NEM SME HEALTH PLAN

PLAN BENEFITS PLAN TYPE

Benefit Sub-Categories SME Rose SME Lotus SME Tulip SME Hazel SME Ivy SME Marigold
Region of Cover Nigeria Nigeria Nigeria Nigeria Nigeria Nigeria + Africa I
Provider Category Tier 1 Tier 1 Tier 1 & 2 Tier 1 - 3 Tier 1- 4 Tier 1- 5
Annual Benefit Limit Unlimited Unlimited Unlimited Unlimited Unlimited Unlimited
OUT PATIENT CARE
GP Consultation Covered Covered Covered Covered Covered Covered
Specialist Consultation Covered Covered Covered Covered Covered Covered
Rare Specialist Consultation Covered Covered Covered Covered Covered Covered
Telemedicine Consultation Covered Covered Covered Covered Covered Covered
Prescribed Medications Covered Covered Covered Covered Covered Covered
Basic Laboratory Investigations/X-Ray/Ultrasounds Covered Covered Covered Covered Covered Covered
IN PATIENT CARE
Admission & Feeding Covered Covered Covered Covered Covered Covered
Room Type Standard Ward Standard Ward Semi-Private room Private room Private room Private room
Nursing Care and Consumables Covered Covered Covered Covered Covered Covered
Accommodation for parents whose children(below 5
Not Covered Not Covered Covered for 24 hours Covered for 2 days Covered for 3 days Covered for 5 days
years) are on admission
INTENSIVE CARE SERVICES
Subject to plan type limit Not Covered 24 hours 2 days 3 days 5 days 7 days
ACCIDENT AND EMERGENCY
Emergency Room Care Covered Covered Covered Covered Covered Covered
Emergency Medical Transportation from Roadside to
Covered Covered Covered Covered Covered Covered
Hospital and Hospital to Hospital
Free Uber or Bolt ride home to hospital (Medical
Covered Covered Covered Covered Covered Covered
Emergencies only)
Emergency Services - Resuscitation and Stabilization Covered Covered Covered Covered Covered Covered
OBSTETRICS AND GYNAECOLOGY
Antenatal care Covered Covered Covered Covered Covered Covered
Induction of Labour & Normal Delivery Covered Covered Covered Covered Covered Covered
Assisted Delivery Covered Covered Covered Covered Covered Covered
Emergency or Elective Caesarean Section(Based on
Covered Covered Covered Covered Covered Covered
Surgical Limit)
Post Natal Care- 6 weeks Covered Covered Covered Covered Covered Covered
Family Planning Services - All Methods ₦10,000.00 ₦10,000.00 ₦15,000.00 ₦25,000.00 ₦40,000.00 ₦50,000.00
NEONATAL CARE SERVICES
Special Baby Care Unit (Intensive care Unit-including
life support, Phototherapy & Incubator care). limit Not Covered 24 hours 2 days 5 days 7 days 7 days
per plan
Male Circumcision and Ear Piercing - Within first 6
Covered Covered Covered Covered Covered Covered
weeks of life
INFERTILITY MANAGEMENT
Consultation and Investigation Not Covered ₦10,000.00 ₦15,000.00 ₦30,000.00 ₦50,000.00 ₦80,000.00
PRIMARY IMMUNIZATION
BCG Covered Covered Covered Covered Covered Covered
OPV Covered Covered Covered Covered Covered Covered
Pentavalent & IPV Covered Covered Covered Covered Covered Covered
HBV Covered Covered Covered Covered Covered Covered
Vitamin A Covered Covered Covered Covered Covered Covered
Measles Covered Covered Covered Covered Covered Covered
Pneumoccoccal Covered Covered Covered Covered Covered Covered
Yellow Fever Covered Covered Covered Covered Covered Covered
SECONDARY IMMUNIZATION
Rotavirus
Meningitis
MMR
Hexaxim Not Covered ₦10,000.00 ₦15,000.00 ₦30,000.00 ₦50,000.00 ₦50,000.00
Typhoid
Chicken Pox
HPV
SURGERY (Subject to plan limit)
Minor Surgery
Intermediate Surgery
₦100,000.00 ₦200,000.00 ₦250,000.00 ₦550,000.00 ₦900,000.00 ₦1,500,000.00
Major Surgery
Tertiary Surgery/Minimal Invasive Surgeries
ENT SERVICES
Treatment for ENT diseases Covered Covered Covered Covered Covered Covered
ENT surgery (Subject to overall surgical limit) Covered Covered Covered Covered Covered Covered
DENTAL CARE SERVICES

