Oga Protect Plan – Wellness Health Care Group | Wellness Health Insurance | Wellness Hub | Wellness Trading Company | Wellness Travels and Medical Tourism
DETAIL BENEFITS SCOPE
Emergency Care & Stabilization: Ambulance transport, Emergency room stabilization  

Covered

Intensive Care Services Covered
General Consultation :Periodic health evaluation, Diagnostic,  

Covered

X-rays
Specialist Consultation: Cardiologist, O& G, Paediatrician, Urology, Dermatology, Endocrinology, Neurology, Nero-surgeon, Ent, Oncologist, Cardiothoracic, Orthopaedic  

 

Covered

Supply of Drugs Covered
Child Care and Immunisation : BCG, Measles, DPT, OPV, HBV, Yellow Fever, Measles ,NPI+Extended  

Covered

Ward Admissions :30 days P/A, including drug, test/diagnostics, Services of a dietician  

Private

Gynaecological Care Covered
 

Maternity Care: Pre-natal care, Normal Delivery, Assisted, Caesarean, Post natal, Termination of pregnancy for life endangering condition, Neonatal Services

 

 

Covered

Ophthalmic Services: Surgical Services, Non-Surgical, Optical (Limit Apply) Covered
Dental Care: Consultation and treatment Covered
General Surgery (Caesarean Section inclusive) Covered
Voluntary Annual Medical Check-up : Physical Examination, Organs screening, Mammogram, Lipid profile, ECG, X- CT Scan (Principal Only)  

Covered

HIV Care: Preventive, Counselling and provision of ARV’s at designated centres only  

Covered

 

Behavioural Services: Assessment and treatment (8 OPD consults per annum)

 

Covered

Physiotherapy Services Covered
Infertility Management: Testing and Diagnosis, IVF ( T & C Apply) Covered
Dialysis Centre: Treatment of Renal Failure & Dialysis (Subject to Limit) Covered
Health Club: Subsidized Use of Gym & SPA Covered
Personal Health Equipment (Principal Only) Covered
Critical Illness Covered
Travel Insurance (Principal Only) Covered
Permanent Disability Benefit Covered
Death Benefit (Principal Only) Covered
Burial Expenses Benefit (Principal Only) Covered
International Treatment: Only for Treatment of condition that is above local capacity Available ( T & C Apply)
Scope : Principal, Spouse, 6 Dependants Covered
 

Annual Premium

 
N1,200,000.00
   
BENEFITS:  
1.       Emergency Medical Services  
a.        Ambulance transport: Covered
i.       Roadside to hospital Covered
ii.       Hospital to hospital Covered
b.      Emergency room stabilization Covered
 

2. Intensive care (subject to the limits of N500,000

 

