| Benefit List | Basic | Bronze | Silver | Gold | Diamond | Platinum |
|---|---|---|---|---|---|---|
| Outpatient Treatment | ||||||
| General Consultation | Covered | Covered | Covered | Covered | Covered | Covered |
| Specialist Consultation | Covered | Covered | Covered | Covered | Covered | |
| Subspecialist Review | Covered | Covered | Covered | Covered | ||
| Follow-up Consultation | Covered | Covered | Covered | Covered | Covered | Covered |
| Prescribed Essential Drugs | Covered | Covered | Covered | Covered | Covered | Covered |
| Routine Laboratory Investigations | Covered | Covered | Covered | Covered | Covered | Covered |
| Dressing of Simple Wounds/Burns | Covered | Covered | Covered | Covered | Covered | Covered |
| Emergency Services | ||||||
| Stabilization | Covered | Covered | Covered | Covered | Covered | Covered |
| Prescribed Essential Drug and Investigation | Covered | Covered | Covered | Covered | Covered | Covered |
| Ambulance Services (from hospital to hospital) | Covered | Covered | Covered | Covered | Covered | Covered |
| Management of Chronic Diseases | Covered up to basic drugs and investigation | Covered | Covered | Covered | Covered | Covered |
| Inpatient Consultation and Treatment | ||||||
| General Review | Covered | Covered | Covered | Covered | Covered | Covered |
| Specialist Review | Covered | Covered | Covered | Covered | Covered | |
| Subspecialist Review | Covered | Covered | Covered | |||
| Admission | General Ward | General Ward | Semi-Private | Semi-Private | Private Ward | Private Ward |
| Nursing Care | Covered | Covered | Covered | Covered | Covered | Covered |
| Feeding while on Admission | Covered | Covered | Covered | Covered | ||
| Prescribed Drugs | Covered | Covered | Covered | Covered | Covered | Covered |
| Counselling and Seminars on Health related issues | ||||||
| All Health Seminars and Counselling | Covered | Covered | Covered | Covered | Covered | Covered |
| Medical Imaging | ||||||
| Plain X-Rays | Covered | Covered | Covered | Covered | Covered | |
| Contrast Studies | Covered | Covered | Covered | |||
| Ultrasound Scan | Covered | Covered | Covered | Covered | Covered | |
| Electrocardiography (ECG) | Covered | Covered | Covered | Covered | Covered | |
| Echocardiography | Covered | Covered | Covered | |||
| Electroencephalography (EEG) | Covered | Covered | Covered | |||
| Endoscopic Investigation/Intervention | Covered | Covered | ||||
| CT Scan | Covered | Covered | Covered | |||
| MRI, PET | Covered | |||||
| Maternity Services (Family Plan only)* | ||||||
| All Maternity Services | N45,000 limit | Covered | Covered | Covered | Covered | |
| Prenatal (Antenatal Care) | Covered | Covered | Covered | Covered | Covered | |
| Perinatal: Normal Delivery | Covered | Covered | Covered | Covered | Covered | |
| Induction of Labour | Covered | Covered | Covered | Covered | Covered | |
| Assisted Delivery | Covered | Covered | Covered | Covered | Covered | |
| Caesarean Section (with surgical limit) | Covered | Covered | Covered | Covered | ||
| Postnatal Care (Six weeks) | Covered | Covered | Covered | Covered | Covered | |
| Laboratory Investigations | ||||||
| Lab Test | Covered for basic lab investigations | Covered | Covered | Covered | Covered | Covered |
| Family Planning Services (Oral Contraceptives, Injectables, Plain IUCD) | ||||||
| Investigations for Infertility | N 20, 000 | N 30, 000 | N 50, 000 | |||
| Child Vaccination (at designated centre) | ||||||
| Oral Polio Vaccine (OPV) | Covered | Covered | Covered | Covered | Covered | |
| BCG Vaccine | Covered | Covered | Covered | Covered | Covered | |
| Pentavalent Vaccine | Covered | Covered | Covered | Covered | Covered | |
| Diphtheria, Pertussis, Tetanus (DPT) | Covered | Covered | Covered | Covered | Covered | |
| Hepatitis B | Covered | Covered | Covered | Covered | Covered | |
