CORPORATE HEALTH SOLUTION PROPOSAL

Transcription

1 CORPORATE HEALTH SOLUTION PROPOSAL 1

2 INTRODUCING WELLNESS HMO Wellness HMO Limited is a foremost national Health Maintenance Organization (HMO) established to positively revolutionize healthcare financing and delivery in Nigeria. Her business is underwriting health risk of various groups and individuals based on sound insurance and risk management principles. Her authorized share capital of One Billion Naira (N1, 000, 000,000) and paid-up of Four Hundred and Fifty Million Naira (N450, 000,000) makes us one of the most capitalized HMOs in the country. She is backed by a Board of Directors made up of well-tested and distinguished individuals with broad experience in the public and private sectors of the Nigerian economy. Our Management Team includes healthcare and insurance professionals with many years of industry practice ensuring that Wellness HMO is well poised to re-define the standard and quality of service obtainable in the Nigerian health insurance industry. Our Vision Statement To be a leading health and wellness products and services provider in Africa Our Mission Statement To innovatively provide our clients with stress-free access to qualitative healthcare through responsive and superior professional services Our Core Values Passionate Excellent customer service Attentive Responsible Our Products We work with our corporate partners through the development of innovative and high quality healthcare solutions that offer them superior service experience, much convenience and flexibility which ensure that they derive maximum value from their money. Our full range of quality healthcare solutions includes: 1. Corporate Health Product Corporate Health Insurance Plan Employee Wellness Solution Overseas Medical Package 2. SME Health Solution SME Health Insurance Plan Employee Wellness Solution Overseas Medical Package 3. Retail Health Insurance Scheme Family & Personal Health Insurance Plan Y hello/national Mobile Health Insurance Programme Overseas Medical Package 4. Education Health Solution Pre-tertiary Schools Health Plan 2

3 Tertiary Institution Social Health Insurance Programme (TISHIP) School Clinic & Events Support Programme 5. Community-based Health Solutions Senior Citizen Care Plan Community Group Health Plan Domestic Care Plan Our Unique Value-Adding Advantage As an innovative organization, Wellness HMO HMO offers you a world of unique value-adding benefits. These benefits recognize that you deserve only the best service even beyond the basic healthcare cover. Some of the benefits include: Free Pre-employment test- Wellness HMO shall offer you free pre-employment test for one (1) new staff when you have a minimum 30 staff on our scheme. This benefit increases in a multiple of 30staff. This is our Ratio 1 to 30 benefit. Rebate on Low Utilization- This is a compensatory scheme which is activated when your total annual scheme usage/utilization is not more than 60%. Wellness HMO shall return to you 10% of your annual premium or discount you 10% at your renewal. On-site Registration Help Desk- In order to take off the hassles of registering off you, Wellness HMO shall work with you to set up a Registration Help Desk on your premises to assist your employees in the completion of their enrollee form. Other Service Benefits Ease of Access & Scheme Transparency- our Member s card is designed to reduce waiting time of our enrollees in the hospital and ensure transparency in benefit access. Health Plan benefits are indicated at the back of the card as a guide to the hospital. Convenience-our member s card is your stress-free visa to our national network of over 200 best-inclass hospitals even when you are outside your area of residence. The providers include primary, secondary and specialist centres. Scheme Flexibility- you are allowed to change your preferred hospital every month while you can also upgrade your health plan at any time during your policy period. Seamless Referral System- our network of hospital comprising primary, secondary and specialist facilities offers you seamless and stress-free referrals from one level of care to the other while also giving you access to the best qualified and experienced medical experts available. Continuous Engagement and Interaction- through our Enrollee Engagement Programme, you enjoy regular updates about your health plan and have access to general health information Round-the-clock access to the HMO via our professionally-manned Care Call Centre- our hotlines are available to enable you reach us any time for enquiries about your membership, plan benefits and hospital access thereby remove all barriers to quality care and service. Enrollee Feedback Programme- our members feedback programme is designed to continuously feel your pulse and elicit your opinion in order to ascertain that you continue to experience the wonderful world of service that Wellness HMO is committed to offering its clients. 3