Primary dental care - Basic dental treatment, Simple

Amalgam or composite filling ,Scaling and Polishing,
Non-Surgical Extractions and Pain Therapy/ Relief
₦7,500.00 ₦10,000.00 ₦15,000.00 ₦45,000.00 ₦75,000.00 ₦135,000.00

Secondary Dental Care - Surgical Tooth Extraction,

Root Canal Treatment and Orthodontics
EYE CARE SERVICES
Primary Eye Care- Consultation, Examination,
Covered Covered Covered Covered Covered Covered
Primary Infections, and Medications
Eye Surgeries covered as part of over all surgical
Covered Covered Covered Covered Covered Covered
limit
Lenses and Frames covered up to limit per plan
₦5,000.00 ₦8,500.00 ₦12,000.00 ₦20,000.00 ₦25,000.00 ₦35,000.00
(Once every 2 years)
MAJOR DISEASE CARE
Cancer Treatment (Chemotherapy, medication,
surgery), Major Organ Diseases- Kidney Dialysis,
Organ transplants, Other major Organ diseases, Not Covered ₦200,000.00 ₦250,000.00 ₦550,000.00 ₦900,000.00 ₦1,500,000.00
Stroke. All drawn from major disease limits
PHYSIOTHERAPY CARE SERVICES
Specialist Consultation & Treatment Covered Covered Covered Covered Covered Covered
Physiotherapy Sessions Not Covered 3 sessions 6 sessions 10 sessions 15 sessions 20 sessions
External Medical Devices & Appliances such as
Crutches, Wheelchair, Neck Collars etc Limits are per ₦10,000.00 ₦30,000.00 ₦50,000.00 ₦80,000.00 Covered Covered
incident.
DIAGNOSTIC SERVICES
Basic Radiological Studies e.g Plain x-ray, Contrast X-
Covered Covered Covered Covered Covered Covered
ray & Ultrasonography (Abdominal and Pelvic)

Laboratory Services- Histopathology, Hematological

Investigations, Microbiological Investigations , Covered Covered Covered Covered Covered Covered
Serology& Clinical chemistry
Spirometry , Electrocardiogram (ECG) - Rest & EEG-
Covered Covered Covered Covered Covered Covered
Electroencephalogram
Advanced and Complex Laboratory and
Radiological Investigations e.g Echocardiogram, CT Not Covered ₦40,000.00 ₦60,000.00 Covered Covered Covered
scan, MRI,e.t.c.
ANNUAL WELLNESS SCREENING (Principal &
Spouse)
Physical Examination Covered Covered Covered Covered Covered Covered
Visual Acuity Covered Covered Covered Covered Covered Covered
Blood Pressure Covered Covered Covered Covered Covered Covered
Fasting Blood Sugar Covered Covered Covered Covered Covered Covered
Full Blood Count Not Covered Covered Covered Covered Covered Covered
Urinalysis Not Covered Covered Covered Covered Covered Covered
Serum Cholesterol Not Covered Not Covered Covered Covered Covered Covered
LFT Not Covered Not Covered Not Covered Covered Covered Covered
ECG Not Covered Not Covered Not Covered Covered Covered Covered
E/U/Cr Not Covered Not Covered Not Covered Covered Covered Covered
Breast scan every 2years for females < 40years,
Mammogram for every 2 years females >40 years , Not Covered Not Covered Not Covered Covered Covered Covered
Pap smear every 2 years for females >35 years
PSA for men above 40 years every 2years Not Covered Not Covered Not Covered Covered Covered Covered
PHARMACY BENEFIT AND CHRONIC DISEASE
MANAGEMENT
Chronic Medical Conditions (Drug Refill) ₦30,000.00 ₦50,000.00 ₦80,000.00 Covered Covered Covered
Drug Delivery and Pick up at Partner Pharmacies Covered Covered Covered Covered Covered Covered
Chronic Disease Management Program Covered Covered Covered Covered Covered Covered
MENTAL HEALTH MANAGEMENT
Specialist Consultations on Outpatient Cases Only 2 weeks 5 weeks 5 weeks 7 weeks 7 weeks 7 weeks
Psychiatric Inpatient Cases Not Covered Not Covered Not Covered 5 days 7 days 7 days

