Red Beryl, Alexandrite Plan & Diamond Plan benefit list
| BENEFITS | RETAIL RED BERYL PLAN | RETAIL ALEXANDRITE PLAN | RETAIL DIAMOND PLAN |
|---|---|---|---|
| HOSPITAL TIER(S) | TIER 4 | TIER 3 | TIER 2 |
| PREMIUMS PER MONTH PER HEAD (NAIRA) | ₦3,500 | ₦6,000 | ₦13,500 |
| TOTAL BENEFIT LIMITS PER INDIVIDUAL PER ANNUM (NAIRA) 1 | ₦1,200,000 | ₦1,800,000 | ₦3,000,000 |
| GENERAL CONSULTATION | COVERED (Outpatient and Inpatient) | COVERED (Outpatient and Inpatient) | COVERED (Outpatient and Inpatient) | |
| Treatment of basic medical outpatient cases | COVERED | COVERED | COVERED | |
| SPECIALIST CONSULTATION (ACCESSIBLE AFTER 1 WEEK) | COVERED UP TO 3 SESSIONS PER ANNUM(Outpatient and Inpatient; Based on referral from Primary Provider) | COVERED UP TO 5 SESSIONS PER ANNUM(Outpatient and Inpatient; Based on referral from Primary Provider) | COVERED UP TO 10 SESSIONS PER ANNUM(Outpatient and Inpatient; Based on referral from Primary Provider) | |
| O and G specialist | COVERED | COVERED | COVERED | |
| Pediatrician | COVERED | COVERED | COVERED | |
| General Surgeon | COVERED | COVERED | COVERED | |
| Cardiothoracic Surgeon | COVERED | COVERED | COVERED | |
| Neurosurgeon | COVERED | COVERED | COVERED | |
| Cardiologist | COVERED | COVERED | COVERED | |
| ENT Surgeon | COVERED | COVERED | COVERED | |
| Urologist | COVERED | COVERED | COVERED | |
| Orthopedic Surgeon | COVERED | COVERED | COVERED | |
| Gastroenterologist | COVERED | COVERED | COVERED | |
| Psychiatrist | COVERED | COVERED | COVERED | |
| Neonatologist | COVERED | COVERED | COVERED | |
| 24 HOURS FREE CHAT ACCESS TO HEALTHCARE PROFESSIONALS (INFOTECH-DRIVEN) | ||||
| Free chats with Doctors and Nurses when in need of care during any medical emergency | COVERED | COVERED | COVERED | |
| Free chats with Doctors and Nurses when in need of any routine medical information | COVERED | COVERED | COVERED | |
| A GPS-enabled access to hospital directories when hospital information is needed | COVERED | COVERED | COVERED | |
| Free Telemedicine app | COVERED | COVERED | COVERED | |
| ACCIDENT AND EMERGENCY CARE | ||||
| Resuscitative care for accident and emergency cases, including basic radiological and laboratory investigations needed to stabilize patient before being moved to the ICU if need be. | COVERED | COVERED | COVERED | |
| Diagnostics and imaging (ACCESSIBLE AFTER 1 WEEK) | ||||
| Chest X-Rays | COVERED | COVERED | COVERED | |
| Plain Abdominal X-Rays | COVERED | COVERED | COVERED | |
| Limbs X-Rays | COVERED | COVERED | COVERED | |
| Neck X-Rays | COVERED | COVERED | COVERED | |
| Skull X-Rays | COVERED | COVERED | COVERED | |
| Lumbosacral X-Rays | COVERED | COVERED | COVERED | |
| X-Rays of Body Joints | COVERED | COVERED | COVERED | |
| Ultrasound Scan | COVERED | COVERED | COVERED | |
| Hematological tests | COVERED | COVERED | COVERED | |
| Hemoglobin | COVERED | COVERED | COVERED | |
| Packed Cell Volume | COVERED | COVERED | COVERED | |
| White cell differential count | COVERED | COVERED | COVERED | |
| Full Blood Count and differentials | COVERED | COVERED | COVERED | |
| White Blood Cell count | COVERED | COVERED | COVERED | |
