Retail Benefit List

Red Beryl & Alexandrite Plan benefit list

BENEFITS RETAIL RED BERYL PLAN RETAIL ALEXANDRITE PLAN
HOSPITAL TIER(S) TIER 4 TIER 3
PREMIUMS PER MONTH PER HEAD (NAIRA) ₦3,500.00 ₦6,000.00
TOTAL BENEFIT LIMITS PER INDIVIDUAL PER ANNUM (NAIRA) 1 ₦1,200,000.00 ₦1,800,000.00

Accesible from Quarter 1

GENERAL CONSULTATION COVERED (Outpatient and Inpatient) COVERED (Outpatient and Inpatient)
Treatment of basic medical and surgical (minor) outpatient and in-patient cases COVERED COVERED
SPECIALIST CONSULTATION 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)
O and G specialist COVERED COVERED
Pediatrician COVERED COVERED
General Surgeon COVERED COVERED
Cardiothoracic Surgeon COVERED COVERED
Neurosurgeon COVERED COVERED
Cardiologist COVERED COVERED
ENT Surgeon COVERED COVERED
Urologist COVERED COVERED
Orthopedic Surgeon COVERED COVERED
Gastroenterologist COVERED COVERED
Psychiatrist COVERED COVERED
Neonatologist 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
Free chats with Doctors and Nurses when in need of any routine medical information COVERED COVERED
A GPS-enabled access to hospital directories when hospital information is needed COVERED COVERED
Free Telemedicine app 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
Diagnostics and imaging
Chest X-Rays COVERED COVERED
Plain Abdominal X-Rays COVERED COVERED
Limbs X-Rays COVERED COVERED
Neck X-Rays COVERED COVERED
Skull X-Rays COVERED COVERED
Lumbosacral X-Rays COVERED COVERED
X-Rays of Body Joints COVERED COVERED
Ultrasound Scan COVERED COVERED
Hematological tests COVERED COVERED
Hemoglobin COVERED COVERED
Packed Cell Volume COVERED COVERED
White cell differential count COVERED COVERED
Full Blood Count and differentials COVERED COVERED
White Blood Cell count COVERED COVERED
Red Blood Cell count COVERED COVERED
Chemistry
Fasting Blood Sugar COVERED COVERED
Random Blood Sugar COVERED COVERED
Electrolyte, Urea and Creatinine COVERED COVERED
Prostate Specific Antigen COVERED COVERED
Serum albumin COVERED COVERED
Serum ALT/SGPT COVERED COVERED
Serum AST/SGOT COVERED COVERED
Serum Bilirubin (Direct and Indirect) COVERED COVERED
Microbiology
Malaria Parasite COVERED COVERED
Widal COVERED COVERED
Urine MCS COVERED COVERED
Stool MCS COVERED COVERED
Serology
Hepatitis B Screening (on request by clinician) COVERED COVERED
HIV Screening (on request by clinician) COVERED COVERED
Genotype (on request by clinician) COVERED COVERED
Blood group (on request by clinician) COVERED COVERED
IMMUNIZATIONS (0-5 YEARS) COVERED COVERED
BCG COVERED COVERED
OPV COVERED COVERED
PENTAVALENT COVERED COVERED
HBV COVERED COVERED
DPT COVERED COVERED
VITAMIN A COVERED COVERED
MEASLES COVERED COVERED
YELLOW FEVER COVERED COVERED
MENINGITIS VACCINE NOT COVERED NOT COVERED
ROTAVIRUS VACCINE NOT COVERED NOT COVERED
PNEUMOCOCCAL VACCINE NOT COVERED NOT COVERED
TYPHOID VACCINE NOT COVERED NOT COVERED
AMBULANCE SERVICES
Movement of patients to and fro Hospital COVERED (ROADSIDE TO HOSPITAL ONLY) COVERED (ROADSIDE TO HOSPITAL AND HOSPITAL TO HOSPITAL)

Accesible from Quarter 2

ADMISSIONS AND ACCOMMODATION
Feeding for enrollees on admission COVERED COVERED
Hospital Ward Care COVERED (GENERAL WARD ONLY) COVERED (SEMI PRIVATE WARD ONLY)
Skilled medical and paramedical services COVERED COVERED
Supply of prescribed intravenous/intramuscular, oral and topical drugs COVERED COVERED
Supply of all medical and surgical consumables COVERED COVERED
Accommodation for in-patient care COVERED (20 DAYS/ANNUM) COVERED (30 DAYS/ANNUM)
MINOR SURGERIES
Wound dressing COVERED COVERED
Incision & drainage of acute and chronic abscesses COVERED COVERED
Suturing of minor wounds COVERED COVERED
Suturing of lacerations COVERED COVERED
Ear piercing COVERED COVERED
Male circumcision COVERED COVERED

Accesible from Quarter 3

PRIMARY DENTAL CARE
Specialist Consultation COVERED COVERED
Routine dental examination COVERED COVERED
Preventive dental care and counselling COVERED COVERED
Dental pain therapy COVERED COVERED
Pharmacological treatment of acute and chronic dental infections COVERED COVERED
Access to prescribed drugs COVERED COVERED
Scaling/Polishing COVERED (UP TO ₦5,000 ANNUAL LIMIT) COVERED (UP TO ₦7,500 ANNUAL LIMIT)
PHYSIOTHERAPY CARE
Specialist Consultation COVERED COVERED
Routine fitness examination COVERED COVERED
Preventive Counselling on referral COVERED COVERED
Pain therapy COVERED COVERED
Access to prescribed drugs COVERED COVERED
Number of Sessions COVERED (UP TO 3 SESSIONS) COVERED (UP TO 5 SESSIONS)
PSYCHIATRY CARE
Mental illnesses COVERED (OUTPATIENT CASES ONLY; UP TO 4 WEEKS LIMIT) COVERED (OUTPATIENT CASES ONLY; UP TO 6 WEEKS LIMIT)

Accessible from Quarter 4

EYE CARE COVERED UP TO A GLOBAL ANNUAL LIMIT OF ₦15,000 COVERED UP TO A GLOBAL ANNUAL LIMIT OF ₦25,000
Specialist Consultation COVERED COVERED
Routine ocular examinations COVERED COVERED
Pharmacological treatment of acute and chronic ocular infections COVERED COVERED
Lenses and Frames (ONCE EVERY 2 YEARS) COVERED (UP TO ₦5,000 ANNUAL LIMIT) COVERED (UP TO ₦10,000 ANNUAL LIMIT)

Accesible from Quarter 5

INTERMEDIATE SURGERIES ** Covered up to ₦150,000 Annual GLOBAL limit ** Covered up to ₦300,000 Annual GLOBAL limit ***

Accesible from Quarter 6

MAJOR SURGERIES** Covered up to ₦150,000 Annual GLOBAL limit** Covered up to ₦300,000 Annual GLOBAL limit***
GYM
Fitness programmes at the gym COVERED (1 SESSION PER WEEK) COVERED (2 SESSIONS PER WEEK)
SPA
Body massage NOT COVERED COVERED (1 SESSION PER YEAR)

*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.


**ALL SURGERIES ON RED BERYL PLAN ARE COVERED UP TO A GLOBAL ANNUAL LIMIT OF ₦150,000 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


***ALL SURGERIES ON ALEXANDRITE PLAN ARE COVERED UP TO A GLOBAL ANNUAL LIMIT OF ₦300,000 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