Employee Assistance Program / Stress Management Covered Covered Covered Covered Covered Covered
LIFESTYLE MANAGEMENT

Discount at Network Gym Centres - iFitness Centres 30% 30% 30% 30% 30% 30%

On-site Health Checks , Fitness/Aerobic Intructors,

Covered Covered Covered Covered Covered Covered
Health Talks/ Education Forum or Wellness Fairs
TELEMEDICINE & E-HEALTH SERVICES
Teleconsultation Covered Covered Covered Covered Covered Covered
TRAVEL INSURANCE
World Wide Cover for Principal Only Not Covered Not Covered Not Covered 2 Weeks 1 Month 1 Month
EXPERT SECOND OPINION SERVICE
Second Opinion Service by Experts Covered Covered Covered Covered Covered Covered
MORTUARY SERVICES FOR FAMILY
Mortuary Service Not Covered Not Covered N50,000 N100,000 N100,000 N100,000
Premium Per Individual ₦ 44,174.97 ₦ 73,624.95 ₦ 103,074.93 ₦ 220,874.85 ₦ 8,368,124.75 ₦ 662,624.55
Premium Per Family of 2 ₦ 86,141.19 ₦ 143,568.65 ₦ 200,996.11 ₦ 430,705.96 ₦ 717,843.26 ₦ 1,292,117.87
Premium Per Family of 3 ₦ 128,107.41 ₦ 213,512.36 ₦ 298,917.30 ₦ 640,537.07 ₦ 1,067,561.78 ₦ 1,921,611.20
Premium Per Family of 4 ₦ 167,864.89 ₦ 279,774.81 ₦ 391,684.73 ₦ 839,324.43 ₦ 1,398,874.05 ₦ 2,517,973.29
Premium Per Family of 5 ₦ 198,787.37 ₦ 331,312.28 ₦ 463,837.19 ₦ 993,936.83 ₦ 1,656,561.38 ₦ 2,981,810.48
Premium Per Family ₦ 220,874.85 ₦ 368,124.80 ₦ 515,374.65 ₦ 1,104,374.25 ₦ 1,840,623.75 ₦ 3,313,122.75

POLICY EXCLUSIONS
•Conditions caused by an Act of War, an Epidemic or Enrollee participating in a Riot, Civil Disobedience, Domestic Violence
•Cosmetic Treatments and Procedures
•Epidemic and Pandemic
•Alternative /Un-orthodox Medicine
•Domiciliary/Hospice care
•Neonatal care not listed under neonatal services
•Self Inflicted Injuries
•Congenital Anomalies for Children not born on the Plan
•Services Primarily for Weight Reduction or Treatment of Obesity
•Treatment of Substance Abuse
•Professional Sports and willful Exposure to Needless Danger
•School Admission Test
•All Procedures, Management and Investigations not written/stated and Covered by the Plan
All types of Dental or Orthodontic Cosmetic Procedures including Cost of Consultation, Examination, Medication, Procedures, Follow-Up Visits, and Teeth Whitening, Dental Prosthesis, Dental & Surgical Implants.
• Donor Costs associated with Transplant Surgeries
• Autopsies
• Hormonal Therapy (Anabolic Steroids and Testosterone)
Occupational Injuries and Hazards

TERMS & CONDITIONS

•The quote is valid for 30 days which is effective from the date proposal is sent to the customer
•Pricing is based on the assumption of 5 - 19 principal lives
•The age limit on the plan is 65 years
•Maximum family size of 6 (principal, spouse and max . of 4 children)
•Discount is granted based on family size
•Moratorium period applicable to 5-9 lives
•The premium computed is paid annually and additional charges may apply for periodic premiums
•Open networks of hospital
•Final contract/negotiations is subject to NEM Health's terms and conditions
•Age for a children of Principals is 25 years and below
*Rare Specialist Consultation are covered up to N15,000.00 for SME Rose and SME Lotus
•6 months moratorium for chronic illness , related chronic diseases, surgeries and cancer care
•9 months moratorium for Obstetrics & Gynaecology including antenatal, delivery and post natal care