| v | cholesterol, HDL/LDL cholesterol | Yes |
| vi | Total protein, Albumin | Yes |
| vii | tryglyceride, Creatinine clearance | Yes |
| viii | Sgot & sgpt | Yes |
| ix | Alkaline phosphatase | Yes |
| x | Liver function test (lft) | Yes |
| xi | Prostatic acid phosphotase | Yes |
| xii | Amylase, Csf glucose | Yes |
| xiii | Csf protein, Csf chloride | Yes |
| xiv | Protein electrophoresis + report | Yes |
| xv | Gamma gt, Ck amylase | Yes |
| xvi | Total acid phosphotase | Yes |
| xvii | Glycosylated Haemoglobin (HbA1c) | Yes |
| xviii | Cardiac enzymes (troponin I,C, CKMB), | Yes |
| b | MICROBIOLOGY | Yes |
| i | Urinalysis, Pregnancy test – urine | Yes |
| ii | Stool occult blood | Yes |
| iii | Urine m/c/s | Yes |
| iv | Aspirate pus m/c/s | Yes |
| v | Hvs m/c/s | Yes |
| vi | Urethral & wound m/c/s | Yes |
| vii | Stool m/c/s | Yes |
| viii | Sputum m/c/s | Yes |
| ix | Mantoux/heaf test | Yes |
| x | Skin snip | Yes |
| xi | Helicobacter pylori assay | Yes |
| x | Helicobacter pylory stool antigene | Yes |
| xii | Semen m/c/s | Yes |
| xiii | Microfilaria | Yes |
| xiv | Skin scrapping for fungal elements | Yes |
| xv | Sputum AAFB for tuberculosis | Yes |
| xvi | Blood culture | Yes |
| xvii | CSF m/c/s | Yes |
| xviii | Semen analysis | Yes |
| xix | Urea Breath test | Yes |
| c | SEROLOGY | |
| i | Widal, | Yes |
| ii | HIV 1 & 2 screening, | Yes |
| iii | Pregnancy test hcg (blood) | Yes |
| iv | Hepatitis B. surface antigen, (HbSag) | Yes |
| v | Clamydia screening, | Yes |
| vi | VDRL test. | Yes |
| vii | Rheumatoid factor, | Yes |
| viii | Aso titre, | Yes |
| ix | Confirmatory test for HIV 1 and 2. | Yes |
| x | Viral load | Yes |
| xi | , Cd4 count | Yes |
| d | IMMUNOLOGY HORMONES | |
| i | Cortisol | Yes |
| ii | Follicle Stimulating Hormone | Yes |
| iii | Growth Hormone (HGH) | Yes |
| iv | HCG level (Molar Pregnancy | Yes |
| v | Insulin, Leutenizing Hormone (HTSH) | Yes |
| vi | Oestriol, Oestradiol | Yes |
| vii | Prolactin, Progesterone, Testosterone | Yes |
| viii | Thyroid hormones (T3 and T4) | Yes |
| ix | Thyroid Stimulating Hormone (TSH) | Yes |
| x | Thyrotrophin | Yes |
| e | HISTOPATHOLOGY | |
| i | Specimen from incisional biopsy, | Yes |
| ii | Specimen from excisional biopsy | Yes |
| iii | Pap smear | Yes |
| iv | Prostatic specific assay (PSA) | Yes |
| 14 | OPTICAL CARE SERVICES | |
| a | Consultation (Optometrist & Ophthalmologist) Refraction | Yes |
| b | visual acquity assessment | Yes |
| c | External E & Internal Ocular examination (Ophthalmoscopy) | Yes |
| f | Drug treatment of simple ocular infection & allergies e.g. Conjunctivitis, blepharitis, pinguecular, stye, etc. | Yes |
| g | Foreign body removal | Yes |
| h | Intraocular pressure test /Tonometry | Yes |
| j | Ocular surgeries (Pterygium, Chalazion, Cataract, Glaucoma) Surgery limit applies | Yes |
| i | Visual field analysis | Yes |
| k | Retinal photography | Yes |
| l | Ocular scan (A & B scans) | Yes |
| m | Ocular Coherence Tomography (OCT) | Yes |
| n | Provision of lenses (biennially) | 100,000 |
| 15 | DENTAL CARE SERVICES | |
| a | Consultation | Yes |
| b | Routine dental examination | Yes |
| c | Drug treatment of Simple Infection and oral pain | Yes |
| d | Dental X-Ray | Yes |
| e | Pain therapy | Yes |
| f | Simple Extraction | Yes |
| g | Scaling & Polishing (once per annum for adult) | Yes |
| h | Amalgam /Composite Filing for caries (Maximum 3 teeth per policy) | Yes |
| i | Gingival Curretage | Yes |
| j | Surgical Extraction | Yes |
| k | Root Canal treatment (Excluding Crowning) | Yes |
| 16 | EAR, NOSE & THROAT | |
| a | Consultation with the ENT (on referral), , | Yes |
| b | Ear Syringing | Yes |
| c | Prescribed Drug | Yes |
| d | Removal of foreign body | Yes |
| e | Pure tone Audiometry, Tympanometry | Yes |
| 17 | HIV/AIDS SUPPORT SERVICES | |
| a | Voluntary Counselling / education and Testing at designated diagnostic centres Treatment of Opportunistic Infections ARV treatment referral to diagnostic centres | Yes |
| 18 | MENTAL HEALTH SERVICES | |
| a | Initial Psychiatric Evaluation 2-weeks Out-patient Psychiatric Treatment (1 consultation, 2 Follow-Up Care) | Yes |
| 19 | CANCER CARE | |
| a | Physical Examination (breasts, prostate and cervix etc) | Yes |
| b | Cancer –screening & investigation | Yes |
| c | Oncological Surgeries | Yes |
| 20 | REPRODUCTION/FERTILITY HEALTH | |
| a | GYNAECOLOGICAL AND OBSTETRICAL PROCEDURE: EUA, cauterization, episiotomy, vaginal laceration. | Yes |
| b | Fertility Treatment: basic investigation, non-hormonal drug treatment | Yes |
| c | Fertility Investigation - Counseling, USS, SFA, HSG, Hormonal Assay | Yes |
| 21 | ADDITIONAL SERVICES | |
| a | Medical examination / screening (Medically indicated) | |
| i | Physical examination | Yes |
| ii | BMI | Yes |
| iii | blood pressure | Yes |
| iv | Fasting blood sugar test (FBS) | Yes |
| Urinalysis | ||
| vii | Random blood sugar test (RBS) | Yes |
| viii | Chest x-ray | Yes |
| x | serum cholesterol | Yes |
| xi | Liver function test (lft) | Yes |
| xii | Kidney functions( E/U/Cr) | Yes |
| xiii | cervical smears every 2 years for women > 30 years | Yes |
| xiv | Prostate-specific antigen (PSA) for men above 40 yrs | Yes |
| xvii | Breast scan | Yes |
| xviii | Mammography (For Women ≥ 40 years of age) | Yes |
| b | Kidney dialysis (Principal) | 5 sessions |
| c | Mortuary Services (Cleaning, Embalmment, Storage, Ambulance) | N100,000 |
| d | Outdoor fitness activities (walk for health, aerobic) | Yes |
| 22 | GYM SERVICE (Principal Only) | |
| a | Access to gyms for regular exercise | (2 session /week) |
| 23 | SPA (Principal Only) | |
| a | Facials | Either of facials or body massage (1 session/year) |
| b | Body massage | |
| 24 | PREVENTIVE HEALTHCARE/ HEALTH PROMOTION | |
| a | Provision of periodic disease prevention and health promotion information, wellness program and materials | Yes |
| a | On-Site Basic Health Check, health education/ counseling, Health Talks. | Yes |
| b | Outdoor fitness activities (walk for health, aerobic) | Yes |
Diamond Plan
| S/N | Medical Benefits | DIAMOND PLAN |
| 1 | OUT-PATIENT SERVICES | |
| a | General Consultation | Yes |
| b | Specialist Consultation /Care (On referral for initial consultation and subsequent follow up subject to covered diagnosis) | |
| c | Routine Laboratory tests | |
| i | Packed cell volume (PCV), Full blood count, | Yes |
| ii | White blood cell count(wbc) (Total & differential), Red blood count (rbc) | Yes |
| iii | Malaria parasites & Widal. | Yes |
| iv | Urinalysis | Yes |
| v | Random blood Sugar | Yes |
| 2 | PRESCRIBED MEDICATIONS | |
| a | Supply of drugs and medication as recommended in the course of treatment for covered services only. | Yes |
| 3 | INPATIENT SERVICES (21 days Hospitalization) | |
| a | General ward | Yes |
| b | Semi Private Ward | Yes |
| c | Private Ward | Yes |
| d | Skilled nursing care and inpatient medical services. General and Specialist medical review. | Yes |
| e | Feeding on Admission | Yes |
| 4 | PHYSIOTHERAPHY | |
| a | Basic physical therapy, massages, shortwave, infra-red radiation | 10 sessions/yr |
| b | Prescribed Physiotherapeutic Appliances: | |
| i | Cervical Collar | Yes |
| ii | Crutches | Yes |
| iii | Lumbar corset | Yes |
