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ProHealth HMO Limited
ProHealth HMO Limited
Health for Wealth

Plans and Benefits


Please take note of the following:

*Cover age 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
*Feeding on Admission is based on (1.) The hospital has the facility (2.) The Patient request it.
All Chronic Diease Management are excluded for the initial one year of purchase for retail businesses


S/NEmeraldBuy RubyBuy PearlBuy DiamondMedical Benefits
1                                                            OUT-PATIENT SERVICES
a🗸🗸🗸🗸General Consultation
b                                                            Specialist Consultation /Care
(On referral for initial consultation and subsequent follow up subject to covered diagnosis)
i🗸🗸🗸🗸Obstetrician
ii🗸🗸🗸🗸Gynaecologist
iii🗸🗸🗸🗸Pediatrician
iv🗸🗸🗸🗸General Surgeon
v🗸🗸🗸🗸Cardiothoracic Surgeon
vi🗸🗸🗸🗸Neurosurgeon
vii🗸🗸🗸🗸ENT Surgeon (Otorhinolaryngologist)
viii🗸🗸🗸🗸Urologist
ix🗸🗸🗸🗸Orthopedic Surgeon
x🗸🗸🗸🗸Gastroenterologist
xi🗸🗸🗸🗸Cardiologist
xii🗸🗸🗸🗸Nephrologist
xiii🗸🗸🗸🗸Psychiatrist
xv🗸🗸🗸🗸Neonatologist
xvi🗸🗸🗸🗸Dermatologist
xvii🗸🗸🗸🗸Pulmonologist/Respiratory Physician
xviii🗸🗸🗸🗸Hematologist
xix🗸🗸🗸🗸Oncologist
xx🗸🗸🗸🗸Endocrinologist
xxi🗸🗸🗸🗸Family Physician
xxii🗸🗸🗸🗸Oral and Maxillofacial Surgeon
xxiii🗸🗸🗸🗸Pathologist
c                                                            Routine Laboratory tests
i🗸🗸🗸🗸Packed cell volume (PCV), Full blood count,
ii🗸🗸🗸🗸White blood cell count(wbc) (Total & differential), Red blood count (rbc)
iii🗸🗸🗸🗸Malaria parasites & Widal.
iv🗸🗸🗸🗸Urinalysis
v🗸🗸🗸🗸Random blood Sugar
2                                                            PRESCRIBED MEDICATIONS
a🗸🗸🗸🗸Supply of drugs and medication as recommended in the course of treatment for covered services only.
3                                                            INPATIENT SERVICES (21 days Hospitalization)
a🗸🗸🗸🗸General ward
b🞬🗸🗸🗸Semi Private Ward
c🞬🞬🗸🗸Private Ward
d🗸🗸🗸🗸Skilled nursing care and inpatient medical services. General and Specialist medical review.
e🗸🗸🗸🗸Supply of drugs and Infusions, dressings, medical & surgical
consumables for covered services only.
f🗸🗸🗸🗸Feeding on Admission
4                                                            PHYSIOTHERAPHY
a4 sessions/yr6 sessions/yr8 sessions/yr10 sessions/yrBasic physical therapy, massages, shortwave, infra-red radiation
b                                                            Prescribed Physiotherapeutic Appliances:
i🞬🞬🗸🗸Cervical Collar
ii🞬🞬🗸🗸Crutches
iii🞬🞬🗸🗸Lumbar corset
5                                                            MANAGEMENT OF CHRONIC CONDITIONS (Group Policy only)
               80,000.00100,000.00150,000.00200,000.00Limit
i🗸🗸🗸🗸Hypertension
ii🗸🗸🗸🗸Diabetes mellitus
iii🗸🗸🗸🗸Sickle Anaemia
iv🗸🗸🗸🗸Chronic bronchitis
v🗸🗸🗸
🗸
Peptic ulcer
vi🗸🗸🗸🗸Arthritis
6                                                            MATERNITY SERVICES (Family Plan only)
a🗸🗸🗸🗸AntenatalServicesfromconceptiontodeliveryincluding consultation,examinationsandsupplyofdrugsforall antenatalvisits,Laboratorytests:haemoglobinestimationor packedcellvolumeevaluation,HIV1&2evaluation,blood groupandgenotypeevaluation,HepatitisBsurfaceantigen, ultrasound scan examination (3 max) during pregnancy.
