Individual and Family Coverage
CONSULTATION
| Topaz | Emerald | Diamond | |
|---|---|---|---|
| Annual benefit limits per individual | N850,000 | N2050000 | N4,800,000 |
| GENERAL CONSULTATION(OUT PATIENT CASES) | |||
| This involves treatment of basic medical and surgical (minor) outpatient cases. | N250,000 | N650,000 | N1,600,000 |
| HOSPITAL NETWORKS | |||
| Hospital Category Accessible | Tier 1 & 2 | Tier 1,2 & 3 | Tier 1,2,3,4 & 5 |
| SPECIALIST CONSULTATION: This includes all specialist fees. The list of diagnosis under this plan is exhaustive | |||
| Consultations with General Practice / Medical Officers Doctors | ✓ | ✓ | ✓ |
| Consultations with Specialist | ✓ | ✓ | ✓ |
| Obstetrician | ✓ | ✓ | ✓ |
| Gynaecologist | ✓ | ✓ | ✓ |
| Pediatrician | ✓ | ✓ | ✓ |
| General Surgeon | ✓ | ✓ | ✓ |
| Cardiothoracic Surgeon | ✓ | ✓ | ✓ |
| Neurosurgeon | ✓ | ✓ | ✓ |
| ENT Surgeon (Otorhinolaryngologist) | ✓ | ✓ | ✓ |
| Urologist | ✓ | ✓ | ✓ |
| Orthopedic Surgeon | ✓ | ✓ | ✓ |
| Gastroenterologist | ✓ | ✓ | ✓ |
| Cardiologist | ✓ | ✓ | ✓ |
| Neurologist | ✓ | ✓ | ✓ |
| Nephrologist | ✓ | ✓ | ✓ |
| Psychiatrist | ✓ | ✓ | ✓ |
| Neonatologist | ✓ | ✓ | ✓ |
| Dermatologist | ✓ | ✓ | ✓ |
| Dietician/Nutritionist | ✓ | ✓ | ✓ |
| Pulmonologist/Respiratory Physician | ✓ | ✓ | ✓ |
| Hematologist | ✓ | ✓ | ✓ |
| Oncologist | ✓ | ✓ | ✓ |
| Pathologist | ✓ | ✓ | ✓ |
| Endocrinologist | ✓ | ✓ | ✓ |
| Family Physician | ✓ | ✓ | ✓ |
| Oral and Maxillofacial Surgeon | ✓ | ✓ | ✓ |
DIAGNOSTICS
| Topaz | Emerald | Diamond | |
|---|---|---|---|
| LABPORATORY INVESTIGATIONS | |||
| Microbiology: | |||
| Malaria Parasite (MP) | ✓ | ✓ | ✓ |
| Urine M/C/S | ✓ | ✓ | ✓ |
| Endocervical Swab (ECS) M/C/S | ✓ | ✓ | ✓ |
| High Vaginal Swab (HVS) M/C/S | ✓ | ✓ | ✓ |
| Urethral Swab M/C/S | ✓ | ✓ | ✓ |
| Throat Swab M/C/S | ✓ | ✓ | ✓ |
| Ear Swab M/C/S | ✓ | ✓ | ✓ |
| Wound Swab M/C/S | ✓ | ✓ | ✓ |
| Eye Swab M/C/S | ✓ | ✓ | ✓ |
| Sputum M/C/S | ✓ | ✓ | ✓ |
| Aspirates M/C/S | ✓ | ✓ | ✓ |
| Stool M/C/S | ✓ | ✓ | ✓ |
| VDRL (Veneral Disease Research Laboratory) Test | ✓ | ✓ | ✓ |
| H.Pylori | ✓ | ✓ | ✓ |
| Trypanosomes Screening | ✓ | ✓ | ✓ |
| Toxoplasma Screening | ✓ | ✓ | ✓ |
| Skin Snip for Microfilaria | ✓ | ✓ | ✓ |
| Skin Scraping for Fungi | ✓ | ✓ | ✓ |
| Leishmania Screening | ✓ | ✓ | ✓ |
| Mantoux/Heaf’s Test | ✓ | ✓ | ✓ |
| Blood Culture | ✓ | ✓ | ✓ |
| Stool Occult Blood | ✓ | ✓ | ✓ |
| Clinical Chemistry: | |||
| Fasting Blood Sugar | ✓ | ✓ | ✓ |
| Random Blood Sugar | ✓ | ✓ | ✓ |
| 2 Hours Post-prandial Blood Sugar | ✓ | ✓ | ✓ |
| Oral Glucose Tolerance Test (OGTT) | ✓ | ✓ | ✓ |
| Glucose Challenge Test | ✓ | ✓ | ✓ |
| Electrolytes, Urea and Creatinine | ✓ | ✓ | ✓ |
| Lipid Profile (Fasting) (Cholesterol, HDL, LDL, Triglyceride Profile) | ✓ | ✓ | ✓ |
| Liver Function Test (LFT) | ✓ | ✓ | ✓ |
| Serum Sodium | ✓ | ✓ | ✓ |
| Serum Calcium | ✓ | ✓ | ✓ |
| Serum Magnesium | ✓ | ✓ | ✓ |
| Serum Potasium | ✓ | ✓ | ✓ |
| Serum Lithium | ✓ | ✓ | ✓ |