| 5 | MANAGEMENT OF CHRONIC CONDITIONS (Group Policy only) | |
| Limit | 250,000.00 | |
| i | Hypertension | Yes |
| ii | Diabetes mellitus | Yes |
| iii | Sickle Anaemia | Yes |
| iv | Chronic bronchitis | Yes |
| v | Peptic ulcer | Yes |
| vi | Arthritis | Yes |
| 6 | MATERNITY SERVICES (Family Plan for Group policy only) | |
| a | Antenatal Care | Yes |
| b | Delivery services, Management of labour, Normal Delivery | Yes |
| c | Induction of Labour and Assisted Delivery, forceps delivery | Yes |
| d | Caesarian section C/S (Emergency & Medically Indicated Electives) | 500,000 |
| e | Hospitalization & skilled nursing care in connection with childbirth for the mother and the new born child(ren). | Yes |
| f | Post Natal Care up to 6 weeks | Yes |
| 7 | FAMILY PLANNING SERVICES (Family Plan only) | |
| a | Counselling | Yes |
| b | Plain IUCDs / Copper T Intrauterine Device | Yes |
| c | Oral Contraception | Yes |
| d | Injectables | Yes |
| e | Implants | Yes |
| f | Tubal ligation, Vasectomy | Yes |
| 8 | CHILD HEALTH SERVICES (Family Plan only) | |
| i | Childcare counselling | Yes |
| ii | Post Nantal Care of unregistered newborn within the first 6 weeks of life limited to routine primary health care | Yes |
| iii | treatment of minor infections | Yes |
| iv | puerperal infection | Yes |
| v | hyper emesis gravid arum | Yes |
| vi | pre-eclampsia | Yes |
| vii | Circumcision of male infants | Yes |
| viii | Ear piercing for female infants | Yes |
| ix | Registration of newborn: Children born on the scheme should be registered on or before 6 weeks of birth | Yes |
| b | Neonatal Care Services (Treatment of Mild or Moderate Neonatal Sepsis) | Yes |
| c | Incubator Care | 5days |
| d | Mild Neonatal Jaundice / Phototherapy | 5days |
| e | Peadiatric services. Out-patient & In-patient consultation and treatment for enrolled infants. Peadiatric Specialist consultation ( on referral) | Yes |
| f | NPI IMMUNIZATION (0-5) | |
| i | BCG, DPT | Yes |
| ii | Hepatitis B | Yes |
| iii | Oral polio | Yes |
| v | Measles | Yes |
| vi | Vitamins A supplementation, | Yes |
| vii | Yellow fever | Yes |
| viii | Rotavirus, MMR | Yes |
| ix | Pneumococal (PCV), Varicella (Chicken pox), Meningitis (Meningococcal) | Yes |
| 9 | MEDICAL EMERGENCY SERVICES | |
| a | Accident & Medical Emergencies Stabilization, Emergency Drugs, Investigations, Resuscitative or lifesaving initial treatment | 72hrs |
| b | Blood Transfusion | 4 pints |
| c | Local Evacuation to Hospital | Yes |
| d | Gunshot wounds | Yes |
| e | Out of Station treatment | Yes |
| 10 | SURGICAL PROCEDURES | |
| All surgical procedures are subject to cost limit and are restricted within the borders of the country, Nigeria | 500,000 | |
| a | 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 |
| b | 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 |
| c | Major Surgical procedures: Adenoidectomy / Tonsilectomy, Laparatomy, Ruptured ectopic gestation, Ovarian cyst, Ruptured Appendix, Myomectomy, Hysterectomy, Prostatectomy, Cholecystectomy. ENT Surgery. | Yes |
| 11 | RADIOLOGICAL SERVICES | |
| a | Plain X-Ray (Chest / Thorax, upper & lower Limbs, & Joint). Digital X-Ray | Yes |
| b | Vertebrae | Yes |
| c | Abdomen, Skull series | Yes |
| d | Lumbar, Cervical | Yes |
| e | Electrocardiography ECG (resting) | Yes |
| f | Spirometry | Yes |
| g | Echocardiography, E.C.G (pre and post exercise/ stress), Electroencephalography (EEG), Mammogram | Yes |
| h | CT Scan | Yes |
| i | Endoscopies | Yes |
| j | Intravenous Urography (IVU) | Yes |
| k | Hysterosalpingoscopy (HSG) | Yes |
| l | MRI (1 session/annum) | Yes |
| m | Special Radiological Investigations: Barium meal, Barium swallow, MCUG, RCUG, Myelogram | Yes |
| 12 | ULTRASOUND SCAN | |
| a | Obstetrics | Yes |
| b | Abdominal scan | Yes |
| c | Abdominopelvic, Pelvic | Yes |
| d | Breast, Transvaginal | Yes |
| c | Prostate | Yes |
| d | Scrotum | Yes |
| e | Tetis | Yes |
| f | Thyroid | Yes |
| g | Transfrontanellar | Yes |
| h | Follicular tracking, Tissue. | Yes |
| 13 | LABORATORY & DIAGNOSTIC SERVICES | |
| Laboratory investigations and diagnostic services will be carried out based on the clinician’s judgment for covered services only. | ||
| HAEMATOLOGY. | ||
| a | Basic / Primary investigations: | |
| i | Haemoglobin (Hb) | Yes |
| ii | Packed cell volume (PCV) | Yes |
| iii | Full blood count, White blood cell count(wbc) (Total & differential) | Yes |
| iv | Red blood count (rbc) | Yes |
| v | Erythrocyte sedimentation rate (esr) | Yes |
| vi | Platelets count, Genotype, Blood group | Yes |
| vii | Malaria parasites | Yes |
| viii | Differential count (wbc) | Yes |
| ix | wester green, Cross matching | Yes |
| b | Secondary investigations: | |
| i | Reticulocytes | Yes |
| ii | Mean corpuscular haemoglobin concentration (mchc), | Yes |
| iii | Mean corpuscular volume (mcv) | Yes |
| iv | Mean corpuscular haemoglobin (mch) | Yes |
| v | Direct coomb’s test | Yes |
| vi | Indirect coomb’s test | Yes |
| vii | Bleeding time, Clotting time | Yes |
| viii | Prothrombin time (pt), Sickling test | Yes |
| a | CLINICAL CHEMISTRY | |
| Basic / Primary investigations: | ||
| i | Fasting blood sugar, Random blood sugar | Yes |
| ii | Urea | Yes |
| iii | Creatinine | Yes |
| iv | Electrolyte & urea | Yes |
| v | Calcium, Phosphorus, Sodium, Potassium, Chloride, Bicarbonate | Yes |
| b | Secondary investigations: | |
| i | 2 hrs. post prandial test | Yes |
| ii | Oral glucose tolerance test | Yes |
| iii | Total bilirubin, Direct bilirubin | Yes |
| iv | Indirect bilirubin, Uric acid | Yes |
| v | cholesterol, HDL/LDL cholesterol | Yes |
| vi | Total protein, Albumin | Yes |
| vii | tryglyceride, Creatinine clearance | Yes |
| viii | Sgot & sgpt | Yes |
| ix | Alkaline phosphatase | Yes |
| x | Liver function test (lft) | Yes |
| xi | Prostatic acid phosphotase | Yes |
| xii | Amylase, Csf glucose | Yes |
| xiii | Csf protein, Csf chloride | Yes |
| xiv | Protein electrophoresis + report | Yes |
| xv | Gamma gt, Ck amylase | Yes |
| xvi | Total acid phosphotase | Yes |
| xvii | Glycosylated Haemoglobin (HbA1c) | Yes |
| xviii | Cardiac enzymes (troponin I,C, CKMB), | Yes |
| b | MICROBIOLOGY | Yes |
| i | Urinalysis, Pregnancy test – urine | Yes |
| ii | Stool occult blood | Yes |
| iii | Urine m/c/s | Yes |
| iv | Aspirate pus m/c/s | Yes |
| v | Hvs m/c/s | Yes |
| vi | Urethral & wound m/c/s | Yes |
| vii | Stool m/c/s | Yes |
| viii | Sputum m/c/s | Yes |
| ix | Mantoux/heaf test | Yes |
| x | Skin snip | Yes |
| xi | Helicobacter pylori assay | Yes |
| x | Helicobacter pylory stool antigene | Yes |
| xii | Semen m/c/s | Yes |
| xiii | Microfilaria | Yes |
| xiv | Skin scrapping for fungal elements | Yes |
| xv | Sputum AAFB for tuberculosis | Yes |
| xvi | Blood culture | Yes |
| xvii | CSF m/c/s | Yes |
| xviii | Semen analysis | Yes |
| xix | Urea Breath test | Yes |
| c | SEROLOGY | |
| i | Widal, | Yes |
| ii | HIV 1 & 2 screening, | Yes |
| iii | Pregnancy test hcg (blood) | Yes |
| iv | Hepatitis B. surface antigen, (HbSag) | Yes |
| v | Clamydia screening, | Yes |
| vi | VDRL test. | Yes |
| vii | Rheumatoid factor, | Yes |
| viii | Aso titre, | Yes |
| ix | Confirmatory test for HIV 1 and 2. | Yes |
| x | Viral load | Yes |
| xi | , Cd4 count | Yes |
| d | IMMUNOLOGY HORMONES | |
