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CUSTOMIZED HEALTHCARE PLAN

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COVERED SERVICES STANDARD CLASSIC SILVER GOLD GOLD PLUS
MEDICAL EMMERGENCY SERVICES: Acute Heart Failure, Shock ✔ 24 hrs✔ 24 hrs ✔ 24 hrs✔ 48 hrs✔ 72 hrs
OUT PATIENT SERVICES General Consultation Only General + Specialist Consultation General + Specialist Consultation General + Specialist Consultation General + Specialist Consultation
Out-patient care for 6 weeks ✖✔✔✔✔
INPATIENT MEDICAL SERVICES
ALLERGIES ✔✔✔✔✔
MEASLES ✔✔✔✔ ✔
CHICKEN POX ✔✔✔✔✔
PARASITIC AND ALLERGIC SKIN CONDITIONS ✔✔✔✔✔
Scabies, Tinea Infection, Acne, Eczema, Seborrheic, Dermatitis ✔✔✔✔✔
URINARY TRACT INFECTION ✔✔✔✔✔
Uncomplicated & Complicated Urinary Tract Infection ✔✔✔✔✔
PEPTIC ULCER DISEASE ✔✔✔✔✔
Acute Axacerbation of Peptic Ulcer Disease, GERD ✔✔✔✔✔
Indigestion ✔✔✔✔✔
UPPER & LOWER RESPIRATORY TRACT INFECTION ✔✔✔✔✔
Pneumonia, Bronchitis, Influenza, Viral Croup, Bronchiolitis, Tonsilitis ✔✔✔✔✔
ASTHMA ✔✔✔✔✔
CORYZA ✔✔✔✔✔
DIARRHEA DISEASES ✔✔✔✔✔
CADIO-VASCULAR CONDITIONS ✔✔✔✔✔
Hypertension, Myocardial Infarction, Cerebrovascular Accident (stroke), ✖✔✔✔✔
Cardiomyopathies, Chronic Heart Failure ✖✔✔✔✔
BLOOD TRANSFUSION ✖✔✔✔✔
HIV/AIDS-Investigation for confirmation ✔✔✔✔✔
Treatment of opportunistic infections ✖✔✔✔✔
INVESTIGATIONS
PVC, MP, WIDAL, FBC+DIFF, PREGNANCY TEST ✔✔✔✔✔
ESR, RBS/FBS, URINALYSIS, M/C/S ✔✔✔✔✔
E/U/CR, BLOOD GROUP AND GENOTYPE, HBSAg. ✔✔✔✔✔
HBV/HCV, H, PYLORI ✖✔✔✔✔
COOMB's TEST, BLOOD CULTURE, PERIPHERAL ✖✖✔✔✔
BLOOD FILM, CLOTTING PROFILE, BLEEDING TIME, INR ✖✖✔✔✔
D-TIMER, FECAL OCCULT BLOOD, FERRITIN LEVELSM HbA1c ✖✖✔✔✔
LFT, KFT ✖✔✔✔✔
MATERNITY AND CHILD SERVICES
Confirmation of Pregnancy ✔✔✔✔✔
Antenatal Care (from 12 weeks) ✖✔✔✔✔
Management of Labour & Delivery ✖✔✔✔✔
Surgical Intervention ✖✔✔✔✔
Post-Natal Care ✖✔✔✔✔
Febrile Convulsions ✔✔✔✔✔
Routine immunization Services ✔✔✔✔✔
Additional Immunization under 5yrs ✖✖✔✔✔
ICU/SCBU (1st 24hrs and monetary limit 50,000) ✖✖✔Limit: 70,000Limit: 100,000
SURGICAL SERVICES
Minor Procedures ✔✔✔✔✔
Intermidiate Procedures✖✔✔✔✔
Major Procedures✖✔✔✔✔
Kindly note that monetary limits apply. Surgical Limit = 50,000 for individual & 150,000 for family plans Surgical Limit = 140,000 for individual & 350,000 for family plans Surgical Limit = 220,000 for individual & 700,000 for family plans Surgical Limit = 440,000 for individual & 1,000,000 for family plans Surgical Limit = 550,000 for individual & (to be determined) for family plans
EYE SERVICES
Basic Eye Examination (only) ✔✔✔✔✔
MANAGEMENT OF COMMON EYE AILMENTS
stye, Conjuctivities, Ocular Allergies, Keratitis ✖✖✔✔✔
Optical Lens Limit (biennial) ✖10,00015,00025,000To be determined
Eye Surgeries (Minor & Intermidiate) ✖✔✔✔✔
Major Eye Surgery ✖✖✔✔✔
DENTAL CARE
TREATMENT OF MINOR AILMENTS
Gingivitis, Scurvy, Tooth pain ✔✔✔✔✔
Routine pain management ✖✔✔✔✔
Surgical Extraction ✖✔✔✔✔
Amalgam Filling ✖✔ (2)✔ (4)✔ (6)✔ (8)
Scaling and Polishing ✖✔ (1)✔ (1)✔ (2)✔ (2)
Denture and Bridges ✖✖✔✔ (1)✔ (1)
Root Canal Therapy ✖✖✔ (1)✔ (2)✔ (4)
Surgical Extraction ✖✔ (2)✔ (4)✔ (6)✔ (8)
RADIOLOGICAL SERVICES
X-rays and Ultrasound ✔✔✔✔✔
CT Scan & MRI (50%co-payment) ✖50%45%35%To be determined
Echocardiography ✖50%45%35%To be determined
Electrocardiography ✖50%45%35%To be determined
Doppler Scan ✖50%45%35%To be determined
PHYSIOTHERAPY 3 sessions5 sessions8 sessions10 sessions20 sessions
CANCER CARE
General Outpatient Consultation ✖✖✔✔✔
Specialist Consultation ✖✖✔✔✔
Cancer Screening only (PSA & Mammography) ✖✖✔ (1)✔ (2)✔ (4)
Surgical Treatment of Cancer (subject to global limit) ✖✖✖✔✔
MEDICAL CHECKUP
Routine Physical ✔✔✔✔✔
Annual Medical Examination (co-payments on investigations ✖✔ 50%✔ 45%✔ 35%✔ 15%
DRUG TYPES COVERED GenericGenericGenericBrandedBranded
ADDED BENEFITS
Renal dialysis (subject to policy limit) ✖✖✔ (2)✔ (6)✔ (8)
Infertility consultation, investigation & non-hormonal drug management ✖✖✔✔✔
CHRONIC DISEASE MANAGEMENT ✖✔✔✔✔
INTERNATIONAL HEALTH INSURANCE ✖✖✖✖✔
GPA (Group Personal Accident) ✖✖✖✖✔
TRAVEL INSURANCE ✖✖✖✖✔
HIGH END HOSPITALS ✖✖✖✖✔
GYM MEMBERSHIP ✖✖✖✖✔
MENTAL HEALTH SERVICES
EXCLUSIONS: to be hilighted in the policy document