- EXCLUSIONS:
The following are excluded from all plans: –
- Transplant surgery
- Plastic/cosmetic surgeries
- Advanced and complex investigations not stated in the schedule of covered services
- Other investigations and treatment for problems relating to infertility e.g. hydrotubation, hysterosalpingogram, I.V.F, G.I.F.T and artificial insemination
- Kidney Dialysis
- Virility enhancing drugs
- Herbal drugs, non-prescription drugs, food supplements, and experimental drugs and treatment
- Other laboratory investigations not listed in the schedule of covered services
- Dental care is not listed in the schedule of covered services
- Home care and domiciliary services
- Joint replacements and prosthetic limbs
- Long term psychiatric illness (Longer than 6 months)
- Dermatological care deemed not medically necessary
- Comprehensive health screening/well persons check outside the scope of the benefits covered by the health checks.
- Pre-School Health examinations
- Treatment for newborns not registered on the plan after 6 weeks of birth.
- Neonatal care not listed under neonatal services
- Self-inflicted injuries
- Treatment of obesity
- All Covid-19 Treatment
- Covid-19 testing except as stated in the schedule of covered services.
- Speech disorders
- Room upgrades beyond that specified in the plan benefits
- Management of severe burns (Burns covering more than 10% body surface area)
- Learning difficulties, behavioral and developmental problems
- Consultations with unrecognized consultants, hospitals, family doctors, therapists, dental practitioners, or complementary medicines practitioners
- Any other treatment, service, procedure, or investigation not listed in the schedule of covered medical services
| Plans | HyLeague |
| Region of Cover | Global |
| Hospital Category | B-D |
| Total Benefit Limit | 10,000,000 |
| Benefits | Benefits |
| General and Specialist Consultations, Prescribed Medicines and Laboratory tests | √ |
| Accidents & Emergencies: Resuscitative or lifesaving initial treatment | √ |
| Management of Chronic Diseases- Consultation, Prescription drugs and Laboratory tests | √ (₦250,000 Limit on Prescription Drugs) |
| Accommodation (including feeding) | Private Ward (Lower of45 Days/Annum &₦500,000/Annum) |
| Accommodation for Mothers Whose Dependants are on admission (excluding feeding) (Limited to SCBU/NICU Cases only) | Lower of (48 Hrs&₦50,000) |
| Physiotherapy | Unlimited |
| X-Rays, Laboratory and Diagnostic Tests | √ |
| Routine Immunisations for 0-5years (NPI), including pentavalent vaccines (diptheria, tetanus, whooping cough) | √ |
| Additional Immunizations for 0-5 years,(Hepatitis B, HiB, chicken pox, MMR, Pneumococcal, Rotavirus, meningitis, yellow fever) | Hepatitis B, Hib, Chicken Pox, MMR, Pneumococcal, Rotavirus, Meningitis, Yellow Fever |
| Additional Immunizations (6yrs and above) (Meningitis, Yellow Fever, Hepatitis B) | Meningitis, Yellow Fever, Hepatitis B |
| Optical Care (Treatment of Chronic & Acute Eye Diseases) | √ (Up to Chronic Drug Management Limit) |
| Opthalmic Surgery (Upto Surgical Limit) | √ |
| Optical: Eye testing, Lenses, Frames & Contact, Lenses(Once in two years) | N40,000 |
| Primary Dental Care – relief of pain, fillings, nonsurgical, extractions, preventive care, scaling and polishing | |
| Secondary Dental Care (Dental Surgical Extraction & Root Canal Therapy), Dental Prosthetics | N150,000 |
| Antenatal Care + Delivery+ Postnatal Care 6 Weeks) ( Global Refundable Limit applies*) | N750,000 |
| Family Planning Services | IUCD (Intrauterine Contraceptive Device e.g. Copper T,Lippes Loop, Injectibles, Mirena Coil, Pills, Norplant |
| Advanced & Complex Investigations(limited To CT, Scan, MRI Scan and echocardiograph) | √ |
| Gym | 3/Week |
| Spa | 4/year |
| Surgeries including daycase procedures (minor, intermediate and major surgeries)( Global Refundable Limit applies*) | N2,000,000 |
| Cancer Care: Oncology Tests, Drugs + Chemotherapy & Radiotherapy ( Global Refundable Limit applies*) | N2,000,000 |
| Intensive Care Services | 15 Days |
| Neonatal Intensive Care Services (Incubator Care) and Special Care Baby Unit | (30 Days/ ₦1,000,000/Annum) |
| Kidney Dialysis | 10 Sessions |
| Health Checks | Basic (Physical, BP, Urinalysis), Genotype, Blood Sugar, Blood Group, PCV, serum, cholesterol and Pap smear, Prostate Specific Antigen and Mammography, Chest X-Ray, Lung Function Test, ECG |
| Ambulance | Home to Hospital, Roadside to Hospital & Hospital to Hospital |
| Infertility Treatment | Fertility Consultations, Counselling, USS, SFA, HSG, Hormone Profile, Laparoscopy (N150,000 Limit) |
| Global Refundable Limit for Cancer Care | Subject to overall Cancer Care Limit |
| Global Refundable Limit for Surgery | Subject to overall Surgical Limit |
| Global Refundable Limit for Maternity | N350,000 |
| Psychiatric Treatment | √ |
| HIV/AIDS Care & Treatment | √ |
| Inter-State Referral Services for services not available in State | √ |
| Interstate travel by commercial airline, (economy category) | √ |
| Medical enquiries | √ |
| Second opinion | √ |
| Hospital Accommodation(where medically necessary) | √ |
| Prescribed medicines and laboratory tests | √ |
| Mortuary Services (Cleaning, Embalment, Storage, Autopsy) | N250,000 limit |
*This refers to the amount that will be refunded by Hygeia HMO should the enrollee choose to access this care outside of Nigeria. Specific terms and conditions apply.
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