| i | Cortisol | Yes |
| ii | Follicle Stimulating Hormone | Yes |
| iii | Growth Hormone (HGH) | Yes |
| iv | HCG level (Molar Pregnancy | Yes |
| v | Insulin, Leutenizing Hormone (HTSH) | Yes |
| vi | Oestriol, Oestradiol | Yes |
| vii | Prolactin, Progesterone, Testosterone | Yes |
| viii | Thyroid hormones (T3 and T4) | Yes |
| ix | Thyroid Stimulating Hormone (TSH) | Yes |
| x | Thyrotrophin | Yes |
| e | HISTOPATHOLOGY | |
| i | Specimen from incisional biopsy, | Yes |
| ii | Specimen from excisional biopsy | Yes |
| iii | Pap smear | Yes |
| iv | Prostatic specific assay (PSA) | Yes |
| 14 | OPTICAL CARE SERVICES | |
| a | Consultation (Optometrist & Ophthalmologist) Refraction | Yes |
| b | visual acquity assessment | Yes |
| c | External E & Internal Ocular examination (Ophthalmoscopy) | Yes |
| f | Drug treatment of simple ocular infection & allergies e.g. Conjunctivitis, blepharitis, pinguecular, stye, etc. | Yes |
| g | Foreign body removal | Yes |
| h | Intraocular pressure test /Tonometry | Yes |
| j | Ocular surgeries (Pterygium, Chalazion, Cataract, Glaucoma) Surgery limit applies | Yes |
| i | Visual field analysis | Yes |
| k | Retinal photography | Yes |
| l | Ocular scan (A & B scans) | Yes |
| m | Ocular Coherence Tomography (OCT) | Yes |
| n | Provision of lenses (biennially) | 50,000 |
| 15 | DENTAL CARE SERVICES | |
| a | Consultation | Yes |
| b | Routine dental examination | Yes |
| c | Drug treatment of Simple Infection and oral pain | Yes |
| d | Dental X-Ray | Yes |
| e | Pain therapy | Yes |
| f | Simple Extraction | Yes |
| g | Scaling & Polishing (once per annum for adult) | Yes |
| h | Amalgam /Composite Filing for caries (Maximum 3 teeth per policy) | Yes |
| i | Gingival Curretage | Yes |
| j | Surgical Extraction | Yes |
| k | Root Canal treatment (Excluding Crowning) | Yes |
| 16 | EAR, NOSE & THROAT | |
| a | Consultation with the ENT (on referral), , | Yes |
| b | Ear Syringing | Yes |
| c | Prescribed Drug | Yes |
| d | Removal of foreign body | Yes |
| e | Pure tone Audiometry, Tympanometry | Yes |
| 17 | HIV/AIDS SUPPORT SERVICES | |
| a | Voluntary Counselling / education and Testing at designated diagnostic centres Treatment of Opportunistic Infections ARV treatment referral to diagnostic centres | Yes |
| 18 | MENTAL HEALTH SERVICES | |
| a | Initial Psychiatric Evaluation 2-weeks Out-patient Psychiatric Treatment (1 consultation, 2 Follow-Up Care) | Yes |
| 19 | CANCER CARE | |
| a | Physical Examination (breasts, prostate and cervix etc) | Yes |
| b | Cancer –screening & investigation | Yes |
| c | Oncological Surgeries | Yes |
| 20 | REPRODUCTION/FERTILITY HEALTH | |
| a | GYNAECOLOGICAL AND OBSTETRICAL PROCEDURE: EUA, cauterization, episiotomy, vaginal laceration. | Yes |
| b | Fertility Treatment: basic investigation, non-hormonal drug treatment | Yes |
| c | Fertility Investigation - Counseling, USS, SFA, HSG, Hormonal Assay | Yes |
| 21 | ADDITIONAL SERVICES | |
| a | Medical examination / screening (Medically indicated) | |
| i | Physical examination | Yes |
| ii | BMI | Yes |
| iii | blood pressure | Yes |
| iv | Fasting blood sugar test (FBS) | Yes |
| Urinalysis | ||
| vii | Random blood sugar test (RBS) | Yes |
| viii | Chest x-ray | Yes |
| x | serum cholesterol | Yes |
| xi | Liver function test (lft) | Yes |
| xii | Kidney functions( E/U/Cr) | Yes |
| xiii | cervical smears every 2 years for women > 30 years | Yes |
| xiv | Prostate-specific antigen (PSA) for men above 40 yrs | Yes |
| xvii | Breast scan | Yes |
| xviii | Mammography (For Women ≥ 40 years of age) | Yes |
| b | Kidney dialysis (Principal) | 3 sessions |
| c | Mortuary Services (Cleaning, Embalmment, Storage, Ambulance) | N75,000 |
| d | Outdoor fitness activities (walk for health, aerobic) | Yes |
| 22 | GYM SERVICE (Principal Only) | |
| a | Access to gyms for regular exercise | (2 session /week) |
| 23 | SPA (Principal Only) | |
| a | Facials | No |
| b | Body massage | No |
| 24 | PREVENTIVE HEALTHCARE/ HEALTH PROMOTION | |
| a | Provision of periodic disease prevention and health promotion information, wellness program and materials | Yes |
| a | On-Site Basic Health Check, health education/ counseling, Health Talks. | Yes |
| b | Outdoor fitness activities (walk for health, aerobic) | Yes |
Pearl Plan
| S/N | Medical Benefits | PEARL PLAN |
| 1 | OUT-PATIENT SERVICES | |
| a | General Consultation | Yes |
| b | Specialist Consultation /Care (On referral for initial consultation and subsequent follow up subject to covered diagnosis) | |
| c | Routine Laboratory tests | |
| i | Packed cell volume (PCV), Full blood count, | Yes |
| ii | White blood cell count(wbc) (Total & differential), Red blood count (rbc) | Yes |
| iii | Malaria parasites & Widal. | Yes |
| iv | Urinalysis | Yes |
| v | Random blood Sugar | Yes |
| 2 | PRESCRIBED MEDICATIONS | |
| a | Supply of drugs and medication as recommended in the course of treatment for covered services only. | Yes |
| 3 | INPATIENT SERVICES (21 days Hospitalization) | |
| a | General ward | Yes |
| b | Semi Private Ward | Yes |
| c | Private Ward | Yes |
| d | Skilled nursing care and inpatient medical services. General and Specialist medical review. | Yes |
| e | Feeding on Admission | Yes |
| 4 | PHYSIOTHERAPHY | |
| a | Basic physical therapy, massages, shortwave, infra-red radiation | 8 sessions/yr |
| b | Prescribed Physiotherapeutic Appliances: | |
| i | Cervical Collar | Yes |
| ii | Crutches | Yes |
| iii | Lumbar corset | Yes |
| 5 | MANAGEMENT OF CHRONIC CONDITIONS (Group Policy only) | |
| Limit | 200,000.00 | |
| i | Hypertension | Yes |
| ii | Diabetes mellitus | Yes |
| iii | Sickle Anaemia | Yes |
| iv | Chronic bronchitis | Yes |
| v | Peptic ulcer | Yes |
| vi | Arthritis | Yes |
| 6 | MATERNITY SERVICES (Family Plan for Group policy only) | |
| a | Antenatal Care | Yes |
| b | Delivery services, Management of labour, Normal Delivery | Yes |
| c | Induction of Labour and Assisted Delivery, forceps delivery | Yes |
| d | Caesarian section C/S (Emergency & Medically Indicated Electives) | 400,000 |
| e | Hospitalization & skilled nursing care in connection with childbirth for the mother and the new born child(ren). | Yes |
| f | Post Natal Care up to 6 weeks | Yes |
| 7 | FAMILY PLANNING SERVICES (Family Plan only) | |
| a | Counselling | Yes |
| b | Plain IUCDs / Copper T Intrauterine Device | Yes |
| c | Oral Contraception | Yes |
| d | Injectables | Yes |
| e | Implants | Yes |
| f | Tubal ligation, Vasectomy | Yes |
| 8 | CHILD HEALTH SERVICES (Family Plan only) | |
| i | Childcare counselling | Yes |
| ii | Post Nantal Care of unregistered newborn within the first 6 weeks of life limited to routine primary health care | Yes |
| iii | treatment of minor infections | Yes |
| iv | puerperal infection | Yes |
| v | hyper emesis gravid arum | Yes |
| vi | pre-eclampsia | Yes |
| vii | Circumcision of male infants | Yes |
| viii | Ear piercing for female infants | Yes |
| ix | Registration of newborn: Children born on the scheme should be registered on or before 6 weeks of birth | Yes |
| b | Neonatal Care Services (Treatment of Mild or Moderate Neonatal Sepsis) | Yes |
| c | Incubator Care | 72hrs |
| d | Mild Neonatal Jaundice / Phototherapy | 4days |