Covered

3.       Physician Services  
a.  General outpatient/inpatient consultation Covered
b.  Specialist outpatient/inpatient consultation Covered
c.  Routine or periodic health evaluation Covered
d.  Well-baby care Covered
e.  Well-child care Covered
f.   Diagnostic X-rays  
i. Upper Limb  
1. Hand/Wrist Covered
2. Forearm (Radius/Ulna) Covered
3. Elbow Covered
4. Humerus Covered
5. Shoulder Covered
6. Clavicle Covered
ii.  Lower Limb  
1. Foot/Toe Covered
2. Ankle Covered
3. Leg (Tibia/Fibula) Covered
4. Knee Covered
5. Femur or Thigh Covered
6.  Hip (Single) Covered
7. Pelvis (AP) Covered
8. Pelvis & Hip Covered
iii. Thorax  
1.   Chest (PA/AP) Covered
2.   Chest (PA/Lateral) Covered
3.  Chest (Oblique) Covered
4.  Apical/Lordotic Covered
5.  Sternum Covered
6. Thoracic Inlet Covered
iv.  Vertebral Spine  
1. Cervical Spine Covered
2. Lateral Neck (Soft Tissue) Covered
3. Thoracic Spine Covered
4. Thoracic-lumbar Spine Covered
5. Lumbosacral Spine Covered
v. Abdomen  
1.  Abdomen (Plain) Covered
2. Abdomen (Erect/Supine) Covered
g.  Diagnostic Laboratory Tests  
i. Haematology  
1. ESR Covered
2.  Full Blood Count (FBC) Covered
3. Haemoglobin Covered
4. Malaria Covered
5. PCV Covered
6.  RBC Covered
7.  Reticulocyte count Covered
8. WBC Covered
9.  Platelets Covered
10. Prothrombin time Covered
11. Microfilaria Covered
12.  Bleeding Time Covered
13. Clotting time Covered
ii. Serology  
1. ASO Titer Covered
2. Coombs test Covered
3. Heaf test Covered
4. Other Hepatitis Strains Covered
5. Pregnancy (blood) Covered
6. Pregnancy (urine) Covered
7. Rheumatoid factor Covered
8. VDRL Covered
iii. Blood Chemistry  
1. Glucose Covered
2.  Calcium Covered
3. Phosphorus Covered
4. Urea Covered
5. Creatinine Covered
6. Uric acid Covered
7. Albumin Covered
8. Cholesterol Covered
9.  Triglyceride Covered
10.  HDL Covered
11. LDL Covered
12.  SGOT Covered
13.  SGPT Covered
14. Alkaline Phosphate Covered
15. Bilirubin Covered
16. Sodium Covered
17. Potassium Covered
18. Bicarbonate Covered
19.  Chloride Covered
iv.   Urine Chemistry  
1. Creatinine Clearance Covered
v.      Microbiology  
1.  Stool Microscopy Covered
2.  Stool Occult Blood Covered
3.  Sputum ZN stain Covered
4. Urine Microscopy, Culture & Sensitivity Covered
5. Stool Microscopy, Culture & Sensitivity Covered
6. Swab Microscopy, Culture & Sensitivity Covered
7. Sputum Microscopy, Culture & Sensitivity Covered
4. SPECIALIST CONSULTATION: 8 Visits
a.   Common Specialist  
1. Cardiologist/Physician Covered
2. O & G Covered
3. Paediatrician Covered
b.     Rare Specialist  
1. Urology Covered
2. Dermatology Covered
3. Endocrinology Covered
4. Neurology Covered
5. Nero-Surgeon Covered
6. ENT Covered
7. Oncologist Covered
8. Cardiothoracic Covered
9. Orthopaedic Covered
5. Rehabilitation Services (Outpatient Short Term                    Therapy)  
a.        Physical 12 sessions
6A. Immunization for ages 0-5 (NPI for all plans)  
i.  BCG Covered
ii. Measles Covered
iii. DPT Covered
iv. Oral Polio(OPV) Covered
v. HBV Covered
vi. Yellow fever Covered
vii. Measles Covered
Immunization (NPI + Extended for exclusive plan only )  
viii. Meningococcal meningitis Covered
ix. Typhoid Covered
x. Pneumococcal (pneumovax) Covered
xi.       Rotavirus Covered
xii.       HIB Covered
xiii.       Chicken Pox Covered
 

 

xiii Well Child Evacuation/Child Health Supervision Services

 

 

Covered

6B.       Maternity Care  
a. Pre-natal care Covered
b. Normal delivery Covered
c. Assisted delivery Covered
d. Caesarean Section Covered
e. Postnatal care Covered
f.  Puerperal infection Covered
g.      Physician-prescribed bed rest during pregnancy Covered
h.      Preeclampsia during the prenatal period Covered
i.     Termination of pregnancy for life-endangering      conditions Covered
j.         Room and board, special diets, the services of a dietician, and skilled nursing in connection with childbirth for the mother or new-born child a vaginal delivery or a caesarean section delivery  

 

 

Covered

7.       Neonatal Services  
Limit on incubator & phototherapy care: N200,000
a. Incubator care: Covered
i. Term delivery Covered
ii. Preterm delivery Covered
b. Phototherapy Covered
c.  Exchange blood transfusion Covered
8.       Ophthalmic Services  
a.       Ophthalmology:  
Surgical Services(Limit) N100,000
i.       Pterygium excision Covered
ii.       Stye incision/drainage Covered
iii.       Chalazion incision/drainage Covered
iv.       Pterygium excision Covered
v.      Trabeculectomy Covered
vi.       Cataract surgery Covered
Non-Surgical Services  
vii.       Consultation Covered
viii.       Follow-up Covered
ix.       Foreign body removal Covered
x.      Refraction Covered
xi.       CVF/ Glaucoma screening and treatment Covered
xii.       Intra-Ocular Pressure Covered
xiii.       Dilated fundoscopy Covered
xiv.      Diabetic & hypertensive retinopathy Covered
b.       Optical (principal only):  
i.       Primary care Covered
ii.       Provision of lenses viz.: unifocal, bifocal, varifocal,

contact

 

