Family/Individual Policy
Our Family and Individual health policy entitles enrollees to 3 carefully designed health plans that provide increasing levels of care that covers a wide range of typical ailments and procedures; while also providing preventive healthcare services. The scheme is ideal for individuals who are self-employed but need a proper medical cover for healthy living. See benefit package for individual enrolments.
Benefit Package Summary
- Room and board (semi- private)
- Prescribed diets
- Services of a dietician
- Skilled nursing
- A bed in an emergency room and observation room/area
- Use of operating, delivery, cast, and treatment rooms and equipment
- Prescribed drugs administered while on admission
- Medical and surgical dressings, supplies
- Administration of oxygen (emergency only for first 48 hours)
- Hormonal Methods viz. oral and injectable contraceptives, implants
- Non-hormonal Methods viz. barrier methods (condoms, diaphragms,cervical caps), intra-uterine devices (IUDs), vasectomy, tubal ligation
- Outpatient Psychiatric Care Services
- Inpatient Psychiatric Care Services excluding convulsive therapy treatment
- Basic Dentistry viz. extraction of teeth and roots, fillings (amalgam and composite-max of 2 per visit), scaling and polishing (therapeutic and preventive), X-rays
- Blood glucose monitors.
- Test strips for glucose monitors.
- Insulin preparations, insulin pens and insulin cartridges
In-country emergency medical services
- Hospital to hospital, hospital to home
- Emergency room stabilization
- Intensive care up to first 48hrs
- Annual Medical Check Up(Limited to BP check, BMI, RBS, Urinalysis)
- Vaccines such as BCG, Measles, DPT, Oral Polio, Vitamin A supplementation, Hepatitis B, HiB, Pneumoccal vaccine
- Diagnosis and counselling
- Normal Pregnancy
- Prenatal care
- Spontaneous vaginal delivery
- Assisted vaginal delivery
- Caesarean section delivery
- Postnatal care
- Puerperal infection
- False labor
- Occasional spotting
- Physician-prescribed inpatient bed rest during pregnancy
- Morning sickness
- Hyperemesis gravidarum
- Preeclampsia
- Termination of pregnancy for life- endangering conditions
- Room and board, prescribed diets, the services of a dietician, and skilled nursing in connection with childbirth for the mother or newborn child a vaginal delivery or a cesarean section delivery
- Ophthalmology viz. primary care limited to pain relief and treatment of simple eye infection
- Optical supplies viz. unifocal, bifocal, varifoal, optical frames (once in 2 years)
- Prenatal classes
- Diabetes classes
- Asthma classes
- Hypertension classes
- General outpatient/inpatient consultation
- Specialist outpatient/inpatient consultation
- Electrocardiography
- Diagnostic Medical Imaging
- Basic X-rays
- Contrast Studies
- Diagnostic Ultrasound
- CT Scan
- Hematology
- Serology
- Blood Chemistry
- Urinalysis
- Urea Clearance
- Creatinine
- Clearance
- Stool Occult Blood
- Seminal Fluid analysis
- Microbiology
- Generic
Branded
- Physical Therapy up to 10 sessions.; Supply of basic physiotherapeutic appliances i.e. Crutches
- Surgical supplies normally required for covered surgical procedures
- Anesthesia normally required for covered surgical procedures
- Administration of blood and blood products
- Second and Third Surgical Opinions
- Minor Surgeries
- Intermediate Surgeries (Uncomplicated)
- Major surgeries
Pre-existing Conditions
Pre-existing conditions are conditions that have existed, been diagnosed or treated by a provider at any time prior to commencement of this health insurance policy for which continuous treatment or management is required.
Waiting Period
This is a period of time that must elapse before coverage can become effective for specified conditions and procedures included in the health benefits package as defined by the HMO. (Kindly refer to Clearline for a list of pre-existing conditions).
Incidences that occur during this period are NOT CLAIMABLE by the enrollee.
Waiting period for all new clients enrolling with pre-existing conditions is ONE YEAR effective from commencement of the policy year. PREGNANCIES will not be covered in the FIRST Policy year for ALL enrollees.