| e | Peadiatric services. Out-patient & In-patient consultation and treatment for enrolled infants. Peadiatric Specialist consultation ( on referral) | Yes |
| f | NPI IMMUNIZATION (0-5) | |
| i | BCG, DPT | Yes |
| ii | Hepatitis B | Yes |
| iii | Oral polio | Yes |
| v | Measles | Yes |
| vi | Vitamins A supplementation, | Yes |
| vii | Yellow fever | Yes |
| viii | Rotavirus, MMR | Yes |
| ix | Pneumococal (PCV), Varicella (Chicken pox), Meningitis (Meningococcal) | Yes |
| 9 | MEDICAL EMERGENCY SERVICES | |
| a | Accident & Medical Emergencies Stabilization, Emergency Drugs, Investigations, Resuscitative or lifesaving initial treatment | 48hrs |
| b | Blood Transfusion | 4 pints |
| c | Local Evacuation to Hospital | Yes |
| d | Gunshot wounds | Yes |
| e | Out of Station treatment | Yes |
| 10 | SURGICAL PROCEDURES | |
| All surgical procedures are subject to cost limit and are restricted within the borders of the country, Nigeria | 400,000 | |
| a | 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 |
| b | 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 |
| c | Major Surgical procedures: Adenoidectomy / Tonsilectomy, Laparatomy, Ruptured ectopic gestation, Ovarian cyst, Ruptured Appendix, Myomectomy, Hysterectomy, Prostatectomy, Cholecystectomy. ENT Surgery. | Yes |
| 11 | RADIOLOGICAL SERVICES | |
| a | Plain X-Ray (Chest / Thorax, upper & lower Limbs, & Joint). Digital X-Ray | Yes |
| b | Vertebrae | Yes |
| c | Abdomen, Skull series | Yes |
| d | Lumbar, Cervical | Yes |
| e | Electrocardiography ECG (resting) | Yes |
| f | Spirometry | Yes |
| g | Echocardiography, E.C.G (pre and post exercise/ stress), Electroencephalography (EEG), Mammogram | Yes |
| h | CT Scan | Yes |
| i | Endoscopies | Yes |
| j | Intravenous Urography (IVU) | Yes |
| k | Hysterosalpingoscopy (HSG) | Yes |
| l | MRI (1 session/annum) | Yes |
| m | Special Radiological Investigations: Barium meal, Barium swallow, MCUG, RCUG, Myelogram | No |
| 12 | ULTRASOUND SCAN | |
| a | Obstetrics | Yes |
| b | Abdominal scan | Yes |
| c | Abdominopelvic, Pelvic | Yes |
| d | Breast, Transvaginal | Yes |
| c | Prostate | Yes |
| d | Scrotum | Yes |
| e | Tetis | Yes |
| f | Thyroid | Yes |
| g | Transfrontanellar | Yes |
| h | Follicular tracking, Tissue. | Yes |
| 13 | LABORATORY & DIAGNOSTIC SERVICES | |
| Laboratory investigations and diagnostic services will be carried out based on the clinician’s judgment for covered services only. | ||
| HAEMATOLOGY. | ||
| a | Basic / Primary investigations: | |
| i | Haemoglobin (Hb) | Yes |
| ii | Packed cell volume (PCV) | Yes |
| iii | Full blood count, White blood cell count(wbc) (Total & differential) | Yes |
| iv | Red blood count (rbc) | Yes |
| v | Erythrocyte sedimentation rate (esr) | Yes |
| vi | Platelets count, Genotype, Blood group | Yes |
| vii | Malaria parasites | Yes |
| viii | Differential count (wbc) | Yes |
| ix | wester green, Cross matching | Yes |
| b | Secondary investigations: | |
| i | Reticulocytes | Yes |
| ii | Mean corpuscular haemoglobin concentration (mchc), | Yes |
| iii | Mean corpuscular volume (mcv) | Yes |
| iv | Mean corpuscular haemoglobin (mch) | Yes |
| v | Direct coomb’s test | Yes |
| vi | Indirect coomb’s test | Yes |
| vii | Bleeding time, Clotting time | Yes |
| viii | Prothrombin time (pt), Sickling test | Yes |
| a | CLINICAL CHEMISTRY | |
| Basic / Primary investigations: | ||
| i | Fasting blood sugar, Random blood sugar | Yes |
| ii | Urea | Yes |
| iii | Creatinine | Yes |
| iv | Electrolyte & urea | Yes |
| v | Calcium, Phosphorus, Sodium, Potassium, Chloride, Bicarbonate | Yes |
| b | Secondary investigations: | |
| i | 2 hrs. post prandial test | Yes |
| ii | Oral glucose tolerance test | Yes |
| iii | Total bilirubin, Direct bilirubin | Yes |
| iv | Indirect bilirubin, Uric acid | Yes |
| v | cholesterol, HDL/LDL cholesterol | Yes |
| vi | Total protein, Albumin | Yes |
| vii | tryglyceride, Creatinine clearance | Yes |
| viii | Sgot & sgpt | Yes |
| ix | Alkaline phosphatase | Yes |
| x | Liver function test (lft) | Yes |
| xi | Prostatic acid phosphotase | Yes |
| xii | Amylase, Csf glucose | Yes |
| xiii | Csf protein, Csf chloride | Yes |
| xiv | Protein electrophoresis + report | Yes |
| xv | Gamma gt, Ck amylase | Yes |
| xvi | Total acid phosphotase | Yes |
| xvii | Glycosylated Haemoglobin (HbA1c) | Yes |
| xviii | Cardiac enzymes (troponin I,C, CKMB), | Yes |
| b | MICROBIOLOGY | Yes |
| i | Urinalysis, Pregnancy test – urine | Yes |
| ii | Stool occult blood | Yes |
| iii | Urine m/c/s | Yes |
| iv | Aspirate pus m/c/s | Yes |
| v | Hvs m/c/s | Yes |
| vi | Urethral & wound m/c/s | Yes |
| vii | Stool m/c/s | Yes |
| viii | Sputum m/c/s | Yes |
| ix | Mantoux/heaf test | Yes |
| x | Skin snip | Yes |
| xi | Helicobacter pylori assay | Yes |
| x | Helicobacter pylory stool antigene | Yes |
| xii | Semen m/c/s | Yes |
| xiii | Microfilaria | Yes |
| xiv | Skin scrapping for fungal elements | Yes |
| xv | Sputum AAFB for tuberculosis | Yes |
| xvi | Blood culture | Yes |
| xvii | CSF m/c/s | Yes |
| xviii | Semen analysis | Yes |
| xix | Urea Breath test | Yes |
| c | SEROLOGY | |
| i | Widal, | Yes |
| ii | HIV 1 & 2 screening, | Yes |
| iii | Pregnancy test hcg (blood) | Yes |
| iv | Hepatitis B. surface antigen, (HbSag) | Yes |
| v | Clamydia screening, | Yes |
| vi | VDRL test. | Yes |
| vii | Rheumatoid factor, | Yes |
| viii | Aso titre, | Yes |
| ix | Confirmatory test for HIV 1 and 2. | Yes |
| x | Viral load | Yes |
| xi | , Cd4 count | Yes |
| d | IMMUNOLOGY HORMONES | |
| i | Cortisol | Yes |
| ii | Follicle Stimulating Hormone | Yes |
| iii | Growth Hormone (HGH) | Yes |
| iv | HCG level (Molar Pregnancy | Yes |
| v | Insulin, Leutenizing Hormone (HTSH) | Yes |
| vi | Oestriol, Oestradiol | Yes |
| vii | Prolactin, Progesterone, Testosterone | Yes |
| viii | Thyroid hormones (T3 and T4) | Yes |
| ix | Thyroid Stimulating Hormone (TSH) | Yes |
| x | Thyrotrophin | Yes |
| e | HISTOPATHOLOGY | |
| i | Specimen from incisional biopsy, | Yes |
| ii | Specimen from excisional biopsy | Yes |
| iii | Pap smear | Yes |
| iv | Prostatic specific assay (PSA) | Yes |
| 14 | OPTICAL CARE SERVICES | |
| a | Consultation (Optometrist & Ophthalmologist) Refraction | Yes |
| b | visual acquity assessment | Yes |
| c | External E & Internal Ocular examination (Ophthalmoscopy) | Yes |
| f | Drug treatment of simple ocular infection & allergies e.g. Conjunctivitis, blepharitis, pinguecular, stye, etc. | Yes |
| g | Foreign body removal | Yes |
| h | Intraocular pressure test /Tonometry | Yes |
| j | Ocular surgeries (Pterygium, Chalazion, Cataract, Glaucoma) Surgery limit applies | Yes |
| i | Visual field analysis | Yes |
| k | Retinal photography | Yes |
| l | Ocular scan (A & B scans) | Yes |
| m | Ocular Coherence Tomography (OCT) | Yes |
| n | Provision of lenses (biennially) | 40,000 |
| 15 | DENTAL CARE SERVICES | |
| a | Consultation | Yes |
| b | Routine dental examination | Yes |
| c | Drug treatment of Simple Infection and oral pain | Yes |
| d | Dental X-Ray | Yes |
| e | Pain therapy | Yes |
| f | Simple Extraction | Yes |
| g | Scaling & Polishing (once per annum for adult) | Yes |
| h | Amalgam /Composite Filing for caries (Maximum 3 teeth per policy) | Yes |
| i | Gingival Curretage | Yes |