| Serum Chloride | ✓ | ✓ | ✓ |
| Serum Bicarbonate | ✓ | ✓ | ✓ |
| Serum Alkaline Phosphate | ✓ | ✓ | ✓ |
| Serum Acid Phosphate | ✓ | ✓ | ✓ |
| Serum Inorganic Phosphate | ✓ | ✓ | ✓ |
| Serum Bilirubin (Total and Direct) | ✓ | ✓ | ✓ |
| Serum Albumin | ✓ | ✓ | ✓ |
| Serum Lactate Dehydrogenase | ✓ | ✓ | ✓ |
| Serum Gamma Glutamyl Transferase | ✓ | ✓ | ✓ |
| Prothrombin time (PT/INR) | ✓ | ✓ | ✓ |
| Urine Pregnancy Test | ✓ | ✓ | ✓ |
| Haematological Tests: | |||
| Hemoglobin (HB) | ✓ | ✓ | ✓ |
| Packed Cell Volume (PCV) | ✓ | ✓ | ✓ |
| White cell count (Total and Differential) | ✓ | ✓ | ✓ |
| Full Blood Count and differentials (FBC) | ✓ | ✓ | ✓ |
| White Blood Cell count | ✓ | ✓ | ✓ |
| Red Blood Cell/Reticulocyte count | ✓ | ✓ | ✓ |
| Grouping and Cross Matching | ✓ | ✓ | ✓ |
| Genotype (on request by clinician) | ✓ | ✓ | ✓ |
| Blood group (on request by clinician) | ✓ | ✓ | ✓ |
| Erythrocyte Sedimentation Rate (ESR) | ✓ | ✓ | ✓ |
| MCHC | ✓ | ✓ | ✓ |
| MCH | ✓ | ✓ | ✓ |
| MCV | ✓ | ✓ | ✓ |
| Blood Film | ✓ | ✓ | ✓ |
| Blood Pregnancy (Beta HCG) Test | ✓ | ✓ | ✓ |
| ADVANCED LABORATORY INVESTIGATION | |||
| Blood urea Nitrogen | ✓ | ✓ | ✓ |
| Hepatitis B Surface Antigen (H+BSAg) | X | ✓ | ✓ |
| (HBA1C) | X | ✓ | ✓ |
| Hepatitis C Screening | ✓ | ✓ | ✓ |
| Hepatitis B Screening | ✓ | ✓ | ✓ |
| HIV Screening | ✓ | ✓ | ✓ |
| HIV Confirmatory Test | ✓ | ✓ | ✓ |
| G-6PD Screening | X | ✓ | ✓ |
| Thyroid Function Tests | ✓ | ✓ | ✓ |
| Serum Uric Acid | ✓ | ✓ | ✓ |
| Creatinine phosphokinase | X | ✓ | ✓ |
| Syphilis Screening | X | X | ✓ |
| Serum immunoglobulins/Antibodies | X | X | ✓ |
| Immunofluorescence assay | X | X | ✓ |
| QBC Malaria Concentration And Fluorescent Staining | ✓ | ✓ | ✓ |
| Pap Smear and Cytology | ✓ | ✓ | ✓ |
| Prostate Specific Antigen | ✓ | ✓ | ✓ |
| Protein Electrophoresis | X | X | ✓ |
| CSF M/C/S (CSF Analysis) | ✓ | ✓ | ✓ |
| Semen M/C/S | ✓ | ✓ | ✓ |
| Serum Creatinine Phosphokinase | X | ✓ | ✓ |
| Serum Iron | X | ✓ | ✓ |
| 24 Hour Creatinine Clearance | ✓ | ✓ | ✓ |
| Coomb’s Test (Indirect) | X | X | ✓ |
| Coomb’s Test (Direct) | X | X | ✓ |
| Osmotic Fragility Test | X | ✓ | ✓ |
| Chlamydia Screening | X | ✓ | ✓ |
| Seminal Fluid Analysis (SFA) | X | ✓ | ✓ |
| Clotting Time | ✓ | ✓ | ✓ |
| Bleeding Time | ✓ | ✓ | ✓ |
| D-Dimer | X | X | ✓ |
| Sputum Acid Fast Bacilli (AFB) Test | X | ✓ | ✓ |
| ROUTINE RADIOLOGY INVESTIGATIONS(Subject To HEALTHSPRING HMO Approval ) | |||
| Chest X-Rays | ✓ | ✓ | ✓ |
| Abdominal X-Rays | ✓ | ✓ | ✓ |
| Limbs(Hand,Forearm,Upper arm,Thigh and Leg) X-rays | ✓ | ✓ | ✓ |
| Neck X-rays | ✓ | ✓ | ✓ |
| Sinus X-rays | ✓ | ✓ | ✓ |
| Mastoid X-rays | ✓ | ✓ | ✓ |
| Cervical Spine X-rays | ✓ | ✓ | ✓ |
| Skull X-rays | ✓ | ✓ | ✓ |
| Pelvic X-rays | ✓ | ✓ | ✓ |
| Thoracic Inlet X-rays | ✓ | ✓ | ✓ |
| Thoraco-Lumbar X-rays | ✓ | ✓ | ✓ |
| Lumbosacral X-Rays | ✓ | ✓ | ✓ |
| Mandibles/Temporomandibular Joint X-Rays | ✓ | ✓ | ✓ |
| X-rays of All Body Joints | ✓ | ✓ | ✓ |
