Platinum Retail Plan/Individual
Sold By: AXA MANSARD HEALTH LIMITED
Seller type: CORPORATE
This Category could have less than 20 subscribers. NOTICE: This health insurance product does not cover pre-existing medical conditions. A pre-existing medical condition is defined as an injury, illness, sickness, disease or other physical, medical, mental or nervous condition, disorder or ailment that with reasonable medical certainty existed at the time of purchase of the policy or prior to the purchase of the policy. Whether or not previously manifested, symptomatic, diagnosed, treated prior to the effective date, including any chronic or recurring complications or consequences related to or arising from such ailment. There would be an underwriting and enrollment period of two weeks (14 days), before inception of cover.
This plan covers the following services;
EMERGENCY CARE: Initial stabilization and care, it also covers intensive care if required.
EVACUATION: Ambulance services are covered under this plan; it includes evacuation from site of injury to hospital and from hospital to hospital.
INTENSIVE CARE (Period of 14 days): Admission and care in a specialized unit where access to a high level of medical care and monitoring would be provided for critical cases.
- General consultations
- Specialist consultations
- Provision of prescribed drugs and medications for covered conditions
- Comprising of admission for the treatment of covered conditions in a private ward
- Feeding of enrollees for the duration of admission
- Provision of medical care, nursing care, and prescribed medication and consumables during the duration of admission
- Physiotherapy services – 20 sessions
- Provision of prescribed physiotherapeutic appliances e.g. Soft and hard cervical collar, Crutches
- Radiological services
- Plain X-rays of the limbs, spine, abdomen, pelvis, chest, skull
- Contrast studies
- Ultrasound scan
- Laboratory services
- Hematological investigations
- Microbiological investigations
- Clinical chemistry
- Electrocardiogram (ECG) Rest
ADVANCED INVESTIGATIONS- On Emergency
- CT Scan (Computed Tomography)
- MRI Scan (Magnetic Resonance Imaging)
ANTE NATAL CARE AND DELIVERY
- Antenatal care including prescribed drugs up to agreed hospital tariffs
- Antenatal procedures including Shirodkar's operation
- Management of pregnancy complications
- Normal delivery
- Assisted vacuum or forceps delivery
- Caesarian section
- Post natal care
FAMILY PLANNING SERVICES - Pills, injectable, IUCD, Vasectomy, Tubal Ligation, Norplant
NEONATAL SERVICES AND PAEDIATRIC CARE
- Neonatal care including sepsis, cord care, physiologic jaundice, opthalmia neonatorum
- Ear piercing
- Well baby clinic at 6 weeks
- Routine Immunizations BCG, Measles, DPT, Oral Polio, Vitamin A supplementation
- Additional Immunizations for 0 - 5years Pneumococcal vaccine & Rotavirus
- Treatment of common childhood diseases like malaria, and other uncomplicated febrile illnesses, diarrheal diseases, Upper respiratory tract infection
MINOR, INTERMEDIATE, MAJOR AND COMPLEX SURGICAL PROCEDURES UP TO LIMIT OF N1,000,000.00
- Wound dressing
- Suturing of minor cuts and lacerations
- Incision and drainage of abscesses
- Minor ENT (Ear, Nose, Throat) procedures like ear syringing
- Minor wound debridement
- Lump excision
- Hernia repairs
- Closed reduction and manipulation of simple fractures and dislocations
- Surgery for haemorrhoids
- ENT procedures like Antral washouts, Tonsillectomy
- Surgery for ectopic pregnancy
- Elective Orthopedic Surgery
- Gynecological surgeries like Hysterectomy
- ENT surgeries like Adenotonsillectomy
- Other complex surgeries such as Thyroidectomy, Open reduction and internal fixation of fractures, Brain surgeries, Cancer surgeries, Vascular and nerve surgeries and Transplant surgeries.
- Primary dental care including
- Basic dental treatment
- Simple amalgam or composite filling
- Scaling and polishing
- Non-surgical extractions
- Pain therapy drugs
- Secondary dental care- up to N80,000
- Dental Surgical Extraction
- Root canal and orthodontics
- Basic eye examination
- Biennial optical lenses (up to N 25,000)
MENTAL HEALTH SERVICES
- Outpatient consultation and treatment (up to 8 weeks)
HIV/AIDS CARE AND TREATMENT
- Voluntary counseling and testing
- Pre-treatment assessment
REGION OF COVER – Nigeria
AXA MANSARD PERSONAL PLATINUM SPECIFIC EXCLUSIONS:
The following exclusions are applicable on all the plans:
- Cosmetic Surgery
- Teeth Whitening
- Dental Prosthesis
- Domiciliary/Hospice Care
- Alternative /Unorthodox medicine
- Neonatal care not listed under neonatal services
- Self-inflicted injuries
- Congenital abnormalities
- Conditions caused by an act of war, an epidemic or enrollee participating in a riot
- Services primarily for weight reduction or treatment of obesity
- Treatment of substance abuse
- Infertility- All investigations and treatment.
- Advanced radiological investigations (e.g. C.T. scan, Myelogram, EEG).
- Advanced and Complex investigations (e.g. Marrow biopsy, skeletal survey).
- Prosthetic devices such as cardiac pacemaker, orthopedic implants.
- Management of Chronic Renal Failure (Dialysis and Transplant Surgery).
- Induced Abortion.
- Laser Treatments.
- Complex major Surgeries (e.g. Heart, Brain and Great blood vessels).
- Neurological surgeries.
- Professional Sports and wilful exposure to needless danger
- Infectious and contagious diseases in an epidemic
- All procedures, management and investigations not covered by the plans
- The following pre-existing or chronic conditions will be excluded in the first 24 months of the inception of the policy, however this list is not exhaustive only includes common one:
- Hypertension and Cardiac related diseases.
- Diabetes and its complications.
- Hepatitis B & C.
- Kidney related conditions.
- Peptic Ulcer Disease.
- Epilepsy and Seizure disorders.
- Glaucoma and Cataract.
- Pregnancy – All treatment related to Antenatal, Natal or Postnatal period.
- Management of Malignancies (Cancer)