| j | Surgical Extraction | Yes |
| k | Root Canal treatment (Excluding Crowning) | No |
| 16 | EAR, NOSE & THROAT | |
| a | Consultation with the ENT (on referral), , | Yes |
| b | Ear Syringing | Yes |
| c | Prescribed Drug | Yes |
| d | Removal of foreign body | Yes |
| e | Pure tone Audiometry, Tympanometry | Yes |
| 17 | HIV/AIDS SUPPORT SERVICES | |
| a | Voluntary Counselling / education and Testing at designated diagnostic centres Treatment of Opportunistic Infections ARV treatment referral to diagnostic centres | Yes |
| 18 | MENTAL HEALTH SERVICES | |
| a | Initial Psychiatric Evaluation 2-weeks Out-patient Psychiatric Treatment (1 consultation, 2 Follow-Up Care) | Yes |
| 19 | CANCER CARE | |
| a | Physical Examination (breasts, prostate and cervix etc) | Yes |
| b | Cancer –screening & investigation | Yes |
| c | Oncological Surgeries | Yes |
| 20 | REPRODUCTION/FERTILITY HEALTH | |
| a | GYNAECOLOGICAL AND OBSTETRICAL PROCEDURE: EUA, cauterization, episiotomy, vaginal laceration. | Yes |
| b | Fertility Treatment: basic investigation, non-hormonal drug treatment | Yes |
| c | Fertility Investigation - Counseling, USS, SFA, HSG, Hormonal Assay | |
| 21 | ADDITIONAL SERVICES | |
| a | Medical examination / screening (Medically indicated) | |
| i | Physical examination | Yes |
| ii | BMI | Yes |
| iii | blood pressure | Yes |
| iv | Fasting blood sugar test (FBS) | Yes |
| Urinalysis | ||
| vii | Random blood sugar test (RBS) | Yes |
| viii | Chest x-ray | Yes |
| x | serum cholesterol | Yes |
| xi | Liver function test (lft) | Yes |
| xii | Kidney functions( E/U/Cr) | Yes |
| xiii | cervical smears every 2 years for women > 30 years | Yes |
| xiv | Prostate-specific antigen (PSA) for men above 40 yrs | Yes |
| xvii | Breast scan | Yes |
| xviii | Mammography (For Women ≥ 40 years of age) | No |
| b | Kidney dialysis (Principal) | 2 sessions |
| c | Mortuary Services (Cleaning, Embalmment, Storage, Ambulance) | N50,000 |
| d | Outdoor fitness activities (walk for health, aerobic) | Yes |
| 22 | GYM SERVICE (Principal Only) | |
| a | Access to gyms for regular exercise | (1 session /week) |
| 23 | SPA (Principal Only) | |
| a | Facials | No |
| b | Body massage | No |
| 24 | PREVENTIVE HEALTHCARE/ HEALTH PROMOTION | |
| a | Provision of periodic disease prevention and health promotion information, wellness program and materials | Yes |
| a | On-Site Basic Health Check, health education/ counseling, Health Talks. | Yes |
| b | Outdoor fitness activities (walk for health, aerobic) | Yes |
Ruby Plan
| S/N | Medical Benefits | RUBY PLAN |
| 1 | OUT-PATIENT SERVICES | |
| a | General Consultation | Yes |
| b | Specialist Consultation /Care (On referral for initial consultation and subsequent follow up subject to covered diagnosis) | |
| c | Routine Laboratory tests | |
| i | Packed cell volume (PCV), Full blood count, | Yes |
| ii | White blood cell count(wbc) (Total & differential), Red blood count (rbc) | Yes |
| iii | Malaria parasites & Widal. | Yes |
| iv | Urinalysis | Yes |
| v | Random blood Sugar | Yes |
| 2 | PRESCRIBED MEDICATIONS | |
| a | Supply of drugs and medication as recommended in the course of treatment for covered services only. | Yes |
| 3 | INPATIENT SERVICES (21 days Hospitalization) | |
| a | General ward | Yes |
| b | Semi Private Ward | Yes |
| c | Private Ward | No |
| d | Skilled nursing care and inpatient medical services. General and Specialist medical review. | Yes |
| e | Feeding on Admission | Yes |
| 4 | PHYSIOTHERAPHY | |
| a | Basic physical therapy, massages, shortwave, infra-red radiation | 6 sessions/yr |
| b | Prescribed Physiotherapeutic Appliances: | |
| i | Cervical Collar | No |
| ii | Crutches | No |
| iii | Lumbar corset | No |
| 5 | MANAGEMENT OF CHRONIC CONDITIONS (Group Policy only) | |
| Limit | 150,000.00 | |
| i | Hypertension | Yes |
| ii | Diabetes mellitus | Yes |
| iii | Sickle Anaemia | Yes |
| iv | Chronic bronchitis | Yes |
| v | Peptic ulcer | Yes |
| vi | Arthritis | Yes |
| 6 | MATERNITY SERVICES (Family Plan for Group policy only) | |
| a | Antenatal Care | Yes |
| b | Delivery services, Management of labour, Normal Delivery | Yes |
| c | Induction of Labour and Assisted Delivery, forceps delivery | Yes |
| d | Caesarian section C/S (Emergency & Medically Indicated Electives) | 300,000 |
| e | Hospitalization & skilled nursing care in connection with childbirth for the mother and the new born child(ren). | Yes |
| f | Post Natal Care up to 6 weeks | Yes |
| 7 | FAMILY PLANNING SERVICES (Family Plan only) | |
| a | Counselling | Yes |
| b | Plain IUCDs / Copper T Intrauterine Device | Yes |
| c | Oral Contraception | Yes |
| d | Injectables | Yes |
| e | Implants | Yes |
| f | Tubal ligation, Vasectomy | Yes |
| 8 | CHILD HEALTH SERVICES (Family Plan only) | |
| i | Childcare counselling | Yes |
| ii | Post Nantal Care of unregistered newborn within the first 6 weeks of life limited to routine primary health care | Yes |
| iii | treatment of minor infections | Yes |
| iv | puerperal infection | Yes |
| v | hyper emesis gravid arum | Yes |
| vi | pre-eclampsia | Yes |
| vii | Circumcision of male infants | Yes |
| viii | Ear piercing for female infants | Yes |
| ix | Registration of newborn: Children born on the scheme should be registered on or before 6 weeks of birth | Yes |
| b | Neonatal Care Services (Treatment of Mild or Moderate Neonatal Sepsis) | Yes |
| c | Incubator Care | 48hrs |
| d | Mild Neonatal Jaundice / Phototherapy | 3days |
| e | Peadiatric services. Out-patient & In-patient consultation and treatment for enrolled infants. Peadiatric Specialist consultation ( on referral) | Yes |
| f | NPI IMMUNIZATION (0-5) | |
| i | BCG, DPT | Yes |
| ii | Hepatitis B | Yes |
| iii | Oral polio | Yes |
| v | Measles | Yes |
| vi | Vitamins A supplementation, | Yes |
| vii | Yellow fever | Yes |
| viii | Rotavirus, MMR | Yes |
| ix | Pneumococal (PCV), Varicella (Chicken pox), Meningitis (Meningococcal) | No |
| 9 | MEDICAL EMERGENCY SERVICES | |
| a | Accident & Medical Emergencies Stabilization, Emergency Drugs, Investigations, Resuscitative or lifesaving initial treatment | 24hrs |
| b | Blood Transfusion | 3 pints |
| c | Local Evacuation to Hospital | Yes |
| d | Gunshot wounds | Yes |
| e | Out of Station treatment | Yes |
| 10 | SURGICAL PROCEDURES | |
| All surgical procedures are subject to cost limit and are restricted within the borders of the country, Nigeria | 300,000 | |
| a | 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 |
| b | 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 |
| c | Major Surgical procedures: Adenoidectomy / Tonsilectomy, Laparatomy, Ruptured ectopic gestation, Ovarian cyst, Ruptured Appendix, Myomectomy, Hysterectomy, Prostatectomy, Cholecystectomy. ENT Surgery. | Yes |
| 11 | RADIOLOGICAL SERVICES | |
| a | Plain X-Ray (Chest / Thorax, upper & lower Limbs, & Joint). Digital X-Ray | Yes |
| b | Vertebrae | Yes |
| c | Abdomen, Skull series | Yes |
| d | Lumbar, Cervical | Yes |
| e | Electrocardiography ECG (resting) | Yes |
| f | Spirometry | Yes |
| g | Echocardiography, E.C.G (pre and post exercise/ stress), Electroencephalography (EEG), Mammogram | Yes |
| h | CT Scan | Yes |
| i | Endoscopies | Yes |
| j | Intravenous Urography (IVU) | Yes |
| k | Hysterosalpingoscopy (HSG) | Yes |