| Red Blood Cell count | COVERED | COVERED | COVERED | |
| Chemistry (ACCESSIBLE AFTER 1 WEEK) | ||||
| Fasting Blood Sugar | COVERED | COVERED | COVERED | |
| Random Blood Sugar | COVERED | COVERED | COVERED | |
| Electrolyte, Urea and Creatinine | COVERED | COVERED | COVERED | |
| Prostate Specific Antigen | COVERED | COVERED | COVERED | |
| Serum albumin | COVERED | COVERED | COVERED | |
| Serum ALT/SGPT | COVERED | COVERED | COVERED | |
| Serum AST/SGOT | COVERED | COVERED | COVERED | |
| Serum Bilirubin (Direct and Indirect) | COVERED | COVERED | COVERED | |
| Microbiology | ||||
| Malaria Parasite | COVERED | COVERED | COVERED | |
| Widal | COVERED | COVERED | COVERED | |
| Urine MCS | COVERED | COVERED | COVERED | |
| Stool MCS | COVERED | COVERED | COVERED | |
| Serology (ACCESSIBLE AFTER 1 WEEK) | ||||
| Hepatitis B Screening (on request by clinician) | COVERED | COVERED | COVERED | |
| HIV Screening (on request by clinician) | COVERED | COVERED | COVERED | |
| Genotype (on request by clinician) | COVERED | COVERED | COVERED | |
| Blood group (on request by clinician) | COVERED | COVERED | COVERED | |
| IMMUNIZATIONS (0-5 YEARS) (ACCESSIBLE AFTER 1 WEEK) | ||||
| BCG | COVERED | COVERED | COVERED | |
| OPV | COVERED | COVERED | COVERED | |
| PENTAVALENT | COVERED | COVERED | COVERED | |
| HBV | COVERED | COVERED | COVERED | |
| DPT | COVERED | COVERED | COVERED | |
| VITAMIN A | COVERED | COVERED | COVERED | |
| MEASLES | COVERED | COVERED | COVERED | |
| YELLOW FEVER | COVERED | COVERED | COVERED | |
| MENINGITIS VACCINE | NOT COVERED | NOT COVERED | COVERED | |
| ROTAVIRUS VACCINE | NOT COVERED | NOT COVERED | COVERED | |
| PNEUMOCOCCAL VACCINE | NOT COVERED | NOT COVERED | COVERED | |
| TYPHOID VACCINE | NOT COVERED | NOT COVERED | COVERED | |
| AMBULANCE SERVICES | ||||
| Movement of patients to and fro Hospital | COVERED (ROADSIDE TO HOSPITAL ONLY) | COVERED (ROADSIDE TO HOSPITAL AND HOSPITAL TO HOSPITAL) | COVERED (ROADSIDE TO HOSPITAL AND HOSPITAL TO HOSPITAL) |
| ADMISSIONS AND ACCOMMODATION | |||
| Feeding for enrollees on admission | COVERED | COVERED | COVERED |
| Hospital Ward Care | COVERED (GENERAL WARD ONLY) | COVERED (SEMI PRIVATE WARD ONLY) | COVERED |
| Skilled medical and paramedical services | COVERED | COVERED | COVERED |
| Supply of prescribed intravenous/intramuscular, oral and topical drugs | COVERED | COVERED | COVERED |
| Supply of all medical and surgical consumables | COVERED | COVERED | COVERED |
| Accommodation for in-patient care | COVERED (20 DAYS/ANNUM) | COVERED (30 DAYS/ANNUM) | COVERED (45 DAYS/ANNUM) |
| MINOR SURGERIES | |||
| Wound dressing | COVERED | COVERED | COVERED |
| Incision & drainage of acute and chronic abscesses | COVERED | COVERED | COVERED |
| Suturing of minor wounds | COVERED | COVERED | COVERED |
| Suturing of lacerations | COVERED | COVERED | COVERED |
| Ear piercing | COVERED | COVERED | COVERED |
| Male circumcision | COVERED | COVERED | COVERED |
| PRIMARY DENTAL CARE | |||
| Specialist Consultation | COVERED | COVERED | COVERED |
| Routine dental examination | COVERED | COVERED | COVERED |
| Preventive dental care and counselling | COVERED | COVERED | COVERED |
