Individual and Family Coverage
CONSULTATION
| Topaz | Emerald | Diamond | |
|---|---|---|---|
| Consultations with General Practice / Medical Officers Doctors | ✓ | ✓ | ✓ |
| Consultations with Specialist | 4 times per year | 6 times per year | 10 times per year |
DIAGNOSTICS
| Topaz | Emerald | Diamond | |
|---|---|---|---|
| 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 Investigations / Pathology | |||
| Blood urea Nitrogen | ✓ | ✓ | ✓ |
| Hepatitis B Surface Antigen (H+BSAg) | X | X | ✓ |
| (HBA1C) | X | 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 | X |
| Serum immunoglobulins/Antibodies | X | X | X |
| Immunofluorescence assay | X | X | X |
| QBC Malaria Concentration And Fluorescent Staining | ✓ | ✓ | ✓ |
| Pap Smear and Cytology | ✓ | ✓ | ✓ |
| Prostate Specific Antigen | ✓ | ✓ | ✓ |
| Protein Electrophoresis | X | X | X |
| CSF M/C/S (CSF Analysis) | ✓ | ✓ | ✓ |
| Semen M/C/S | ✓ | ✓ | ✓ |
| Serum Creatinine Phosphokinase | X | ✓ | ✓ |
| Serum Iron | X | X | ✓ |
| 24 Hour Creatinine Clearance | ✓ | ✓ | ✓ |
| Coomb’s Test (Indirect) | X | X | X |
| Coomb’s Test (Direct) | X | X | X |
| Osmotic Fragility Test | X | ✓ | ✓ |
| Chlamydia Screening | X | ✓ | ✓ |
| Seminal Fluid Analysis (SFA) | X | ✓ | ✓ |
| Clotting Time | ✓ | ✓ | ✓ |
| Bleeding Time | ✓ | ✓ | ✓ |
| D-Dimer | X | X | X |
| Sputum Acid Fast Bacilli (AFB) Test | X | ✓ | ✓ |
| Routine Radiology Investigations(Subject to HealthSpring HMO Health Approval) | Covered. | Covered. | Covered. |
| 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 | X | X | ✓ |
| Skull X-rays | ✓ | ✓ | ✓ |
| Pelvic X-rays | ✓ | ✓ | ✓ |
| Thoracic Inlet X-rays | X | ✓ | ✓ |
| Thoraco-Lumbar X-rays | X | ✓ | ✓ |
| Lumbosacral X-Rays | ✓ | ✓ | ✓ |
| Mandibles/Temporomandibular Joint X-Rays | X | X | ✓ |
| X-rays of All Body Joints | ✓ | ✓ | ✓ |
| Routine Ultrasound Scans (Obstetrics; Abdominal, Pelvic, Abdominopelvic, Breast, Testicular/Scrotal, Thyroid, Prostate, Bladder, and Brain Ultrasound Scans) | X | ✓ | ✓ |
| Specialized Radiology investigations (ECG,EEG,CT-SCAN,MRI,ECHO) | ONLY ECG once in a year | Covered (Maximum of once a year, for ONLY ONE of the listed investigations) | Covered (Maximum of once a year, for Any two of the listed investigations) |
| Doppler Ultrasound Scan | X | X | X |
| ECG | ✓ | ✓ | ✓ |
| CT Scan | X | Covered (for life threatening emergency) Once per annum | Covered (1 session per annum) |
| Echocardiography | X | X | Covered (1 session per annum) |
ADMISSION & ACCOMMODATION
| Topaz | Emerald | Diamond | |
|---|---|---|---|
| Hospitalization (Accommodation & Feeding) | Regular Room. Cumulative 15days | Semi -Private Room. Cumulative 25 days | Private Room. Cumulative 30 days |
| Intensive Care (ICU) | X | Maximum of 24 hrs duration per annum | Maximum of 48 hours duration per annum |
MATERNAL& INFANT CARE
| Topaz | Emerald | Diamond | |
|---|---|---|---|
| ANC & Delivery & 6weeks Postnatal care & 4weeks neonatal care (Covered after 12 months from commencement of scheme) | Covered only for family plan up to surgery limit. After 12 months of commencement of the scheme. | Covered only for family plan up to surgery limit. After 12 months of commencement of the scheme. | Covered only for family plan up to surgery limit. After 12 months of commencement of the scheme. |
| Neonatal Care (First 4 weeks of life) (Incubator care,Phototherapy, Management) | First 24 hours (Covered up to surgery limit) | First 72hrs (Covered up to surgery limit) | First 5 days (Covered up to surgery limit) |
| Gynecological Procedures / Surgeries (Covered after 12 months from commencement of scheme) | Covered up to surgery limit | Covered up to surgery limit | Covered up to surgery limit |
| Family Planning / Contraceptives (Not Covered for Individual plans) | Oral Contraceptives and IUCD (Intrauterine Contraceptive Device) e.g. Copper T | Oral Contraceptives and IUCD (Intrauterine Contraceptive Device) e.g. Copper T | Oral Contraceptives and IUCD (Intrauterine Contraceptive Device) e.g. Copper T |
| Primary Immunizations:BCG, Measles, DPT, Oral polio, IPV, Vitamin A supplementation only.(Covered after 12 months of commencement of scheme) | ✓ | ✓ | ✓ |