| Haemophilus Influenza B (HIB) | Covered | Covered | Covered | Covered | Covered | |
| Pneumococcal Vaccine (PCV) | Covered | Covered | Covered | Covered | Covered | |
| Measles | Covered | Covered | Covered | Covered | Covered | |
| Yellow Fever | Covered | Covered | Covered | Covered | Covered | |
| Additional Immunization Children U-5MMR, Chicken Pox, Meningitis A | Covered | Covered | Covered | Covered | Covered | Covered |
| Dialysis for Kidney Disease | ||||||
| Dialysis - Elective | ||||||
| Dialysis - Emergency | 1 Session | 3 Session | 3 Session | 5 Session | ||
| Ophthalmology Services | ||||||
| Primary Care | Covered | Covered | Covered | Covered | Covered | Covered |
| Lens | N 5, 000 | N 7, 500 | N 15, 000 | N 25, 000 | N 30, 000 | |
| Ophthalmic Surgery per annum | N 85, 000 | N 150, 000 | N 200, 000 | |||
| Eye Investigations | ||||||
| Refraction | Covered | Covered | Covered | Covered | Covered | Covered |
| Tonometry | Covered | Covered | Covered | Covered | ||
| Fundoscopy | Covered | Covered | Covered | Covered | Covered | |
| Visual Field | Covered | Covered | Covered | Covered | Covered | Covered |
| Color Vision | Covered | Covered | Covered | Covered | Covered | |
| Slit Lamp Examination | Covered | Covered | Covered | Covered | ||
| Dental Services | ||||||
| Dental Consultation | Covered | Covered | Covered | Covered | Covered | Covered |
| Pain Therapy | Covered | Covered | Covered | Covered | Covered | Covered |
| Treatment of Infection | Covered | Covered | Covered | Covered | Covered | Covered |
| Simple Extraction | Covered | Covered | Covered | Covered | Covered | |
| Surgical Extraction | Covered | Covered | ||||
| Amalgam Filling | Covered | Covered | Covered | Covered | Covered | |
| Composite Filling | Covered | Covered | Covered | Covered | Covered | |
| Scaling and Polishing (Annual) | Covered | Covered | Covered | Covered | Covered | |
| Root Canal Treatment | Covered | Covered | ||||
| Surgical Operations | ||||||
| Annual Limit | N 40, 000 | N 60, 000 | N 120, 000 | N 160, 000 | N 250, 000 | N 500, 000 |
| Minor | Covered | Covered | Covered | Covered | Covered | Covered |
| Intermidiate | Covered | Covered | Covered | Covered | Covered | |
| Major | Covered | Covered | Covered | Covered | ||
| NICU National Care | ||||||
| Incubator Care and Treatment | Covered | Covered | Covered | Covered | ||
| Phototheraphy, Physiotheraphy (Annual) | Covered up to 5 sessions | Covered up to 5 sessions | Covered up to 10 sessions | Covered up to 10 sessions | Covered up to 15 sessions |
|
| Intensive Care Unit (ICU) | ||||||
| ICU Treatment | Covered for 24 Hours | Covered for 48 Hours | Covered for 5 Days | Covered for 10 Days |
||
| Physiotherapy (Annual) | ||||||
| Sessions of Physiotheraphy | Covered up to 5 sessions | Covered up to 5 sessions | Covered up to 10 sessions | Covered up to 10 sessions | Covered up to 15 sessions |
|
| HIV/AIDS* | ||||||
| Necessary Counselling and Testing | Covered | Covered | Covered | Covered | Covered | Covered |
| Treatment (refer to HIV Care Centres) | ||||||
| Cancer Treatment | ||||||
| Chemotheraphy, Radiotheraphy and Surgery | ||||||
| Psychiatric Disorder | ||||||
| Emergency Mental Treatment | Covered | Covered | Covered | Covered | ||
| Elective Mental Treatment | ||||||
| Wellness Programs | ||||||
| Annual Physical Examination | Covered | Covered | Covered | Covered | Covered | Covered |
| Annual Medical Examination (Basic) (Physical Exam, Eye Exam, Urine and Blood Tests) | Covered | Covered | Covered | Covered | ||
| Annual Comprehensive Investigations (Physical Exam, Eye Exam, Radiological Investigation, Urine and Blood Tests) | Covered | Covered | ||||
| Complementary Gymnasium Services | Principal | Principal and Spouse |
||||
| Pap Smear/PSA (where medically indicated) | Covered | Covered | Covered | |||
| Mammography (where medically indicated) | Covered | Covered | Covered |