| l | MRI (1 session/annum) | No |
| m | Special Radiological Investigations: Barium meal, Barium swallow, MCUG, RCUG, Myelogram | No |
| 12 | ULTRASOUND SCAN | |
| a | Obstetrics | Yes |
| b | Abdominal scan | Yes |
| c | Abdominopelvic, Pelvic | Yes |
| d | Breast, Transvaginal | Yes |
| c | Prostate | Yes |
| d | Scrotum | Yes |
| e | Tetis | Yes |
| f | Thyroid | Yes |
| g | Transfrontanellar | Yes |
| h | Follicular tracking, Tissue. | Yes |
| 13 | LABORATORY & DIAGNOSTIC SERVICES | |
| Laboratory investigations and diagnostic services will be carried out based on the clinician’s judgment for covered services only. | ||
| HAEMATOLOGY. | ||
| a | Basic / Primary investigations: | |
| i | Haemoglobin (Hb) | Yes |
| ii | Packed cell volume (PCV) | Yes |
| iii | Full blood count, White blood cell count(wbc) (Total & differential) | Yes |
| iv | Red blood count (rbc) | Yes |
| v | Erythrocyte sedimentation rate (esr) | Yes |
| vi | Platelets count, Genotype, Blood group | Yes |
| vii | Malaria parasites | Yes |
| viii | Differential count (wbc) | Yes |
| ix | wester green, Cross matching | Yes |
| b | Secondary investigations: | |
| i | Reticulocytes | Yes |
| ii | Mean corpuscular haemoglobin concentration (mchc), | Yes |
| iii | Mean corpuscular volume (mcv) | Yes |
| iv | Mean corpuscular haemoglobin (mch) | Yes |
| v | Direct coomb’s test | Yes |
| vi | Indirect coomb’s test | Yes |
| vii | Bleeding time, Clotting time | Yes |
| viii | Prothrombin time (pt), Sickling test | Yes |
| a | CLINICAL CHEMISTRY | |
| Basic / Primary investigations: | ||
| i | Fasting blood sugar, Random blood sugar | Yes |
| ii | Urea | Yes |
| iii | Creatinine | Yes |
| iv | Electrolyte & urea | Yes |
| v | Calcium, Phosphorus, Sodium, Potassium, Chloride, Bicarbonate | Yes |
| b | Secondary investigations: | |
| i | 2 hrs. post prandial test | Yes |
| ii | Oral glucose tolerance test | Yes |
| iii | Total bilirubin, Direct bilirubin | Yes |
| iv | Indirect bilirubin, Uric acid | Yes |
| v | cholesterol, HDL/LDL cholesterol | Yes |
| vi | Total protein, Albumin | Yes |
| vii | tryglyceride, Creatinine clearance | Yes |
| viii | Sgot & sgpt | Yes |
| ix | Alkaline phosphatase | Yes |
| x | Liver function test (lft) | Yes |
| xi | Prostatic acid phosphotase | Yes |
| xii | Amylase, Csf glucose | Yes |
| xiii | Csf protein, Csf chloride | Yes |
| xiv | Protein electrophoresis + report | Yes |
| xv | Gamma gt, Ck amylase | Yes |
| xvi | Total acid phosphotase | Yes |
| xvii | Glycosylated Haemoglobin (HbA1c) | No |
| xviii | Cardiac enzymes (troponin I,C, CKMB), | No |
| b | MICROBIOLOGY | |
| i | Urinalysis, Pregnancy test – urine | Yes |
| ii | Stool occult blood | Yes |
| iii | Urine m/c/s | Yes |
| iv | Aspirate pus m/c/s | Yes |
| v | Hvs m/c/s | Yes |
| vi | Urethral & wound m/c/s | Yes |
| vii | Stool m/c/s | Yes |
| viii | Sputum m/c/s | Yes |
| ix | Mantoux/heaf test | Yes |
| x | Skin snip | Yes |
| xi | Helicobacter pylori assay | Yes |
| x | Helicobacter pylory stool antigene | Yes |
| xii | Semen m/c/s | Yes |
| xiii | Microfilaria | Yes |
| xiv | Skin scrapping for fungal elements | Yes |
| xv | Sputum AAFB for tuberculosis | Yes |
| xvi | Blood culture | Yes |
| xvii | CSF m/c/s | Yes |
| xviii | Semen analysis | Yes |
| xix | Urea Breath test | No |
| c | SEROLOGY | |
| i | Widal, | Yes |
| ii | HIV 1 & 2 screening, | Yes |
| iii | Pregnancy test hcg (blood) | Yes |
| iv | Hepatitis B. surface antigen, (HbSag) | Yes |
| v | Clamydia screening, | Yes |
| vi | VDRL test. | Yes |
| vii | Rheumatoid factor, | Yes |
| viii | Aso titre, | Yes |
| ix | Confirmatory test for HIV 1 and 2. | No |
| x | Viral load | No |
| xi | , Cd4 count | No |
| d | IMMUNOLOGY HORMONES | |
| i | Cortisol | Yes |
| ii | Follicle Stimulating Hormone | Yes |
| iii | Growth Hormone (HGH) | Yes |
| iv | HCG level (Molar Pregnancy | Yes |
| v | Insulin, Leutenizing Hormone (HTSH) | Yes |
| vi | Oestriol, Oestradiol | Yes |
| vii | Prolactin, Progesterone, Testosterone | Yes |
| viii | Thyroid hormones (T3 and T4) | Yes |
| ix | Thyroid Stimulating Hormone (TSH) | Yes |
| x | Thyrotrophin | Yes |
| e | HISTOPATHOLOGY | |
| i | Specimen from incisional biopsy, | Yes |
| ii | Specimen from excisional biopsy | Yes |
| iii | Pap smear | No |
| iv | Prostatic specific assay (PSA) | No |
| 14 | OPTICAL CARE SERVICES | |
| a | Consultation (Optometrist & Ophthalmologist) Refraction | Yes |
| b | visual acquity assessment | Yes |
| c | External E & Internal Ocular examination (Ophthalmoscopy) | Yes |
| f | Drug treatment of simple ocular infection & allergies e.g. Conjunctivitis, blepharitis, pinguecular, stye, etc. | Yes |
| g | Foreign body removal | Yes |
| h | Intraocular pressure test /Tonometry | Yes |
| j | Ocular surgeries (Pterygium, Chalazion, Cataract, Glaucoma) Surgery limit applies | Yes |
| i | Visual field analysis | Yes |
| k | Retinal photography | Yes |
| l | Ocular scan (A & B scans) | Yes |
| m | Ocular Coherence Tomography (OCT) | No |
| n | Provision of lenses (biennially) | 30,000 |
| 15 | DENTAL CARE SERVICES | |
| a | Consultation | Yes |
| b | Routine dental examination | Yes |
| c | Drug treatment of Simple Infection and oral pain | Yes |
| d | Dental X-Ray | Yes |
| e | Pain therapy | Yes |
| f | Simple Extraction | Yes |
| g | Scaling & Polishing (once per annum for adult) | Yes |
| h | Amalgam /Composite Filing for caries (Maximum 3 teeth per policy) | Yes |
| i | Gingival Curretage | Yes |
| j | Surgical Extraction | Yes |
| k | Root Canal treatment (Excluding Crowning) | No |
| 16 | EAR, NOSE & THROAT | |
| a | Consultation with the ENT (on referral), , | Yes |
| b | Ear Syringing | Yes |
| c | Prescribed Drug | Yes |
| d | Removal of foreign body | Yes |
| e | Pure tone Audiometry, Tympanometry | No |
| 17 | HIV/AIDS SUPPORT SERVICES | |
| a | Voluntary Counselling / education and Testing at designated diagnostic centres Treatment of Opportunistic Infections ARV treatment referral to diagnostic centres | Yes |
| 18 | MENTAL HEALTH SERVICES | |
| a | Initial Psychiatric Evaluation 2-weeks Out-patient Psychiatric Treatment (1 consultation, 2 Follow-Up Care) | Yes |
| 19 | CANCER CARE | |
| a | Physical Examination (breasts, prostate and cervix etc) | Yes |
| b | Cancer –screening & investigation | Yes |
| c | Oncological Surgeries | Yes |
| 20 | REPRODUCTION/FERTILITY HEALTH | |
| a | GYNAECOLOGICAL AND OBSTETRICAL PROCEDURE: EUA, cauterization, episiotomy, vaginal laceration. | Yes |
| b | Fertility Treatment: basic investigation, non-hormonal drug treatment | Yes |
| c | Fertility Investigation - Counseling, USS, SFA, HSG, Hormonal Assay | No |
| 21 | ADDITIONAL SERVICES | |
| a | Medical examination / screening (Medically indicated) | |
| i | Physical examination | Yes |
| ii | BMI | Yes |
| iii | blood pressure | Yes |
| iv | Fasting blood sugar test (FBS) | Yes |
| Urinalysis | Yes | |
| vii | Random blood sugar test (RBS) | Yes |
| viii | Chest x-ray | Yes |
| x | serum cholesterol | Yes |
| xi | Liver function test (lft) | Yes |
| xii | Kidney functions( E/U/Cr) | Yes |
| xiii | cervical smears every 2 years for women > 30 years | No |
| xiv | Prostate-specific antigen (PSA) for men above 40 yrs | No |
| xvii | Breast scan | Yes |
| xviii | Mammography (For Women ≥ 40 years of age) | No |