b🗸🗸🗸🗸Delivery services, Management of labour, Normal Delivery
c🗸🗸🗸🗸Induction of Labour and Assisted Delivery, forceps delivery
d100,000200,000250,000400,000Caesarian section C/S (Emergency & Medically Indicated Electives)
e🗸🗸🗸🗸Hospitalization & skilled nursing care in connection with childbirth for the mother and the new born child(ren).
f🗸🗸🗸🗸Post Natal Care up to 6 weeks
7                                                            FAMILY PLANNING SERVICES (Family Plan only)
a🗸🗸🗸🗸Counselling
b🗸🗸🗸🗸Plain IUCDs / Copper T Intrauterine Device
c🗸🗸🗸🗸Oral Contraception
d🞬🗸🗸🗸Injectables
e🞬🞬🞬🗸Implants
f🞬🞬🗸🗸Tubal ligation, Vasectomy
8                                                            CHILD HEALTH SERVICES (Family Plan only)
ai🗸🗸🗸🗸Childcare counselling
ii🗸🗸🗸🗸Post Nantal Care of unregistered newborn within the first 6 weeks of life limited to
routine primary health care
iii🗸🗸🗸🗸treatment of minor infections
iv🗸🗸🗸🗸puerperal infection
v🗸🗸🗸🗸hyper emesis gravid arum
vi🗸🗸🗸🗸pre-eclampsia
vii🗸🗸🗸🗸Circumcision of male infants
viii🗸🗸🗸🗸Ear piercing for female infants
ix🗸🗸🗸🗸Registration of newborn: Children born on the scheme should be registered on or before 6 weeks of birth
b🗸🗸🗸🗸Neonatal Care Services (Treatment ofMild or Moderate Neonatal Sepsis)
c24hrs48hrs72hrs5daysIncubator Care
d24hrs3days4days5daysMild Neonatal Jaundice / Phototherapy
e🗸🗸🗸🗸Peadiatric services.
Out-patient & In-patient consultation and treatment for enrolled infants.
Peadiatric Specialist consultation ( on referral)
f                                                            NPIIMMUNIZATION (0-5)
i🗸🗸🗸🗸BCG, DPT
ii🗸🗸🗸🗸Hepatitis B
iii🗸🗸🗸🗸Oral polio
v🗸🗸🗸🗸Measles
vi🗸🗸🗸🗸Vitamins A supplementation,
vii🗸🗸🗸🗸Yellow fever
viii🞬🗸🗸🗸Rotavirus, MMR
ix🞬🞬🞬🗸Pneumococal (PCV), Varicella (Chicken pox), Meningitis (Meningococcal)
9                                                            MEDICAL EMERGENCY SERVICES
a24hrs24hrs48hrs72hrsAccident & Medical Emergencies
Stabilization, Emergency Drugs, Investigations, Resuscitative or lifesaving initial treatment
b2 pints3 pints4 pints4 pintsBlood Transfusion
c🗸🗸🗸🗸Local Evacuation to Hospital
d🗸🗸🗸🗸Gunshot wounds
e🗸🗸🗸🗸Out of Station treatment
10                                                            SURGICAL PROCEDURES
               100,000200,000250,000400,000All surgical procedures are subject to cost limit and are restricted within the borders of the country, Nigeria
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.
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.
c🞬🗸🗸🗸Major Surgical procedures: Adenoidectomy / Tonsilectomy,
Laparatomy, Ruptured ectopic gestation, Ovarian cyst, Ruptured Appendix, Myomectomy, Hysterectomy, Prostatectomy, Cholecystectomy.
ENT Surgery.