Exclusion
The following are excluded from all plans: –
- Transplant surgery
- Plastic/cosmetic surgeries
- Other investigations and treatment for problems relating to infertility, e.g hydrotubation, hysterosalpingogram, I.V.F, G.I.F.T and artificial insemination
- Virility enhancing drugs
- Herbal drugs, non-prescription drugs, food supplements and experimental drugs and treatment
- Dental care not listed in the covered services
- Home care and domiciliary services
- Joint replacements and prosthetic limbs
- Comprehensive health screening/well persons check outside the scope of the benefits covered by the selective health screening
- Treatment for newborns not registered on the plan after 6 weeks of birth.
- Congenital abnormalities
- Neonatal care not listed under neonatal services
- Self-inflicted injuries
- Treatment of obesity
- Speech disorders
- Learning difficulties, behavioral and developmental problems
- Consultations with unrecognized consultants, hospitals, family doctors, therapists, dental practitioners or complementary medicines practitioners
- Any other treatment, service, procedure or investigation not listed in the schedule of covered medical services.
Benefit Package Summary
Benefit Package Summary
Tab Content
Benefits Packages
Benefit Package Summary
- Room and board (semi- private)
- Prescribed diets
- Services of a dietician
- Skilled nursing
- A bed in an emergency room and observation room/area
- Use of operating, delivery, cast, and treatment rooms and equipment
- Prescribed drugs administered while on admission
- Medical and surgical dressings, supplies
- Administration of oxygen (emergency only for first 48 hours)
- Hormonal Methods viz. oral and injectable contraceptives, implants
- Non-hormonal Methods viz. barrier methods (condoms, diaphragms,cervical caps), intra-uterine devices (IUDs), vasectomy, tubal ligation
- Outpatient Psychiatric Care Services
- Inpatient Psychiatric Care Services excluding convulsive therapy treatment
- Basic Dentistry viz. extraction of teeth and roots, fillings (amalgam and composite-max of 2 per visit), scaling and polishing (therapeutic and preventive), X-rays
- Blood glucose monitors.
- Test strips for glucose monitors.
- Insulin preparations, insulin pens and insulin cartridges
In-country emergency medical services
- Hospital to hospital, hospital to home
- Emergency room stabilization
- Intensive care up to first 48hrs
- Annual Medical Check Up(Limited to BP check, BMI, RBS, Urinalysis)
- Vaccines such as BCG, Measles, DPT, Oral Polio, Vitamin A supplementation, Hepatitis B, HiB, Pneumoccal vaccine
- Diagnosis and counselling
- Normal Pregnancy
- Prenatal care
- Spontaneous vaginal delivery
- Assisted vaginal delivery
- Caesarean section delivery
- Postnatal care
- Puerperal infection
- False labor
- Occasional spotting
- Physician-prescribed inpatient bed rest during pregnancy
- Morning sickness
- Hyperemesis gravidarum
- Preeclampsia
- Termination of pregnancy for life- endangering conditions
- Room and board, prescribed diets, the services of a dietician, and skilled nursing in connection with childbirth for the mother or newborn child a vaginal delivery or a cesarean section delivery
- Ophthalmology viz. primary care limited to pain relief and treatment of simple eye infection
- Optical supplies viz. unifocal, bifocal, varifoal, optical frames (once in 2 years)
- Prenatal classes
- Diabetes classes
- Asthma classes
- Hypertension classes
- General outpatient/inpatient consultation
- Specialist outpatient/inpatient consultation
- Electrocardiography
- Diagnostic Medical Imaging
- Basic X-rays
- Contrast Studies
- Diagnostic Ultrasound
- CT Scan
- Hematology
- Serology
- Blood Chemistry
- Urinalysis
- Urea Clearance
- Creatinine
- Clearance
- Stool Occult Blood
- Seminal Fluid analysis
- Microbiology
- Generic
Branded
- Physical Therapy up to 10 sessions.; Supply of basic physiotherapeutic appliances i.e. Crutches
- Surgical supplies normally required for covered surgical procedures
- Anesthesia normally required for covered surgical procedures
- Administration of blood and blood products
- Second and Third Surgical Opinions
- Minor Surgeries
- Intermediate Surgeries (Uncomplicated)
- Major surgeries
Pre-existing Conditions
Pre-existing conditions are conditions that have existed, been diagnosed or treated by a provider at any time prior to commencement of this health insurance policy for which continuous treatment or management is required.