| b | Kidney dialysis (Principal) | No |
| c | Mortuary Services (Cleaning, Embalmment, Storage, Ambulance) | N30,000 |
| d | Outdoor fitness activities (walk for health, aerobic) | Yes |
| 22 | GYM SERVICE (Principal Only) | |
| a | Access to gyms for regular exercise | (1 session /week) |
| 23 | SPA (Principal Only) | |
| a | Facials | No |
| b | Body massage | No |
| 24 | PREVENTIVE HEALTHCARE/ HEALTH PROMOTION | |
| a | Provision of periodic disease prevention and health promotion information, wellness program and materials | Yes |
| a | On-Site Basic Health Check, health education/ counseling, Health Talks. | Yes |
| b | Outdoor fitness activities (walk for health, aerobic) | Yes |
Emerald Plan
| S/N | Medical Benefits | EMERALD PLAN |
| 1 | OUT-PATIENT SERVICES | |
| a | General Consultation | Yes |
| b | Specialist Consultation /Care (On referral for initial consultation and subsequent follow up subject to covered diagnosis) | |
| c | Routine Laboratory tests | |
| i | Packed cell volume (PCV), Full blood count, | Yes |
| ii | White blood cell count(wbc) (Total & differential), Red blood count (rbc) | Yes |
| iii | Malaria parasites & Widal. | Yes |
| iv | Urinalysis | Yes |
| v | Random blood Sugar | Yes |
| 2 | PRESCRIBED MEDICATIONS | |
| a | Supply of drugs and medication as recommended in the course of treatment for covered services only. | Yes |
| 3 | INPATIENT SERVICES (21 days Hospitalization) | |
| a | General ward | Yes |
| b | Semi Private Ward | No |
| c | Private Ward | No |
| d | Skilled nursing care and inpatient medical services. General and Specialist medical review. | Yes |
| e | Feeding on Admission | Yes |
| 4 | PHYSIOTHERAPHY | |
| a | Basic physical therapy, massages, shortwave, infra-red radiation | 4 sessions/yr |
| b | Prescribed Physiotherapeutic Appliances: | |
| i | Cervical Collar | No |
| ii | Crutches | No |
| iii | Lumbar corset | No |
| 5 | MANAGEMENT OF CHRONIC CONDITIONS (Group Policy only) | |
| Limit | 100,000.00 | |
| i | Hypertension | Yes |
| ii | Diabetes mellitus | Yes |
| iii | Sickle Anaemia | Yes |
| iv | Chronic bronchitis | Yes |
| v | Peptic ulcer | Yes |
| vi | Arthritis | Yes |
| 6 | MATERNITY SERVICES (Family Plan for Group policy only) | |
| a | Antenatal Care | Yes |
| b | Delivery services, Management of labour, Normal Delivery | Yes |
| c | Induction of Labour and Assisted Delivery, forceps delivery | Yes |
| d | Caesarian section C/S (Emergency & Medically Indicated Electives) | 200,000 |
| e | Hospitalization & skilled nursing care in connection with childbirth for the mother and the new born child(ren). | Yes |
| f | Post Natal Care up to 6 weeks | Yes |
| 7 | FAMILY PLANNING SERVICES (Family Plan only) | |
| a | Counselling | Yes |
| b | Plain IUCDs / Copper T Intrauterine Device | Yes |
| c | Oral Contraception | Yes |
| d | Injectables | No |
| e | Implants | No |
| f | Tubal ligation, Vasectomy | No |
| 8 | CHILD HEALTH SERVICES (Family Plan only) | |
| i | Childcare counselling | Yes |
| ii | Post Nantal Care of unregistered newborn within the first 6 weeks of life limited to routine primary health care | Yes |
| iii | treatment of minor infections | Yes |
| iv | puerperal infection | Yes |
| v | hyper emesis gravid arum | Yes |
| vi | pre-eclampsia | Yes |
| vii | Circumcision of male infants | Yes |
| viii | Ear piercing for female infants | Yes |
| ix | Registration of newborn: Children born on the scheme should be registered on or before 6 weeks of birth | Yes |
| b | Neonatal Care Services (Treatment of Mild or Moderate Neonatal Sepsis) | Yes |
| c | Incubator Care | 24hrs |
| d | Mild Neonatal Jaundice / Phototherapy | 24hrs |
| e | Peadiatric services. Out-patient & In-patient consultation and treatment for enrolled infants. Peadiatric Specialist consultation ( on referral) | Yes |
| f | NPI IMMUNIZATION (0-5) | |
| i | BCG, DPT | Yes |
| ii | Hepatitis B | Yes |
| iii | Oral polio | Yes |
| v | Measles | Yes |
| vi | Vitamins A supplementation, | Yes |
| vii | Yellow fever | Yes |
| viii | Rotavirus, MMR | No |
| ix | Pneumococal (PCV), Varicella (Chicken pox), Meningitis (Meningococcal) | No |
| 9 | MEDICAL EMERGENCY SERVICES | |
| a | Accident & Medical Emergencies Stabilization, Emergency Drugs, Investigations, Resuscitative or lifesaving initial treatment | 24hrs |
| b | Blood Transfusion | 2 pints |
| c | Local Evacuation to Hospital | Yes |
| d | Gunshot wounds | Yes |
| e | Out of Station treatment | Yes |
| 10 | SURGICAL PROCEDURES | |
| All surgical procedures are subject to cost limit and are restricted within the borders of the country, Nigeria | 200,000 | |
| a | 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 |
| b | 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 |
| c | Major Surgical procedures: Adenoidectomy / Tonsilectomy, Laparatomy, Ruptured ectopic gestation, Ovarian cyst, Ruptured Appendix, Myomectomy, Hysterectomy, Prostatectomy, Cholecystectomy. ENT Surgery. | Yes |
| 11 | RADIOLOGICAL SERVICES | |
| a | Plain X-Ray (Chest / Thorax, upper & lower Limbs, & Joint). Digital X-Ray | Yes |
| b | Vertebrae | No |
| c | Abdomen, Skull series | No |
| d | Lumbar, Cervical | No |
| e | Electrocardiography ECG (resting) | Yes |
| f | Spirometry | No |
| g | Echocardiography, E.C.G (pre and post exercise/ stress), Electroencephalography (EEG), Mammogram | No |
| h | CT Scan | No |
| i | Endoscopies | No |
| j | Intravenous Urography (IVU) | No |
| k | Hysterosalpingoscopy (HSG) | No |
| l | MRI (1 session/annum) | No |
| m | Special Radiological Investigations: Barium meal, Barium swallow, MCUG, RCUG, Myelogram | No |
| 12 | ULTRASOUND SCAN | |
| a | Obstetrics | Yes |
| b | Abdominal scan | Yes |
| c | Abdominopelvic, Pelvic | Yes |
| d | Breast, Transvaginal | No |
| c | Prostate | No |
| d | Scrotum | No |
| e | Tetis | No |
| f | Thyroid | No |
| g | Transfrontanellar | No |
| h | Follicular tracking, Tissue. | No |
| 13 | LABORATORY & DIAGNOSTIC SERVICES | |
| Laboratory investigations and diagnostic services will be carried out based on the clinician’s judgment for covered services only. | ||
| HAEMATOLOGY. | ||
| a | Basic / Primary investigations: | |
| i | Haemoglobin (Hb) | Yes |
| ii | Packed cell volume (PCV) | Yes |
| iii | Full blood count, White blood cell count(wbc) (Total & differential) | Yes |
| iv | Red blood count (rbc) | Yes |
| v | Erythrocyte sedimentation rate (esr) | Yes |
| vi | Platelets count, Genotype, Blood group | Yes |
| vii | Malaria parasites | Yes |
| viii | Differential count (wbc) | Yes |
| ix | wester green, Cross matching | Yes |
| b | Secondary investigations: | |
| i | Reticulocytes | No |
| ii | Mean corpuscular haemoglobin concentration (mchc), | No |
| iii | Mean corpuscular volume (mcv) | No |
| iv | Mean corpuscular haemoglobin (mch) | No |
| v | Direct coomb’s test | No |
| vi | Indirect coomb’s test | No |
| vii | Bleeding time, Clotting time | No |
| viii | Prothrombin time (pt), Sickling test | No |
| a | CLINICAL CHEMISTRY | |
| Basic / Primary investigations: | ||
| i | Fasting blood sugar, Random blood sugar | Yes |
| ii | Urea | Yes |
| iii | Creatinine | Yes |
| iv | Electrolyte & urea | Yes |
| v | Calcium, Phosphorus, Sodium, Potassium, Chloride, Bicarbonate | Yes |
| b | Secondary investigations: | |