| Dental pain therapy | COVERED | COVERED | COVERED |
| Pharmacological treatment of acute and chronic dental infections | COVERED | COVERED | COVERED |
| Access to prescribed drugs | COVERED | COVERED | COVERED |
| Scaling/Polishing | COVERED (UP TO ₦5,000 ANNUAL LIMIT) | COVERED (UP TO ₦7,500 ANNUAL LIMIT) | COVERED (UP TO ₦10,500 ANNUAL LIMIT) |
| PHYSIOTHERAPY CARE | |||
| Specialist Consultation | COVERED | COVERED | COVERED |
| Routine fitness examination | COVERED | COVERED | COVERED |
| Preventive Counselling on referral | COVERED | COVERED | COVERED |
| Pain therapy | COVERED | COVERED | COVERED |
| Access to prescribed drugs | COVERED | COVERED | COVERED |
| Number of Sessions | COVERED (UP TO 3 SESSIONS) | COVERED (UP TO 5 SESSIONS) | COVERED (UP TO 10 SESSIONS) |
| PSYCHIATRY CARE | |||
| Mental illnesses | COVERED (OUTPATIENT CASES ONLY; UP TO 4 WEEKS LIMIT) | COVERED (OUTPATIENT CASES ONLY; UP TO 6 WEEKS LIMIT) | COVERED (OUTPATIENT CASES ONLY; UP TO 10 WEEKS LIMIT) |
| EYE CARE | ALL EYE CARE COVERED UP TO A GLOBAL ANNUAL LIMIT OF 15,000 NAIRA | ALL EYE CARE COVERED UP TO A GLOBAL ANNUAL LIMIT OF 25,000 NAIRA | ALL EYE CARE COVERED UP TO A GLOBAL ANNUAL LIMIT OF 40,000 NAIRA |
| Specialist Consultation | COVERED | COVERED | COVERED |
| Routine ocular examinations | COVERED | COVERED | COVERED |
| Pharmacological treatment of acute and chronic ocular infections | COVERED | COVERED | COVERED |
| Lenses and Frames (ONCE EVERY 2 YEARS) | COVERED (UP TO ₦5,000 ANNUAL LIMIT) | COVERED (UP TO ₦10,000 ANNUAL LIMIT) | COVERED (UP TO ₦10,000 ANNUAL LIMIT) |
| INTERMEDIATE SURGERIES 2 | Covered up to ₦150,000 Annual GLOBAL limit | Covered up to ₦300,000 Annual GLOBAL limit | Covered up to ₦500,000 Annual GLOBAL limit |
| MAJOR SURGERIES 2 | Covered up to ₦150,000 Annual GLOBAL limit | Covered up to ₦300,000 Annual GLOBAL limit | Covered up to ₦500,000 Annual GLOBAL limit |
| GYM | |||
| Fitness programmes at the gym | COVERED (1 SESSION PER WEEK) | COVERED (2 SESSIONS PER WEEK) | COVERED (3 SESSIONS PER WEEK) |
| SPA | |||
| Body massage | NOT COVERED | COVERED (1 SESSION PER YEAR) | COVERED (2 SESSION PER YEAR) |
1. THE OVERALL BENEFIT LIMITS PER INDIVIDUAL PER ANNUM ARE NOT TRANSFERABLE TO ANY OTHER ENROLLEE ON ANY OF THE PLANS, OR TO ANY OTHER THIRD PARTY.
2. ALL SURGERIES ON RED BERYL PLAN (EXCEPT THOSE ON EXCLUSION LIST) ARE COVERED UP TO A GLOBAL ANNUAL LIMIT OF ₦150,000 NAIRA PER INDIVIDUAL PER ANNUM, REGARDLESS OF THE TYPE OF SURGERY; ONCE THIS LIMIT IS EXCEEDED, NO MORE SURGICAL COVER FOR THE INDIVIDUAL IN THE SAME POLICY YEAR UNTIL RENEWAL
3. ALL SURGERIES ON ALEXANDRITE PLAN (EXCEPT THOSE ON EXCLUSION LIST) ARE COVERED UP TO A GLOBAL ANNUAL LIMIT OF ₦300,000 NAIRA PER INDIVIDUAL PER ANNUM, REGARDLESS OF THE TYPE OF SURGERY; ONCE THIS LIMIT IS EXCEEDED, NO MORE SURGICAL COVER FOR THE INDIVIDUAL IN THE SAME POLICY YEAR UNTIL RENEWAL
4. ALL SURGERIES ON DIAMOND PLAN (EXCEPT THOSE ON EXCLUSION LIST) ARE COVERED UP TO A GLOBAL ANNUAL LIMIT OF ₦500,000 NAIRA PER INDIVIDUAL PER ANNUM, REGARDLESS OF THE TYPE OF SURGERY; ONCE THIS LIMIT IS EXCEEDED, NO MORE SURGICAL COVER FOR THE INDIVIDUAL IN THE SAME POLICY YEAR UNTIL RENEWAL