Waiting Period
This is a period of time that must elapse before coverage can become effective for specified conditions and procedures included in the health benefits package as defined by the HMO. (Kindly refer to Clearline for a list of pre-existing conditions).
Incidences that occur during this period are NOT CLAIMABLE by the enrollee.
Waiting period for all new clients enrolling with pre-existing conditions is ONE YEAR effective from commencement of the policy year. PREGNANCIES will not be covered in the FIRST Policy year for ALL enrollees.
Exclusion
The following are excluded from all plans: –
- Transplant surgery
- Plastic/cosmetic surgeries
- Other investigations and treatment for problems relating to infertility, e.g hydrotubation, hysterosalpingogram, I.V.F, G.I.F.T and artificial insemination
- Virility enhancing drugs
- Herbal drugs, non-prescription drugs, food supplements and experimental drugs and treatment
- Dental care not listed in the covered services
- Home care and domiciliary services
- Joint replacements and prosthetic limbs
- Comprehensive health screening/well persons check outside the scope of the benefits covered by the selective health screening
- Treatment for newborns not registered on the plan after 6 weeks of birth.
- Congenital abnormalities
- Neonatal care not listed under neonatal services
- Self-inflicted injuries
- Treatment of obesity
- Speech disorders
- Learning difficulties, behavioral and developmental problems
- Consultations with unrecognized consultants, hospitals, family doctors, therapists, dental practitioners or complementary medicines practitioners
- Any other treatment, service, procedure or investigation not listed in the schedule of covered medical services.
Benefit Package Summary
- Room and board (semi- private)
- Prescribed diets
- Services of a dietician
- Skilled nursing
- Isolation ward
- A bed in an emergency room and observation room/area
- Use of operating, delivery, cast, and treatment rooms and equipment
- Prescribed drugs administered while on admission
- Medical and surgical dressings, supplies
- Administration of oxygen (emergency only for first 24 hours)
- Diagnostic laboratory and medical imaging services
- Hormonal Methods viz. oral and injectable contraceptives, implants
- Non-hormonal Methods viz. barrier methods (condoms, diaphragms,cervical caps), intra-uterine devices (IUDs), vasectomy, tubal ligation
- Emergency psychiatric care up to 48hrs.
Basic Dentistry viz. extraction of teeth and roots, fillings (amalgam and composite-max of 2 per visit), scaling and polishing (therapeutic and preventive), X-rays, pain relief.
- Fast blood sugar & Random blood sugar ( only in the hospital)
- Provision of oral diabetic drugs
- Acute renal disease involving dialysis up to 2 sessions. Chronic renal disease is not covered.
- Prenatal classes
- Diabetes classes
- Asthma classes
- Hypertension classes
- General outpatient/inpatient consultation
- Specialist outpatient/inpatient consultation
- Electrocardiography
- Diagnostic Medical Imaging
- Basic X-rays
- Contrast Studies
- Diagnostic Ultrasound
- CT Scan
- Hematology
- Serology
- Blood Chemistry
- Urinalysis
- Urea Clearance
- Creatinine Clearance
- Stool Occult Blood
- Seminal Fluid analysis
- Microbiology
- Physical Therapy up to 5 sessions.
- Surgical supplies normally required for covered surgical procedures
- Anesthesia normally required for covered surgical procedures
- Administration of blood and blood products
- Second and Third Surgical Opinions
- Minor Surgeries
- Intermediate Surgeries (Uncomplicated)
- Major surgeries
Pre-existing Conditions
Pre-existing conditions are conditions that have existed, been diagnosed or treated by a provider at any time prior to commencement of this health insurance policy for which continuous treatment or management is required.
Waiting Period
This is a period of time that must elapse before coverage can become effective for specified conditions and procedures included in the health benefits package as defined by the HMO. (Kindly refer to Clearline for a list of pre-existing conditions).
Incidences that occur during this period are NOT CLAIMABLE by the enrollee.
