APPENDIX A-CLIENT BENEFIT TABLE

AZUL SHIELD
General
Consultation

AZUL PLUS
SHIELD

ROJO SHIELD

PLATINO SHIELD

covered

Covered

covered

covered

Common Specialist
covered
Consultation
(Gynaecologist,
Dermatologist,
Orthopaedic Surgeon,
Cardiologist,
Paediatrics,E.N.T
surgeon)

Covered

covered

covered

Rare Specialist Consultation Not covered

(Nephrologist, Neuro
Surgeon Urologist,
Rheumatologist)

Covered

covered

covered

**Second Opinion

covered

Covered

covered

covered

covered

Covered

covered

covered

Drugs and
medications for
acute illnesses
and injuries

covered

Covered

covered

covered

Prescription drugs
for pre-existing
cases

Covered within
Network only

Covered within
Network only

Covered within
net- work only

Covered within and

outside net- work only

Basic

covered

Covered

covered

covered

Comprehensive

covered

Covered

covered

covered

Care

Health awareness
program

(cases declared preenrollment)

Laboratory

X-ray
Basic

covered

Covered

covered

covered

Comprehensive

covered

Covered

covered

covered

Ultrasound Scan

Not covered

Covered

Covered

Covered

Basic

covered

Covered

covered

covered

Comprehensive

covered

Covered

covered

covered

General ward

covered

Covered

covered

covered

3-4 bedded ward

covered

Covered

covered

covered

Semi-Private /

Not Covered

Semi- Private ward Standard Private covered

Hospitalization

ward

standard private Ward

Executive Private Ward Not covered

Not Covered

Not covered

Covered

Dental Care
Primary dental care

Treatment for

Treatment for pain Treatment for

Treatment for pain with

pain with PCP

with PCP

pain with PCP

PCP

Non-surgical Dental

Annual Limit

Annual Limit

Annual limit.

Annual limit. N30,000

Care (All dentist

N15,000

N20,000

N25,000

Not covered

Not covered

Limit N20,000

Treatment with

Treatment with PCP Treatment with

visits require
appointment author-

Surgical Dental Care

Limit N30,000

Eye Care
Primary eye care

PCP

Treatment with PCP

PCP

Lens and Frame /2yrs

Limit N7,500

Limit N7,500

Drugs/Eye

limit up to

Limit up to N3,000 limit up to

Limit up to N7,000 each

each policy year

policy year

Tests/Refraction(Requir N3,000 each

e appointment

policy year

limit N15,000

N5,000 each

limit N20,000

policy year

authorisation)
Ophthalmological
surgery

Not covered

Pterygium and

N100,000 Limit

N150,000 limit per

cataract only

per annum

annum

rst 24 hrs post

rst 24 hrs post

Emergency
Accident / Emergency rst 24 hrs post rst 24 hrs post

Stabilization

Emergency.

Emergency.

Subsequent

Subsequent cover Subsequent

cover is to

is to benet limit

benet limit
Emergency road

Emergency.

emergency. Subsequent
cover is to benet limit

cover is to
benet limit

Covered

Covered

Covered

Covered

N200,000

N250,000

N350,000

N500,000

Ambulance Services
Intensive Care Unit
Maternity Care
Antenatal Care

N200,000

N250,000

N350,000

N500,000

Covered within

Covered within

Covered within

Limit

Limit

Limit

Medical expenses for

Covered within

Covered within

Covered within

delivery

Limit

Limit

Limit

Covered

Covered

Covered

Covered

Covered

Covered

Covered

Covered

Covered

Covered

Covered

Pre-mature babies up

Covered within

Covered within rst Covered within

to 48hrs

rst 48hrs

48hrs

rst 48hrs

***Travel Care

Covered

Covered

Covered

Post natal check-up 1st Covered

Covered within Limit

Covered within Limit

6wks
Child Welfare Clinic
Circumcision, ear
piercing.
Routine Neo-natal
immunization (NPI)

Surgeries
Minor

N200,000LIMIT

N250,000LIMIT

N350,000 LIMIT

Covered within

Covered within

Covered within

Limit

Limit

Limit

Intermediate

Covered within

Covered within

Covered within

(Hernioraphy,

Limit

Limit

Limit

(Primary suture,

Covered for rst 7days

Covered
N400,000 LIMIT
Covered within Limit

lipoma excision,
ganglion excision,
incision and drainage,
keloid excision, minor
burns, wound
debridement etc.)

colostomy, tenoplasty,

Covered within Limit

diaphragmatic hernia
repair,
gastroenterostomy,
splenorraphy etc.)
Major (laparotomy

Not Covered

(broid), urehtrectomy

Covered within

Covered within

Limit

Limit

Covered within Limit

adrenalectomy,
thyroidectomy etc.)
Special Procedures
Blood Transfusion

Covered

Covered

Covered

Covered

P.O.P

1 Cast

1 Cast

1 Cast

Covered

Physiotherapy

2 sessions

3 Sessions

4 sessions

5 sessions

HIV Counselling and

Covered

Covered

Covered

Covered

Dialysis

Not covered

Not covered

1 acute session

2 Sessions

Cancer

Limit N100,000 Limit N150,000

Limit N200,000

Limit N250,000

testing and drugs from

local centres

Tests/investigation,
therapy
Extra Radiological
CT Scan, MRI

1 full payment

1 full payment per 1 full payment

Covered (1full payment

per annum (only annum (only when per annum (only per annum)
when necessary) necessary)

when necessary)

Covered

Covered

Covered including

including

including

Hepatitis B

Hepatitis B

Hepatitis B

Immunization
Basic

Covered

Additional (Typhoid,

Hib and MMR

Hib, menigitis and Covered

Rotavirus MMR, HiB,

only

MMR only

Physical

Physical

Covered

Pneumococcal,)
Preventive and
promotive health
Adult wellness

Standard health Executive health

check

examination

examination

checkup

checkup

Health information

covered

Covered

covered

covered

Treatment and

covered

Covered

Covered

covered

Disease
management
program

monitoring of Chronic
illnesses

Dear All,
This is to inform you that access to Novo health Africa Provider network has
been opened.
Novo Health I.D cards are currently not available but in the event that you
require to visit the hospital this weekend,
kindly call the phone numbers below.
This service is available to those who submitted HMO forms on or before
Monday July 27th , 2015.
LAGOS:
08174585814-FUNMILAYO
08099913212-NNEKA
08174602239-FRANCA
09094821447-BIMBO
08174604186-DR PAMELA
KWALE:
08180980413-DR IFECHUKWUDE
08181696751-ANULIKA

Warm Regards,