| Routine Ultrasound Scans (Obstetrics; Abdominal, Pelvic, Abdominopelvic, Breast, Testicular/Scrotal, Thyroid, Prostate, Bladder, and Brain Ultrasound Scans) | Covered (Mammogran not covered) | ✓ | ✓ |
| SPECIALIZED RADIOLOGY INVESTIGATIONS. (ECG, EEG, CT- Scan, MRI, ECHO, Doppler, Angiogram etc) | |||
| Doppler Ultrasound Scan | X | X | Eight Investigations per annum |
| ECG | ✓ | ✓ | |
| CT Scan | X | Covered (for life threatening emergency) Once per annum | |
| MRI | X | X | |
| Echocardiography | X | X | |
| Proctoscopy | X | X | |
| Sigmoidoscopy | X | X | |
| Upper GI Endoscopy | X | X | |
| Endoscopic Ultrasound | X | X | |
| Endoscopic retrograde cholangiopancreatography (ERCP) | X | X | |
| Enteroscopy | X | X | |
| Gastroscopy | X | X | |
| Colonoscopy | X | X | |
| Laryngoscopy (Direct and Indirect) | X | X | |
| Bronchoscopy | X | X | |
| Thoracoscopy | X | X | |
| Hysteroscopy | X | X | |
| Cystoscopy | X | X | |
| Laparoscopy | X | X | |
| Arthroscopy | X | X | |
ADMISSION & ACCOMMODATION
| Topaz | Emerald | Diamond | |
|---|---|---|---|
| Accommodation type | Regular Room. | Semi-Private Room. | Private Room. |
| Hospitalization (Accommodation & Feeding) | Cumulative 30days | Cumulative 30days | Cumulative 50days |
| Accomodation for parent whose neonate is on admission or ICU (This service excludes feeding for the parent) | ✓ | ✓ | ✓ |
| Intensive Care (ICU) | |||
| No of days applicable on the plan | 24hrs duration | 48hrs duration | 7 days duration |
MATERNAL& INFANT CARE
| PLAN | Topaz | Emerald | Diamond |
|---|---|---|---|
| PRIMARY IMMUNIZATION (Based On NPI Scheme) | |||
| BCG | ✓ | ✓ | ✓ |
| OPV/IPV | ✓ | ✓ | ✓ |
| Pentavalent Vaccine | ✓ | ✓ | ✓ |
| DPT | ✓ | ✓ | ✓ |
| Vitamin A | ✓ | ✓ | ✓ |
| Yellow Fever | ✓ | ✓ | ✓ |
| Measles | ✓ | ✓ | ✓ |
| SECONDARY IMMUNIZATION | |||
| Tetanus Toxoid | ✓ | ✓ | ✓ |
| Anti-Rabies | ✓ | ✓ | ✓ |
| Anti-Snake | ✓ | ✓ | ✓ |
| HIB | ✓ | ✓ | ✓ |
| Hepatitis B | X | X | ✓ |
| Chicken pox | X | X | ✓ |
| MMR | X | X | ✓ |
| Pneumococcal | X | X | ✓ |
| Rotavirus | X | X | ✓ |
| Meningitis | X | X | ✓ |
| Booster Dose for children 6 years and above (Meningitis, Yellow Fever & Hepatitis B) at designated centres. | |||
| Meningitis | X | X | ✓ |
| Yellow Fever | X | X | ✓ |
| Hepatitis B | X | X | ✓ |
| OBSTETRICS and GYNAECOLOGICAL SERVICES | |||
| Antenatal Care (Including specialist care and drugs) | ✓ | ✓ | ✓ |
| Delivery (SVD – Normal, Assisted or Complicated) | Normal Delivery Covered | ✓ | ✓ |
| Caesarean Section | Covered upto N75,000 per annum | ✓ | ✓ |
| Infertility Management /Services ( Hormonal profile, laparascopy, HSG, SFA, USS, Consults ) (Microsurgery , Insemination and Embryo transfer procedures not covered) | Covered up to a limit of N10,000 per annum | Covered up to a limit of N25,000 per annum | Covered up to a limit of N75,000 per annum |
| Reinbursement for Delivery Abroad SVD/CS | SVD-N50,000/CS- N75,000 | SVD-N100,000/CS- N125,000 | SVD-N250,000/CS N300,000 |