Waiting period for all new clients enrolling with pre-existing conditions is ONE YEAR effective from commencement of the policy year. PREGNANCIES will not be covered in the FIRST Policy year for ALL enrollees.
Exclusion
The following are excluded from all plans: –
- Transplant surgery
- Plastic/cosmetic surgeries
- Other investigations and treatment for problems relating to infertility, e.g hydrotubation, hysterosalpingogram, I.V.F, G.I.F.T and artificial insemination
- Virility enhancing drugs
- Herbal drugs, non-prescription drugs, food supplements and experimental drugs and treatment
- Dental care not listed in the covered services
- Home care and domiciliary services
- Joint replacements and prosthetic limbs
- Comprehensive health screening/well persons check outside the scope of the benefits covered by the selective health screening
- Treatment for newborns not registered on the plan after 6 weeks of birth.
- Congenital abnormalities
- Neonatal care not listed under neonatal services
- Self-inflicted injuries
- Treatment of obesity
- Speech disorders
- Learning difficulties, behavioral and developmental problems
- Consultations with unrecognized consultants, hospitals, family doctors, therapists, dental practitioners or complementary medicines practitioners
- Any other treatment, service, procedure or investigation not listed in the schedule of covered medical services.
Benefit Package Summary
- Room and board (semi- private)
- Prescribed diets
- Services of a dietician
- Skilled nursing
- Isolation ward
- A bed in an emergency room and observation room/area
- Use of operating, delivery, cast, and treatment rooms and equipment
- Prescribed drugs administered while on admission
- Medical and surgical dressings, supplies
- Administration of oxygen (emergency only for first 48 hours)
- Diagnostic laboratory and medical imaging services
- Hormonal Methods viz. oral and injectable contraceptives, implants
- Non-hormonal Methods viz. barrier methods ((condoms, diaphragms, cervical caps), intra-uterine devices (IUDs), vasectomy, tubal ligation
- Outpatient Psychiatric Care Services
- Inpatient Psychiatric Care Services excluding convulsive therapy treatment
- Basic Dentistry viz. extraction of teeth and roots, fillings (amalgam and composite-max of 2 per visit), scaling and polishing (therapeutic and preventive), X-rays
- In-country emergency medical services
- Administration of Oxygen
- Annual Medical Check Up(Limited to BP check, BMI, RBS, Urinalysis)
- Vaccines such as BCG, Measles, DPT, Oral Polio, Vitamin A supplementation, Hepatitis B, HiB, Pneumoccal vaccine
- Diagnosis, Counselling and Treatment of opportunistic infections
- Normal Pregnancy
- Prenatal care
- Spontaneous vaginal delivery
- Assisted vaginal delivery
- Caesarean section delivery
- Postnatal care
- Puerperal infection
- False labor
- Occasional spotting
- Physician-prescribed inpatient bed rest during pregnancy
- Morning sickness
- Hyperemesis gravidarum
- Preeclampsia
- Termination of pregnancy for life- endangering conditions
- Room and board, prescribed diets, the services of a dietician, and skilled nursing in connection with childbirth for the mother or newborn child a vaginal delivery or a cesarean section delivery
- Ophthalmology viz. primary care limited to pain relief and treatment of simple eye infection
-
Patient Education
- Prenatal classes
- Diabetes classes
- Asthma classes
- Hypertension classes
-
Physician Services
- General outpatient/inpatient consultation
- Specialist outpatient/inpatient consultation
- Electrocardiography
- Diagnostic Medical Imaging
- Basic X-rays
- Contrast Studies
- Diagnostic Ultrasound
- CT Scan
-
Diagnostic Laboratory Tests
- Hematology
- Serology
- Blood Chemistry
- Urinalysis
- Creatinine Clearance
- Stool Occult Blood
- Seminal Fluid analysis
- Microbiology
- Generic
- Branded
- Surgical supplies normally required for covered surgical procedures
- Anesthesia normally required for covered surgical procedures
- Administration of blood and blood products
- Second and Third Surgical Opinions
- Minor Surgeries
- Intermediate Surgeries (Uncomplicated)
- Major surgeries