11                                                            RADIOLOGICAL SERVICES
a🗸🗸🗸🗸Plain X-Ray (Chest / Thorax, upper & lower Limbs, & Joint). Digital X-Ray
b🞬🗸🗸🗸Vertebrae
c🞬🗸🗸🗸Abdomen, Skull series
d🞬🞬🗸🗸Lumbar, Cervical
e🗸🗸🗸🗸Electrocardiography ECG (resting)
f🞬🗸🗸🗸Spirometry
g🞬🗸🗸🗸Echocardiography, E.C.G (pre and post exercise/ stress), Electroencephalography (EEG), Mammogram
h🞬🗸🗸🗸CT Scan
i🞬🗸🗸🗸Endoscopies
j🞬🞬🗸🗸MRI (1 session/annum)
k🞬🞬🞬🗸Special Radiological Investigations: Barium meal, Barium swallow, HSG, MCUG, RCUG, Myelogram, Intravenous Urography (IVU)
12                                                            ULTRASOUND SCAN
a🗸🗸🗸🗸Obstetrics
b🗸🗸🗸🗸Abdominal scan
c🗸🗸🗸🗸Abdominopelvic, Pelvic
d🞬🞬🗸🗸Breast, Transvaginal
c🞬🗸🗸🗸Prostate
d🞬🗸🗸🗸Scrotum
e🞬🗸🗸🗸Tetis
f🞬🗸🗸🗸Thyroid
g🞬🗸🗸🗸Transfrontanellar
h🞬🗸🗸🗸Follicular tracking, Tissue.
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)
ii🗸🗸🗸🗸Packed cell volume (PCV)
iii🗸🗸🗸🗸Full blood count, White blood cell count(wbc) (Total & differential)
iv🗸🗸🗸🗸Red blood count (rbc)
v🗸🗸🗸🗸Erythrocyte sedimentation rate (esr)
vi🗸🗸🗸🗸Platelets count, Genotype, Blood group
vii🗸🗸🗸🗸Malaria parasites
viii🗸🗸🗸🗸Differential count (wbc)
ix🗸🗸🗸🗸wester green, Cross matching
b                                                            Secondary investigations:
i🞬🗸🗸🗸Reticulocytes
ii🞬🗸🗸🗸Mean corpuscular haemoglobin concentration (mchc),
iii🞬🗸🗸🗸Mean corpuscular volume (mcv)
iv🞬🗸🗸🗸Mean corpuscular haemoglobin (mch)
v🞬🗸🗸🗸Direct coomb’s test
vi🞬🗸🗸🗸Indirect coomb’s test
vii🞬🗸🗸🗸Bleeding time, Clotting time
viii🞬🗸🗸🗸Prothrombin time (pt), Sickling test
a                                                            CLINICAL CHEMISTRY
Basic / Primary investigations:                                                                           
i🗸🗸🗸🗸Fasting blood sugar, Random blood sugar
ii🗸🗸🗸🗸Urea
iii🗸🗸🗸🗸Creatinine
iv🗸🗸🗸🗸Electrolyte & urea
v🗸🗸🗸🗸Calcium, Phosphorus, Sodium, Potassium, Chloride, Bicarbonate
b                                                            Secondary investigations:
i🞬🗸🗸🗸2 hrs. post prandial test
ii🞬🗸🗸🗸Oral glucose tolerance test
iii🞬🗸🗸🗸Total bilirubin, Direct bilirubin
iv🞬🗸🗸🗸Indirect bilirubin, Uric acid
v🞬🗸🗸🗸cholesterol, HDL/LDL cholesterol
vi🞬🗸🗸🗸Total protein, Albumin
vii🞬🗸🗸🗸tryglyceride, Creatinine clearance
viii🞬🗸🗸🗸Sgot & sgpt
ix🞬🗸🗸🗸Alkaline phosphatase
x🞬🗸🗸🗸Liver function test (lft)
xi🞬🗸🗸🗸Prostatic acid phosphotase
xii🞬🗸🗸🗸Amylase, Csf glucose
xiii🞬🗸🗸🗸Csf protein, Csf chloride
xiv🞬🗸🗸🗸Protein electrophoresis + report
xv🞬🗸🗸🗸Gamma gt, Ck amylase
xvi🞬🗸🗸🗸Total acid phosphotase
xvii🞬🞬🗸🗸Cardiac enzymes (troponin I,C, CKMB), Glycosylated Haemoglobin (HbA1c)
b                                                            MICROBIOLOGY
i🗸🗸🗸🗸Urinalysis, Pregnancy test – urine
ii🗸🗸🗸🗸Stool occult blood
iii🗸🗸🗸🗸Urine m/c/s
iv🗸🗸🗸🗸Aspirate pus m/c/s
v🗸🗸🗸🗸Hvs m/c/s
vi🗸🗸🗸🗸Urethral & wound m/c/s
vii🗸🗸🗸🗸Stool m/c/s
viii🗸🗸🗸🗸Sputum m/c/s
ix🞬🗸🗸🗸Mantoux/heaf test
x🞬🗸🗸🗸Skin snip
xi🞬🗸🗸🗸Helicobacter pylori assay
xii🞬🗸🗸🗸Semen culture & sensitivity
xiii🞬🗸🗸🗸Microfilaria
xiv🞬🗸🗸🗸Skin scrapping for fungal elements
xv🞬🗸🗸🗸Sputum AAFB for tuberculosis
xvi🞬🗸🗸🗸Blood culture
xvii🞬🗸🗸🗸CSF m/c/s
xviii🞬🗸🗸🗸Semen analysis
xix🞬🞬🗸🗸Urea Breath test
c                                                            SEROLOGY
i🗸🗸🗸🗸Widal, HIV 1 & 2 screening, Pregnancytest hcg (blood)
ii🗸🗸🗸🗸Hepatitis B. surface antigen, Clamydia screening, VDRL test.