4 DETAILS OF OUR BENEFIT COVER Emergency Ambulance evacuation Emergency room stabilization; Emergency life saving treatment for medical and surgical conditions, which are not limited to listed hospitals on our network. General Medicine Out-patient and in-patient consultation and treatment; Drugs and investigations Hospital admission and treatment; Chronic ailments including but not limited to hypertension and diabetes Physiotherapy services Ward admission for mental illness for a maximum of 15days. Paediatrics Out-patient and in-patient consultation and treatment Immunization/child welfare services Cost of admission/hospitalization Immunization Coverage for NPI: Yellow fever, OPV DPT, Measles, BCG Extended Immunization Coverage: Pneumovax, Chicken pox Rota Virus, HIB Meningitis, MMR, Typhoid Obstetrics/Gynecology (Obstetrics Limited to Family Plans) Consultation Antenatal care/maternity services Cost of delivery including caesarian section, assisted delivery; Postnatal care; Cost of drugs and investigations Cost of hospitalization; Treatment of fibroid including surgery; Treatment of infertility up to approved limits. Surgery Specialist consultations; Out-patient and in-patient surgical care; Cost of all drugs and medications prescribed by the Surgeon; Treatment for fractures/orthopedic conditions; Treatment for general surgical condition; Treatment for minor and major surgical conditions; Treatment of ear, nose and throat diseases. 4

5 Laboratory Investigations Routine and specialist investigations X-rays and scans; CT scan and MRI where required for diagnosis by the specialist subject to approval by Wellness HMO Dentals Primary dental care Scaling and polishing; Amalgam filling; Simple extractions; Surgical extractions Treatment of Root Canal Ophthalmology Specialist consultation; Eye test and treatment; Eye surgeries (simple and major); Cost of drugs and medicament prescribed by the doctor; Out-patient and in-patient consultation and treatment; Cost of admission/hospitalization; 5

6 WELLNESS HMO CORPORATE HEALTH S TO SEC BENEFITS GUARD SHIELD PREMIUM EXCLUSIVE PRESTIGE General Outpatient Consult/ Covered Covered Covered Covered Covered Specialist Consultation Ward Admission General Semi-private Private Executive Executive Intensive Care Unit Not covered Covered Covered Covered Covered Emergency care & stabilization Covered Covered Covered Covered Covered Supply Of Drugs Covered Covered Covered Covered Covered Immunization And Child Care NPI NPI NPI NPI + NPI + Extended Extended Routine Lab Investigations Covered Covered Covered Covered Covered Basic X-Rays, CT Scan, MRI Covered (excluding MRI) Covered (excluding MRI) Covered + MRI Covered + MRI Covered + MRI Gynecological Care Covered Covered Covered Covered Covered Maternity Care (family plan Covered Covered Covered Covered Covered only): ANC, Normal delivery, CS Primary Eye Care: Routine Covered Covered Covered Covered Covered Consultation, Drugs Eye Surgery Minor Minor Full Cover Full Cover Full Cover Lens Coverage (principal only) N7,000 N15,000 N25,000 N35,000 N45,000 Lens Coverage (Dependents only) N3,000 N5,000 N7,500 N12,500 N15,000 Dental Care Simple Extractions + S&P Simple & Surgical Extractions + S&P Simple & Surgical Extractions + RCT Simples & Surgical Extractions + RCT Simples & Surgical Extractions + RCT Cancer Treatment Not Covered Not Covered N500,000 N1,000,000 N1,500,000 General Surgery Minor + Minor + Major Major Major Intermediate Intermediate Voluntary Annual Basic Medical Not Covered Covered Covered Covered Covered Check-up Voluntary Annual Not Covered Not Covered Covered Covered Covered Comprehensive Medical Checkup HIV Preventive Care & Covered Covered Covered Covered Covered Counseling Psychiatric Care Covered Covered Covered Covered Covered Physiotherapy Services 8 Sessions 10 Sessions 12 Sessions 15 Sessions 15 Sessions Infertility Management Tests & drugs Tests & drugs Tests, drugs & Minor corrective procedures) Treatment of Renal Failure & Dialysis 15days or 2 dialysis 15days or 3 dialysis 30 days or 5 dialysis Tests, drugs & Minor corrective procedures) 30 days or 7 dialysis Tests, drugs & Minor corrective procedures) 30 days or 12 dialysis Choice Of Hospital (see provider list) Guard Shield Premium Exclusive Exclusive Reimbursement On Overseas Treatment Not Covered Not Covered Not Covered Not Covered Max. $1,500 per annum Provider Roaming Not Covered Not Covered Not Covered Not Covered Covered 6

