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Transforming healthcare delivery through innovative management solutions.
Hopewell Benefit Plan
| Service | PrimeLite Coverage |
|---|---|
| Hospital Network Access | Band A |
| Region of Coverage | Nigeria |
| General Waiting Period | 90 days (Telemedicine available during waiting period) |
| OUT-PATIENT SERVICES | |
| Out-patient limit | ₦75,000 |
| Out patient care, general and specialist consultation | Subject to outpatient limit |
| Xray's, laboratory and diagnostic tests | Subject to outpatient limit |
| Prescribed medicine and drugs | Subject to outpatient limit |
| Advance/complex investigation (CT SCAN, MRI SCAN) | Not covered |
| IN-PATIENTS SERVICES | |
| In-Patient Limit/PA | ₦100,000 |
| In- patient services (including feeding) | General ward |
| Laboratory and diagnostic test | Subject to inpatient limit |
| Prescribed medicines and drugs | Subject to inpatient limit |
| RADIOLOGICAL INVESTIGATION | |
| X-rays | Subject to inpatient limit |
| Complex Investigations (ECG, CT, MRI) | Not Covered |
| DENTAL SERVICES [Up to 6 month moratorium] | |
| Limit | ₦10,000 |
| Primary dental care/secondary dental care | Covered |
| OPTICAL SERVICES [6 month moratorium] | |
| Consultations | Covered |
| Eye Examinations | Covered |
| Treatments of primary conditions (allergies/conjunctivitis) | Covered |
| Provision of Optical Lenses and Frames (Once in two years) | Covered |
| Ophthalmic surgeries | Refer to the surgery limit |
| Optical Limit | ₦7,000 |
| ENT SERVICES [up to 3 month moratorium] | |
| Consultations | Covered |
| Treatment of primary diseases | Covered |
| Removal of foreign bodies | Covered |
| ENT surgeries | Refer to the surgery limit |
| ENT LIMIT | Outpatient limit |
| TELEMEDICINE SERVICES | |
| Chat with a doctor during medical emergency | Covered |
| Chat with medical personnel for routine medical information | Covered |
| GPS enabled access to hospital directories | Covered |
| ROUTINE IMMUNIZATIONS [up to 12 month moratorium] | |
| BCG, Oral Polio, Measles, Pentavalent, Vitamin A | Covered |
| Yellow Fever | Not covered |
| Additional Immunizations (<5years), Meningococcal, Rota Virus, Varicella, MMR, Pneumococcal | Not Covered |
| OBSTETRICS/GYNAECOLOGY [12-month moratorium] | |
| Antenatal care, consultation, Normal Delivery, Assisted delivery, Caesarean Section, Post natal care, Nursing Care | Covered |
| Prescribed medicine and drugs (non chronic) | Covered |
| Ultrasound obstetrics scan (max of 1 scan in each trimester) | Covered by authorization |
| OBS/GYN SERVICES block limit [12month moratorium applies] | ₦100,000 |
| FAMILY PLANNING & FERTILITY SERVICES [subject to outpatient limit and 12 month moratorium] | |
| Counselling, Pills, Injectable | Covered |
| IUCD (Copper T), Vasectomy, Implants, Tubal ligation | Not Covered |
| Fertility services (Investigations only) | |
| counselling | covered |
| SFA, USS, HSG, Hormonal Assay, Hysteroscopy | Not Covered |
| Limit | ₦15,000 |
| EMERGENCY MEDICAL SERVICES [subject to 12-month moratorium] | |
| Intensive Care Unit (ICU) | Up to 24hour subject to 12-month moratorium |
| Evacuation (Hospital to hospital & Roadside to Hospital) | Covered |
| Accident and emergency | covered |
| Emergency Medical Services Limit | ₦70,000 |
| PHYSIOTHERAPY SERVICES | |
| Physiotherapy Session | Not covered |
| SURGICAL SERVICES [up to 12 month moratorium] | |
| Surgical supplies/Consumables | Not Covered |
| Administration of Anesthesia, blood or blood products | Not Covered |
| Minor Surgeries (wound dressing, wound stitching, foreign body removal, etc.) | Covered |
| Intermediate Surgeries | Not Covered |
| Major Surgeries | Not Covered |
| Surgical Services Limit | ₦150,000 |
| OTHER MAJOR MEDICAL SERVICES | |
| HIV/AIDS Diagnosis + Treatment at free specialist centers | Covered |
| Preventive Health Education | Covered |
| Outpatient Psychiatry Care [subject to 12month moratorium] | Not Covered |
| Chronic pre-existing conditions [12-month moratorium] | Not covered |
| ANNUAL SCREENING [at designated centers and subject to outpatients limit once a year] Age 22 +/All gender | |
| Blood sugar, Blood Pressure Measurement, Body Mass Index Measurement, HIV, PCV | Covered |
| EUCR, CHOLESTEROL, Chest X-ray, ECG/LFT, Pap Smear, PSA, urinalysis | Not Covered |
| OTHERS | |
| Enrollee App | Covered |
| Health Education/Promotion | Covered |
| Individual Premium P/A | ₦75,000 |
| Family of 5/annum | ₦375,000 |
1. The Premium computed is payable once annually.
2. The age limit on all the Plans is 60 years and dependents 18 years.
3. Plans or Benefits are not transferable.
4. Family refers to principal, spouse and a maximum of 4 biological children under 18 years.
5. At least one adult must purchase a plan to enable us to register a child/minor less than 18 years. We do not register with minor alone, as we do not enter contracts with minors.
There is a waiting period of 90 days after receipt and portal registration. During the period of waiting, there is telemedicine Services available for consultation and management.
HOPEWELL HEALTHCARE (HMO) plans provide care from a network of specific providers and hospitals. These plans often don't cover any care from providers outside their network.
Hopewell HMO reserves the right to refer an enrollee to a designated secondary or tertiary healthcare provider.
Chronic pre-existing medical conditions are excluded in the first 12 month of the health plan (1 year moratorium). E.g. Hypertension, Cardiac related diseases, Diabetes mellitus and its related conditions, Hepatitis C and B, Asthma, and just to mention a few.
Note: This is a summary of major exclusions. Please refer to the full terms and conditions for complete list.