√ indicates services which are covered: – indicates services not covered under the specific plan

*Access to Category B Hospitals, Lagoon Hospital, and Reddington Hospital
**The visits cannot be cumulated over a period of time
***Applies to HyPrime Plus enrollees in Lagos only

D.     EXCLUSIONS:

The following are excluded from all plans: –

1. Overseas treatment and transplant surgery
2. Plastic/cosmetic surgeries
3. Advanced and complex investigations not stated in schedule of covered services
4. Investigations and treatment for problems relating to infertility e.g. hydrotubation, hysterosalpingogram, I.V.F, G.I.F.T, and artificial insemination
5. Virility enhancing drugs
6. Herbal drugs, non-prescription drugs and experimental drugs and treatment
7. Other laboratory investigations not listed in the schedule of covered services
8. Dental care not listed in the schedule of covered services
9. Home care and domiciliary services
10. Intensive care treatment
11. Joint replacements and prosthetic limbs
12. Interstate travel for services not available in State
13. Psychiatric Treatment and illness
14. Comprehensive health screening/well persons’ check
15. Pre – School Health examinations
16. Renal Dialysis
17. Cancer Care
18. HIV/AIDS Care & Treatment
19. Treatment for newborns not registered on the plan after 6 weeks of birth.
20. Neonatal Care Services (Treatment of mild or moderate neonatal sepsis, Phototherapy, Incubator Care and Special Care Baby Unit
21. Optical Care: Lenses, Frames & Contact, Lenses
22. Self-inflicted injuries
23. Treatment of obesity
24. Covid-19 testing and treatment
25. Treatment of Congenital Abnormalities
26. Speech disorders
27. Room upgrades beyond that specified in the plan benefits
28. Management of severe burns (Burns covering more than 10% body surface area)
29. Learning difficulties, behavioral and developmental problems
30. Consultations with unrecognized consultants, hospitals, family doctors, therapists, dental practitioners or complementary medicines practitioners
31. Any other treatment, service, procedure or investigation not listed in the schedule of covered medical services.

E.   NOTE

1. Maximum principal age limit is 60 years and Dependant age limit is 18 years.
2. Family means Principal, Spouse and 2 Dependants.
3. There will be a waiting period of 2 weeks after registration. Plan purchased becomes active 2 weeks after purchase date.
4. All benefits are subject to their respective sectional limits which is described as: Inpatient Limit and Outpatient Limit However, within the respective sectional limit, there are specific benefit limits as well. Consequently, in the event that any specific benefit limit under the sectional limit is exhausted, the remaining limit in that section will only cover other benefits within the section apart from the one that the specific benefit limit has been exhausted.
5. The following benefits will not be covered or provided in the first year of the commencement of the scheme: Maternity Services, Surgeries, Critical Illness + Death Cover and Psychiatric Care. This period otherwise known as waiting period shall commence on the date of entry to the date of renewal. On renewal, this benefit will be accessible provided the enrollee has been enrolled for one year with the HMO.
6. The following benefits will not be covered or provided in the first 6 months of the commencement of the scheme: Neonatal Care Services and All Immunisations
7. The following benefits will not be covered or provided in the first 3 months of the commencement of the scheme: Optical Care, Dental Care and Chronic Disease Medication.