iii🞬🗸🗸🗸Aso titre, Rheumatoid factor, Confirmatory test for HIV 1 and 2.
iv🞬🞬🗸🗸Viral load, Cd4 count
d                                                            IMMUNOLOGY HORMONES
i🞬🗸🗸🗸Cortisol
ii🞬🗸🗸🗸Follicle Stimulating Hormone
iii🞬🗸🗸🗸Growth Hormone (HGH)
iv🞬🗸🗸🗸HCG level (Molar Pregnancy
v🞬🗸🗸🗸Insulin, Leutenizing Hormone (HTSH)
vi🞬🗸🗸🗸Oestriol, Oestradiol
vii🞬🗸🗸🗸Prolactin, Progesterone, Testosterone
viii🞬🗸🗸🗸Thyroid hormones (T3 and T4)
ix🞬🗸🗸🗸Thyroid Stimulating Hormone (TSH)
x🞬🗸🗸🗸Thyrotrophin
e                                                            HISTOPATHOLOGY
i🞬🗸🗸🗸Specimen from incisional biopsy, Specimen from excisional biopsy
ii🞬🞬🗸🗸Pap smear, Prostatic specific assay (PSA)
f🞬🞬🗸🗸CONTRAST STUDIES: Ba meal, Ba enema, Hsg
14                                                            OPTICAL CARE SERVICES
a🗸🗸🗸🗸Consultation (Optometrist & Ophthalmologist) Refraction
b🗸🗸🗸🗸visual acquity assessment
c🗸🗸🗸🗸Routine & External Examination
d🗸🗸🗸🗸Ophthamoscopy
e🗸🗸🗸🗸Phoria tests
f🗸🗸🗸🗸Drug treatment of simple ocular infection & allergies e.g. Conjunctivitis, blepharitis, pinguecular, stye, etc.
g🗸🗸🗸🗸Foreign body removal
h🞬🗸🗸🗸Intraocular pressure test
i🞬🗸🗸🗸Visual field analysis
j🞬🗸🗸🗸Pterygium
k🞬🗸🗸🗸chalazion, Retinal photography
l🞬🗸🗸🗸Ocular scan (A & B scans)Surgical treatment of occular diseases e.g, pterygium excision
m🞬🗸🗸🗸Cataract extraction
n10,00020,00025,00030,000Provision of lenses:plain, bifocal& varifocal lenses subject to limit of coverage (once annually)
o🞬🞬🞬🗸OCT scan
15                                                            DENTAL CARE SERVICES
a🗸🗸🗸🗸Consultation
b🗸🗸🗸🗸Routine dental examination
c🗸🗸🗸🗸Drug treatment of Simple Infection and oral pain
d🗸🗸🗸🗸Dental X-Ray
e🗸🗸🗸🗸Pain therapy
f🗸🗸🗸🗸Simple Extraction
g🗸🗸🗸🗸Scaling & Polishing (once per annum for adult)
h2 teeth/yr2 teeth/yr2 teeth/yr2 teeth/yrAmalgam Filing for caries
i🞬🞬2 teeth/yr4 teeth/yrGingival Curretage, Composite Filling, Surgical Extraction
j🞬🞬🞬🗸Root Canal treatment (Excluding Crowning)
16                                                            EAR, NOSE & THROAT
a🗸🗸🗸🗸Consultation with the ENT (on referral), Prescribed Drug, Ear Syringing
b🞬🗸🗸🗸Removal of foreign body
c🞬🞬🗸🗸Pure tone Audiometry, Tympanometry
17                                                            HIV/AIDS SUPPORT SERVICES
a🗸🗸🗸🗸Voluntary Counselling / education and Testing at designated diagnostic centres
Treatment of Opportunistic Infections
ARV treatment referral todiagnosticcentres
18                                                            MENTAL HEALTH SERVICES
a🗸🗸🗸🗸Initial Psychiatric Evaluation
2-weeks Out-patient Psychiatric Treatment (1 consultation, 2 Follow-Up Care)
19                                                            CANCER CARE
a🗸🗸🗸🗸PhysicalExamination(breasts, prostate and cervix etc)
b🞬🞬🗸🗸Cancer –screening & investigation
20                                                            REPRODUCTION/FERTILITY HEALTH
a🞬🗸🗸🗸GYNAECOLOGICAL AND OBSTETRICAL PROCEDURE: EUA,
cauterization, episiotomy, vaginal laceration.