| i | 2 hrs. post prandial test | No |
| ii | Oral glucose tolerance test | No |
| iii | Total bilirubin, Direct bilirubin | No |
| iv | Indirect bilirubin, Uric acid | No |
| v | cholesterol, HDL/LDL cholesterol | No |
| vi | Total protein, Albumin | No |
| vii | tryglyceride, Creatinine clearance | No |
| viii | Sgot & sgpt | No |
| ix | Alkaline phosphatase | No |
| x | Liver function test (lft) | No |
| xi | Prostatic acid phosphotase | No |
| xii | Amylase, Csf glucose | No |
| xiii | Csf protein, Csf chloride | No |
| xiv | Protein electrophoresis + report | No |
| xv | Gamma gt, Ck amylase | No |
| xvi | Total acid phosphotase | No |
| xvii | Glycosylated Haemoglobin (HbA1c) | No |
| xviii | Cardiac enzymes (troponin I,C, CKMB), | No |
| b | MICROBIOLOGY | |
| i | Urinalysis, Pregnancy test – urine | Yes |
| ii | Stool occult blood | Yes |
| iii | Urine m/c/s | Yes |
| iv | Aspirate pus m/c/s | Yes |
| v | Hvs m/c/s | Yes |
| vi | Urethral & wound m/c/s | Yes |
| vii | Stool m/c/s | Yes |
| viii | Sputum m/c/s | Yes |
| ix | Mantoux/heaf test | No |
| x | Skin snip | No |
| xi | Helicobacter pylori assay | No |
| x | Helicobacter pylory stool antigene | No |
| xii | Semen m/c/s | No |
| xiii | Microfilaria | No |
| xiv | Skin scrapping for fungal elements | No |
| xv | Sputum AAFB for tuberculosis | No |
| xvi | Blood culture | No |
| xvii | CSF m/c/s | No |
| xviii | Semen analysis | No |
| xix | Urea Breath test | No |
| c | SEROLOGY | |
| i | Widal, | Yes |
| ii | HIV 1 & 2 screening, | Yes |
| iii | Pregnancy test hcg (blood) | Yes |
| iv | Hepatitis B. surface antigen, (HbSag) | Yes |
| v | Clamydia screening, | No |
| vi | VDRL test. | No |
| vii | Rheumatoid factor, | No |
| viii | Aso titre, | No |
| ix | Confirmatory test for HIV 1 and 2. | No |
| x | Viral load | No |
| xi | , Cd4 count | No |
| d | IMMUNOLOGY HORMONES | |
| i | Cortisol | No |
| ii | Follicle Stimulating Hormone | No |
| iii | Growth Hormone (HGH) | No |
| iv | HCG level (Molar Pregnancy | No |
| v | Insulin, Leutenizing Hormone (HTSH) | No |
| vi | Oestriol, Oestradiol | No |
| vii | Prolactin, Progesterone, Testosterone | No |
| viii | Thyroid hormones (T3 and T4) | No |
| ix | Thyroid Stimulating Hormone (TSH) | No |
| x | Thyrotrophin | No |
| e | HISTOPATHOLOGY | |
| i | Specimen from incisional biopsy, | No |
| ii | Specimen from excisional biopsy | No |
| iii | Pap smear | No |
| iv | Prostatic specific assay (PSA) | No |
| 14 | OPTICAL CARE SERVICES | |
| a | Consultation (Optometrist & Ophthalmologist) Refraction | Yes |
| b | visual acquity assessment | Yes |
| c | External E & Internal Ocular examination (Ophthalmoscopy) | Yes |
| f | Drug treatment of simple ocular infection & allergies e.g. Conjunctivitis, blepharitis, pinguecular, stye, etc. | Yes |
| g | Foreign body removal | Yes |
| h | Intraocular pressure test /Tonometry | Yes |
| j | Ocular surgeries (Pterygium, Chalazion, Cataract, Glaucoma) Surgery limit applies | Yes |
| i | Visual field analysis | No |
| k | Retinal photography | No |
| l | Ocular scan (A & B scans) | No |
| m | Ocular Coherence Tomography (OCT) | No |
| n | Provision of lenses (biennially) | 20,000 |
| 15 | DENTAL CARE SERVICES | |
| a | Consultation | Yes |
| b | Routine dental examination | Yes |
| c | Drug treatment of Simple Infection and oral pain | Yes |
| d | Dental X-Ray | Yes |
| e | Pain therapy | Yes |
| f | Simple Extraction | Yes |
| g | Scaling & Polishing (once per annum for adult) | Yes |
| h | Amalgam /Composite Filing for caries (Maximum 3 teeth per policy) | Yes |
| i | Gingival Curretage | |
| j | Surgical Extraction | No |
| k | Root Canal treatment (Excluding Crowning) | No |
| 16 | EAR, NOSE & THROAT | |
| a | Consultation with the ENT (on referral), , | Yes |
| b | Ear Syringing | Yes |
| c | Prescribed Drug | Yes |
| d | Removal of foreign body | Yes |
| e | Pure tone Audiometry, Tympanometry | No |
| 17 | HIV/AIDS SUPPORT SERVICES | |
| a | Voluntary Counselling / education and Testing at designated diagnostic centres Treatment of Opportunistic Infections ARV treatment referral to diagnostic centres | Yes |
| 18 | MENTAL HEALTH SERVICES | |
| a | Initial Psychiatric Evaluation 2-weeks Out-patient Psychiatric Treatment (1 consultation, 2 Follow-Up Care) | Yes |
| 19 | CANCER CARE | |
| a | Physical Examination (breasts, prostate and cervix etc) | Yes |
| b | Cancer –screening & investigation | No |
| c | Oncological Surgeries | No |
| 20 | REPRODUCTION/FERTILITY HEALTH | |
| a | GYNAECOLOGICAL AND OBSTETRICAL PROCEDURE: EUA, cauterization, episiotomy, vaginal laceration. | No |
| b | Fertility Treatment: basic investigation, non-hormonal drug treatment | No |
| c | Fertility Investigation - Counseling, USS, SFA, HSG, Hormonal Assay | No |
| 21 | ADDITIONAL SERVICES | |
| a | Medical examination / screening (Medically indicated) | |
| i | Physical examination | Yes |
| ii | BMI | Yes |
| iii | blood pressure | Yes |
| iv | Fasting blood sugar test (FBS) | Yes |
| Urinalysis | Yes | |
| vii | Random blood sugar test (RBS) | Yes |
| viii | Chest x-ray | No |
| x | serum cholesterol | No |
| xi | Liver function test (lft) | No |
| xii | Kidney functions( E/U/Cr) | No |
| xiii | cervical smears every 2 years for women > 30 years | No |
| xiv | Prostate-specific antigen (PSA) for men above 40 yrs | No |
| xvii | Breast scan | No |
| xviii | Mammography (For Women ≥ 40 years of age) | No |
| b | Kidney dialysis (Principal) | No |
| c | Mortuary Services (Cleaning, Embalmment, Storage, Ambulance) | No |
| d | Outdoor fitness activities (walk for health, aerobic) | Yes |
| 22 | GYM SERVICE (Principal Only) | |
| a | Access to gyms for regular exercise | No |
| 23 | SPA (Principal Only) | |
| a | Facials | No |
| b | Body massage | No |
| 24 | PREVENTIVE HEALTHCARE/ HEALTH PROMOTION | |
| a | Provision of periodic disease prevention and health promotion information, wellness program and materials | Yes |
| a | On-Site Basic Health Check, health education/ counseling, Health Talks. | Yes |
| b | Outdoor fitness activities (walk for health, aerobic) | Yes |
What Our Customers Say
"We write in respect of ProHealth HMO limited, whose service we have employed in the last 3 years and we attest that we have received an impressive and satisfactory performance in the provision of Health care services to our staff and dependents.
In view of the foregoing, we are delighted to recommend ProHealth HMO Limited to you, in the provision of similar services to your staff and dependents."
Comrade Emmanuel Ugboaja, General Secretary, NLC
What Our Customers Say
What Our Customers Say
As I am grateful to Prohealth HMO Limited for refunding timely, for expenses made out-of-pocket last year. For the reason stated, ProHealth is receptive, responsive and has always been very helpful in resolving any issues.
Oche Oloche, NSITF
What Our Customers Say
What Our Customers Say
"Prompt action is always taken when we call on them. From my heart, I am recommending ProHealth to everybody because they are the best from what we have seen so far. We've never had any disappointment. So, all over, I am very happy with them and I am going to continue to patronize them"
Funsho Oshiro, MD, Newark Securities System
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