| Family Planning / Contraceptives | Oral Contraceptives and IUCD (Intrauterine Contraceptive Device) e.g. Copper T. | Oral Contraceptives and IUCD (Intrauterine Contraceptive Device) e.g. Copper T, Injectibles | Oral Contraceptives and IUCD (Intrauterine Contraceptive Device) e.g. Copper T, Injectibles. Tubal Ligation |
SURGERY, ENT, DENTAL, OPTICAL and PHYSIOTHERAPY
| Topaz | Emerald | Diamond | |
|---|---|---|---|
| SURGERIES AND PROCEDURES | |||
| SURGICAL LIMIT (Subject to Overall Inpatient limit) | To The Limit of N250,000.00 | To The Limit of N400,000.00 | To The Limit of N2,000,000.00 |
| Surgical Procedures Including Minor, Intermediate And Major Surgeries. (See Excluded Surgeries). Limits includes all related hospital care costs on each surgical case, and it includes all investigations related to surgery Pre and post-Op | Covered up to surgery limit | Covered up to surgery limit | Covered up to surgery limit |
| ENT SERVICES | |||
| Treatment and Removal of Foreign Bodies | ✓ | ✓ | ✓ |
| ENT Surgeries | Covered up to surgery limit. (See excluded Surgeries /Procedures ). | Covered up to surgery limit. (See excluded Surgeries /Procedures ). | Covered up to surgery limit. (See excluded Surgeries /Procedures ). |
| DENTAL CARE SERVICES | |||
| Primary & Secondary Dental care services | All Dental care services covered up N15,000 per annum | All Dental care services covered up N40,000 per annum | All Dental care services covered up N120,000 per annum |
| Specialist Consultation | |||
| Routine dental examination | |||
| Preventive dental care and counselling | |||
| Dental pain therapy | |||
| Pharmacological treatment of acute and chronic dental infections | |||
| Access to prescribed drugs | |||
| Surgical extraction | |||
| Non-surgical extraction | |||
| Root Canal Therapy | |||
| Scaling and Polishing | |||
| Operculectomy | |||
| Gingival Curettage | |||
| Composite Filling | |||
| Amalgam Filling | |||
| Incision and Drainage | |||
| EYE / OPTICAL SERVICES | |||
| Ophthalmology/Optical Care Including Consultations , Investigations , Prescriptions And Procedures . | Covered to the limit of N15,000/Per Policy Year | Covered to the limit of N35,000/Per Policy Year | Covered to the limit of N120,000/Per Policy Year |
| Biennial Optical Lenses /Frames (Either Unifocal, Bifocal Or Varifocal Lenses) | Covered (Principal only with a Limit of N7,500) | Covered (Principal only with a Limit of N12,500) | Covered (Limit of N40,000) |
| PHYSIOTHERAPY | |||
| Inclusive of prescribed prosthesis limited to clutches, cervical collar. | Covered to the limit of N25,000/Per Policy Year | Covered to the limit of 50,000/Per Policy Year | Covered to the limit of N200,000/Per Policy Year |
CHRONIC TREATMENT, A&E, HIV
| Topaz | Emerald | Diamond | |
|---|---|---|---|
| ACCIDENTS AND EMERGENCY CARE | |||