b🞬🗸🗸🗸Fertility Treatment: basic investigation, non-hormonal drug treatment
c🞬🞬               🗸Fertility Investigation - Counseling, USS, SFA, HSG, Hormonal Assay
21                                                            ADDITIONAL SERVICES
a                                                            Medical examination / screening (Medically indicated)
i🗸🗸🗸🗸Physical examination
ii🗸🗸🗸🗸BMI
iii🗸🗸🗸🗸blood pressure
iv🗸🗸🗸🗸FBS & Urinalysis
v🞬🗸🗸🗸PCV
vi🞬🗸🗸🗸blood pressure
vii🞬🗸🗸🗸blood sugar
viii🞬🗸🗸🗸Chest x-ray
ix🞬🗸🗸🗸Genotype
x🞬🗸🗸🗸serum cholesterol
xi🞬🗸🗸🗸Liver function test (lft)
xii🞬🗸🗸🗸Kidney functions( E/U/Cr)
xiii🞬🗸🗸🗸cervical smears every 2 years for women > 30 years
xiv🞬🗸🗸🗸Prostate-specific antigen (PSA) for men above 40 yrs
xv🞬🞬🗸🗸Blood Cholesterol Check
xvi🞬🞬🗸🗸Visual Acuity Check (Using Snellen Chart)
xvii🞬🞬🗸🗸Pap Smear
xviii🞬🞬🞬🗸Mammography (For Women ≥ 40 years of age)
b🞬🞬2 sessions3 sessionsKidney dialysis (Principal)
c🞬🗸🗸🗸Gym Service
d🞬N30,000N50,000N75,000Mortuary Services (Cleaning, Embalmment, Storage, Ambulance)
e🗸🗸🗸🗸Outdoor fitness activities (walk for health, aerobic)
22                                                            PREVENTIVE HEALTHCARE/ HEALTH PROMOTION
a🗸🗸🗸🗸Provision of periodic disease prevention and health promotion information, wellness program and materials
a🗸🗸🗸🗸On-Site Basic Health Check, health education/ counseling, Health Talks.
b🗸🗸🗸🗸Outdoor fitness activities (walk for health, aerobic)
                                                                                          
23                                                            Premium
a48,00078,000115,000198,000Annual Premium CORPORATE (Individual Group Policy)
b170,000258,000405,000620,000Annual Premium CORPORATE(Family Group Policy)
cNIL108,000183,000270,000Annual Premium RETAIL (Individual Private))
dNIL332,000612,000805,000Annual Premium RETAIL (Family Private)

EXCLUSIONS: 


1Advanced conservative restorations
2Orthodontic and associated treatment
3Artificial limbs
4Tuberculosis
5Liver and Kidney Transplant
6Supply of physiotherapeutic appliances
7Incubator care and use of oxygen support in cases of premature rupture of membrane.
8Dialysis(Dependant)
9Cosmetic/Plastic surgeries
10Prosthesis and other fitting
11Denture and special dental procedures
12Cytotoxic treatment
13Chronic Conditions end stage diseases including renal failure, kidney failure, liver failure
14Certain injuries,- old sport injuries, self-inflicted injuries
15Overseas treatment and transplant surgery
16The 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.