7 ANNUAL PREMIUMS Annual Financial Limit Nil Nil Nil Nil Nil Annual Premium Per Head 25,000 38,000 70, , ,000 Annual Premium Per Family 96, , , ,000 1,500,000 POLICY EXCLUSIONS (FEE-FOR-SERVICE) Treatment of cancer on the Shield Plan Treatment of infertility by artificial insemination or other high technology procedures. Provision of prosthesis, corrective devices and medical appliances. Treatment of renal failure after a maximum period of thirty (30) days and after a maximum of ten dialyses (please see Plan Benefits). Artificial heart implantation and all organ transplants. Elective cosmetic surgeries. Treatment for self-inflicted injuries, drug addiction or alcoholism or treatment occasioned by the abuse and/or influence of alcohol or hard drugs. Cost of dentures (except where it is indicated as part of the line of treatment in maxillofacial surgical cases), braces, capping, cosmetic dental procedures and other advanced restorative dental procedures. Provision of visual and hearing aids. Congenital anomaly/birth defects. Treatment by alternative medicine and other unorthodox medical practices. Definitive treatment of HIV/AIDS and other related and opportunistic infections. Treatment resulting from participating in war, the outbreak of war, participating in riots, strikes, civil commotion or any illegal act. Treatment resulting from participating in motor racing, motorcycle racing and/or other high-risk sports. Treatment abroad except with the prior consent of the company. All occupational accidents. They are covered under the Workmen s Compensation Policy of the Client. 7

8 OUR CLIENTELE S/N NAME LOCATION(S) 1. MRS Oil & Gas Lagos/Kaduna/Kano/Abuja 2. Sweet Sensation Confectionery Lagos/ Abeokuta 3. Nigeria Breweries Plc Lagos 4. Hyprops Nigeria Limited Lagos/PH 5. Crescent Schools Lagos 6. ENG RYPAC Limited PH 7. Sundry Food Limited PH 8. Honeywell Oil & Gas Lagos 9. Lanre Shittu Motors Limited Lagos/PH 10. Lancaster Lagos 11. Mountene International Services Lagos/Abuja 12. INBISCO Limited Lagos/Enugu/Imo 13. MRS Plc Lagos/Abuja 14. Wiltshere International Service Lagos/Abuja 15. GQP Limited Lagos 16. Warner Lewis Limited Lagos/Ibadan 17. MRS Basic Lagos/PH/Abuja/Kano 18. Haskoning DHV PLC Lagos/PH/Abuja/Kano 19. NCIC Oil Services Limited Lagos 20. Brand Revelations GSL Limited Lagos 21. Alibert Product Limited Lagos 22. Kaplan International Colleges Lagos 23. Villeworth Security Limited Port Harcourt 24. Frigate Limited Port Harcourt 25. E-Stream Networks Limited Lagos 8

9 26. Ronchess Global Resources Limited Lagos 27. Vital Products Nigeria Limited Lagos 28. NEXIM Bank Abuja 29. TopCrust Bakery Limited Lagos 30. MediaReach Limited Lagos 31. BT Technologies Lagos OUR CONTACTS HEADQUARTERS/LAGOS REGIONAL OFFICE: 9, Jogunomi Street, Gbagada Phase 11, Gbagada, Lagos ABUJA/NORTH REGIONAL OFFICE: Suite D104, Garki Mall, Opp. Garki Int l Shopping Complex, Garki, Abuja PORT HARCOURT/SOUTH SOUTH/SOUTH EAST REGIONAL OFFICE: Suite Ew2, Luli Plaza, 20, Rumuola Road, Port Harcourt IBADAN/SOUTH WEST REGIONAL OFFICE: Cocoa House Building, Dugbe, Ibadan CALL CENTRE NUMBERS: ; WEBSITE: [email protected] 9