Covered

iii.       Provision of optical frames N25, 000
Please note that unless otherwise mutually agreed by parties, these benefits shall not be transferred to spouse or dependants.  
9.       Dental Care  
a. Simple extraction Covered
b. Surgical extraction Covered
c. Amalgam filling Covered
d. Composite filling Covered
e.  Scaling & polishing (Therapeutic) (Preventive:1 per 6 months) Covered
f.  Pain therapy Covered

 

g.  Root Canal Therapy Covered
 

Dental financial limits

Individual

=N35,000

  Family = N70,000
10.  Ear, Nose and Throat Care:  
Primary ENT  
i. Consultation Covered
Secondary ENT  
i. Foreign Body Removal Covered
ii. Otitis Covered
iii. Ear Syringing Covered
11.  SURGERY (Limits) N400,000
Minor surgeries:  
Surgical drainage of breast abscesses Covered
Surgical drainage of galactocele Covered
Sub-periosteal drainage for acute osteomyelitis Covered
Drainage for septic arthritis Covered
Intercostal drainage insertion Covered
Aspiration of joints Covered
Debridement of wounds Covered
Surgical repair of simple wounds Covered
Biopsy of breast lump Covered
Tracheostomy Covered
Thoracotomy Covered
Drainage of paronychia Covered
Proctoscopy Covered
Evacuation of impacted feces Covered
Closed reduction of fractures Covered
Closed reduction and immobilization of joint dislocations Covered
Exostectomy Covered
Chondromectomy Covered
Ganglionectomy Covered
Temporary diversion of urine Covered
Circumcision Covered
Electro fulguration of condylomataacuminata Covered
Injection sclerotherapy of varicose veins Covered
Incision of Accessory sinuses, mouth, salivary glands, or ducts Covered
The reduction or manipulation of fractures of facial bones Covered
Intermediate Surgeries:(Limit)  
Tonsillectomy for children (less than 12yrs) Covered
Vasectomy Covered
Excision of tumor on abdominal wall Covered
Excision-biopsy of breast mass Covered
Biopsy of tumor on abdominal wall Covered
Biopsy of bone tumor Covered
Inguinal herniorraphy Covered
Femoral herniorraphy Covered
Excision of lesions, cysts, tumors of the mandible, mouth, lip, or tongue  

 

Covered

Ventral herniorraphy Covered
Appendectomy Covered
Major Surgeries:(Limit)  
Caesarean section delivery Covered
Biopsy of thyroid gland Covered
Oophorectomy Covered
Surgical drainage of hematoma of rectus abdominus Covered
Surgical drainage of peritoneal abscess Covered
Laparotomy Covered
Laparotomy and biopsy of disease viscera in abdominal cavity Covered
Repair of colostomy Covered
Anal sphincteroplasty Covered
Excision-Ligation Hemorrhoidectomy Covered
Milligan’s procedure Covered
Surgical drainage of anal abscess Covered
Polypectomy Covered
Sequesrectomy Covered
Saucerization of chronically infected bone Covered
Surgical excision of soft tissue tumor Covered
Excision-biopsy of soft tissue tumors Covered
Surgical drainage of hand abscess Covered
Orchidopexy Covered
Hydroceleoctomy Covered
Excision of Intrascrotal mass Covered
Surgery for torsion of spermatic cord Covered
Varicocelectomy Covered
Sigmoidoscopy Covered
Theirsch’s procedure Covered
Lord’s procedure Covered
Epigasticherniorraphy Covered
Dissection of femoral triangle Covered
Dissection of inguinal nodes Covered
Venoplasty Covered
Division of perforating veins Covered
Prostatectomy Covered
Myomectomy Covered
Hysterectomy Covered
Thyroidectomy Covered
 

 

Surgical Services and related Diagnostic Services for the treatment of Temporomandibular Joint Dysfunction (TMJ) or other deformities of the jaw, including orthognathic surgery, osteotomy, or any surgical repositioning of portions of the upper or lower jaws or the bodily repositioning of entire jaws

 

 

 

 

 

 

covered

12.  Health Maintenance and preventive services  
a.  Annual comprehensive Medical Examination  
i. Physical Examination Covered
ii.       Full blood count Covered
iii.       Urinalysis Covered
iv.       Blood sugar test Covered
v.       Chest X-ray Covered
vi.       Cervical Screening Covered
vii.       Prostate Screening (age 40 and above) Covered
viii.       Mammogram (age 35 and above) OR breast scan (age 30 and above)  

 

Covered

ix.      Lipid profile Covered
x.      ECG Covered
b.      Annual Basic Medical Examination (All plans)  
i.       Physical Examination Covered
ii.       Full blood count Covered
iii.       Urinalysis Covered
iv.       Blood sugar test Covered
v.      Chest X-ray Covered
13.  HIV Prevention & Counselling Covered
1. Preventive and Counselling  
Provision of ARV’s at designated centres only  
   
14.  Hospital Inpatient Services  
Ward Eligibility: (30 days per year) Private
a. Special diets Covered
b. Services of a dietician Covered
c.  Skilled nursing Covered
d. Use of operating, delivery, cast, and treatment rooms and equipment  

 

Covered

 

 

e. Prescribed drugs administered while the Enrolees is an Inpatient.