| Additional Immunizations (Covered after 12 Months of commencement of the scheme) | Tetanus Toxoid, Anti- Rabies, Anti- Snake, HIB only. | Tetanus Toxoid, Anti-Rabies, Anti-Snake, HIB, Hepatitis B & Chicken pox | Tetanus Toxoid, Anti- Rabies, Anti- Snake, HIB, Hepatitis B, Chicken pox & MMR |
SURGERY, ENT, DENTAL, OPTICAL and PHYSIOTHERAPY
| Topaz | Emerald | Diamond | |
|---|---|---|---|
| SURGERIES AND PROCEDURES | |||
| SURGICAL LIMIT (Covered after 12 months from commencement of scheme) | To the Limit of N200,000.00 | To the Limit of N350,000.00 | To the Limit of N750,000.00 |
| Surgical Procedures Including Minor, Intermediate and Major Surgeries. (See Exclusion list) | Covered up to surgery limit. After 12 months of commencement of the scheme | Covered up to surgery limit. After 12 months of commencement of scheme. | Covered up to surgery limit. After 12 months of commencement of the scheme. |
| Orthopedic Surgeries (Covered after 12 months from commencement of scheme). | Covered up to surgery Limit | Covered up to surgery limit | Covered up to surgery limit |
| ENT SERVICES | |||
| ENT Care and Surgeries (Covered after 12 months from commencement of scheme). | Covered up to surgery Limit. | Covered up to surgery limit | Covered up to surgery limit |
| DENTAL CARE SERVICES | |||
| Dental Care Including;Consultations, Investigations, Prescriptions and Procedures. (See exclusion list) | Moratorium of 6 months applies. | Moratorium of 6 months applies. | Moratorium of 6 months applies. |
| Primary & Secondary Dental care services | All Dental care services covered up N10,000 per annum | All Dental care services covered up N20,000 per annum | All Dental care services covered up N40,000 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 Procedure | Covered to the limit of N10,000 per annum after 6 months. | Covered to the limit of N15,000 per annum after 6 Months | Covered to the limit of N30,000 per annum after 6 months. |
| Lenses (Either Unifocal,Bifocal or Varifocal Lenses with A Limit of Once Every 2 Years) | Covered to the Limit of N10,000 | Covered to the Limit of N15,000 | Covered to the Limit of N30,000 |
| PHYSIOTHERAPY | |||
| Physiotherapy inclusive of prescribed prosthetic limited to clutches, cervical collar. | Covered after 6 months to the limit of N15,000/Per Policy Year. | Covered after 6 Months to the limit of N25,000/Per Policy Year | Covered After 6 Months to the limit of N40,000/Per Policy Year |
CHRONIC TREATMENT, A&E, HIV
| Topaz | Emerald | Diamond | |
|---|---|---|---|
| ACCIDENTS AND EMERGENCY CARE | |||
| Accidents & Emergencies (Limited to resuscitation treatments / procedures) | Covered up to surgery limit | Covered up to surgery limit | Covered up to surgery limit |
| Emergency Ambulance Services (Covered up to Surgery Limit) | Hospital transfer) (For Immobile Enrollees Only) | to-Hospital transfer)(For Immobile Enrollees Only) | Hospital transfer) (For Immobile Enrollees Only) |
| HIV CARE | |||
| Management of HIV (Diagnosis only) (Referral to Government Approved Centers only) | ✓ | ✓ | ✓ |
| CHRONIC DISEASES | |||
| Drug Prescription (Inclusive of outpatient & Inpatient) | Covered to the limit of N75,000/Per Policy Year | Covered to the limit of N100,000/Per Policy Year | Covered to the limit of N150,000/Per Policy Year |
| Chronic Ailments ;Management & Medications (Covered After 12 Months of commencement of the scheme) | Covered up to Drug Prescription limit | Covered up to Drug Prescription limit | Covered up to Drug Prescription limit |
PREV.CARE,PSYCHIATRIC& WELLNES
| Topaz | Emerald | Diamond | |
|---|---|---|---|
| Medical Counselling | ✓ | ✓ | ✓ |
| PSYCHIATRY CARE | |||
| Mental Health – Consultation and out-patients Services. In- patient care not covered | Limited to 3 Visits/Year. | Limited to 6 Visits/Year. | Limited to 9 Visits/Year. |
| Topaz | Emerald | Diamond | |
|---|---|---|---|
| ANNUAL PREMIUM PER INDIVIDUAL | |||
| PREMIUMS-Individual (N) | 100,000.00 | 200,000.00 | 300,000.00 |
| PREMIUMS-Family (N) | 500,000.00 | 1,000,000.00 | 1,500,000.00 |
| Overall Limits | 1,500,000.00 | 3,000,000.00 | 4,500,000.00 |