| Accidents & Emergencies (Limited to resuscitation treatments / procedures) | Covered to the limit of N150,000 Per Policy Year | Covered to the limit of N500,000 Per Policy Year | Covered to the limit of N2,500,000 Per Policy Year |
| Emergency Ambulance Services ( Covered up to Accidents & Emergencies Limit) | Ambulance (Hospital- to- Hospital transfer) (For Immobile Enrollees Only) Covered up to N20,000 per annum | Ambulance (Hospital- to- Hospital transfer)(For Immobile Covered up to N40,000 per annum | Ambulance (Hospital-to- Hospital transfer)(For Immobile Enrollees Only) |
| HIV CARE | |||
| Management of HIV ( Diagnosis only ) (Referral to Government Approved Centers only) | ✓ | ✓ | ✓ |
| CHRONIC DISEASES | |||
| Acute Kidney Failure Including Diagnosis, Treatment And Dialysis. | Covered up to surgery limit. Emergency Renal Dialysis for Max 1 session. | Covered up to surgery limit. Emergency Renal Dialysis for Max 2 sessions. | Covered up to surgery limit. Emergency Renal Dialysis for Max 8 sessions . |
| Chronic Kidney Failure Including Diagnosis, Treatment And Dialysis. | X | Covered up to surgery limit. Emergency Renal Dialysis for Max 2 sessions. | Covered up to surgery limit. Emergency Renal Dialysis for Max 8 sessions . |
| Cancer Care (Consultation, Diagnosis, Conservative/Resuscitative Management) (Definitive Management excluded) | Basic investigations, then Consultation covered. | Covered up to surgery limit | Covered up to surgery limit |
PREV.CARE,PSYCHIATRIC& WELLNES
| Topaz | Emerald | Diamond | |
|---|---|---|---|
| Health Screening For Principal & Spouse (HSH Designated Centres) once Per annum | |||
| BMI Check | ✓ | ✓ | ✓ |
| General Physical Examination | ✓ | ✓ | ✓ |
| Blood Pressure Check (Hypertension Screening) | ✓ | ✓ | ✓ |
| Fasting Blood Sugar or Random Blood Sugar | ✓ | ✓ | ✓ |
| Blood Cholesterol Check | X | ✓ | ✓ |
| Mammography (For Women ≥ 40 years of age) | X | X | ✓ |
| Pap Smear | X | X | ✓ |
| PSA Check (For Men ≥ 40 years of age) | X | X | ✓ |
| Liver Function Test | X | X | ✓ |
| Kidney Function Tests (E, U, and Cr) | X | X | ✓ |
| Urinalysis | ✓ | ✓ | ✓ |
| WELLNESS | |||
| Reinbursement for Surgery/Procedure Abroad | X | X | Up to N250,000 |
| Medical Counselling/Employee Programme Assitance | ✓ | ✓ | ✓ |
| Second opinion service by Experts local | ✓ | ✓ | ✓ |
| PSYCHIATRY CARE | |||
| Mental Health – Consultation and out- patients Services. In-patient care not covered | Limited to 6 Visits/Year. | Limited to 10 Visits/Year. | Limited to 18 Visits/Year. |
| Telemedicine and Telecommunication | |||
| Chat with Doctors and Nurses when in need of care during any medical emergency | ✓ | ✓ | ✓ |
| Free chats with Doctors and Nurses when in need of any routine medical information | ✓ | ✓ | ✓ |
| A GPS-enabled access to hospital directories when hospital information is needed | ✓ | ✓ | ✓ |
| Topaz | Emerald | Diamond | |
|---|---|---|---|
| PREMIUMS-Individual (N) | 47,275.00 | 73,750.00 | 282,300.00 |
| PREMIUMS-Family (N) | 236,375.00 | 368,750.00 | 1,411,500.00 |