 

 

Covered

f.  Medical and surgical dressings, supplies, casts, and splints that have been ordered by a Physician for Covered Services  

 

Covered

g. Oxygen and administration of oxygen Covered
h.       Basic imaging (including X-rays) Covered
i.         Basic Serologic Investigations Covered
·   Full blood count  
·   Erythrocyte sedimentation rate  
·  Urinalysis  
·     Widal  
·     Malaria parasite  
·    Fasting blood sugar  
·    Blood grouping  
·     Genotype  
·    HIV test  
·     Hepatitis B serum antigen test  
j.  Intermediate Imaging Investigations – CT Scan, ECG, Breast scan Covered
.  Intermediate Serologic Tests Covered
·   Hormone profiling  
·     Hepatitis panel  
·     E/U/Cr  
·       Lipid profile  
·       H-Pylori test  
·       PSA  
·       Liver Function Tests  
·       Sputum tests  
·     Other general blood tests  
·   Swab MCS  
k.       Advanced Investigations:  
·     MRI Covered
·     Echocardiogram Covered
·       Mammogram Covered
15. Behavioural Health Services  
a. valuation and treatment of conditions, which are responsive to Time Limited Treatment.  

 

Covered

b. Severe Mental Illness i.e. any of the following: Covered
i.       Schizophrenia Covered
ii.       Bipolar disorder (manic-depressive illness) Covered
iii.       Major depressive disorder Covered
iv.       Panic disorder Covered
v.      Obsessive-compulsive disorder Covered
vi.       Schizoaffective disorder Covered
c.        Individual Psychotherapy Covered
d.      Group Psychotherapy Covered
e.       Psychological Testing Covered
f.       Family Counselling – Counselling with family members to aid diagnosis and treatment  

 

Covered

g.       Outpatient Psychiatric Care Services( 8 OPD Consult) Covered
16.  Infertility Services (Testing and Diagnosis Only)  
a. Consultation with a reproductive endocrinology/infertility specialist  

 

Covered

b. Complete semen analysis Covered
c.  Hysterosalpingogram, as an initial test of tubal patency, unless contraindicated  

 

Covered

d.  Medically Necessary laboratory testing to determine cause of infertility  

 

Covered

e.  Hysteroscopy Covered
f.  Mid-luteal endometrial biopsy Covered
 

 

g. In Vitro Fertilization (IVF)

Available ( T & C Apply)
17.  Family Planning/Birth Control  
a. Depo Provera (injection) Covered
b. IUDs Covered
c.  Norplant insertion Covered
d. Norplant removal Covered
e.  Oral contraceptives Covered
18.  Dialysis Hospital/Dialysis Centre  
a. In-patient treatment of Acute renal disease subject to bed-day limits indicated in schedule of benefit above  

 

3 dialysis

b. Chronic renal disease (subject to limits per plan as stated above) 3 Dialysis
19.  Patient Education  
Patient education classes are covered for the following diagnoses: Covered
a. Prenatal childbirth – for pregnant mothers Covered
b. Diabetes Covered
c.   Asthma Covered
20. Health Club: Subsidized Use of Gym & SPA Covered
use of GYM (Limit: 100,000.00) 24 Sessions
use of SPA (50,000.00) 2 Per annum
21.  Personal Health Equipment (Principal Only) Covered
22.   Critical Illness   (N3,000,000.00) Covered
23.   Travel Insurance (Principal Only) (Limit: 2 Months) worldwide
24.     Permanent Disability Benefit: (Limit:N1,500,000.00) Covered
25.  Death Benefit (Principal Only) (Limit: N1,500,000.00) Covered
26. Burial Expenses Benefit (Principal Only)(Limit: N 500,000.00) Covered
27. International Treatment: Only for Treatment of condition that is above local capacity Available ( T & C Apply)
Annual PERMIUM 1,200,000.00
 

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