PRESTIGE HEALTH INSURANCE PRODUCTS

INTRODUCTION:

Prestige Assurance Plc has launched its health insurance products to meet the medical exigencies of an average Nigerian at affordable prices.

The product range is:

o   Prestige Mediclaim policy

o   Prestige Family Floater Mediclaim Policy

o   Prestige Group Mediclaim policy

o   Prestige Group Floater Mediclaim Policy

“Prestige Health Insurance Products” are designed to cover hospitalization expenses arising out of covered illnesses or injury from accident while giving other benefits not offered by regular HMO scheme.

Family members who could be covered include the proposer, spouse and up to 4 dependent children subject to maximum of 6 members under a single Floater policy.

This policy is available to persons between the ages of 18 years and 60 years. Children are also covered under the policy from the age of 3 – 25 years only if they are dependent. Continuity benefit cover can be availed provided the policy is continually renewed as and when due.

SCOPE OF COVER:

HOSPITALIZATION:

o   Room rent up to 1% of sum insured per day

o   ICU/ICCU up to 2% of sum insured per day

o   Surgeon, Anesthetist, Medical Practitioner, Consultants and Specialists Fees.

o   Diagnostics, Anesthesia, Blood, Oxygen, Operation Theatre Charges, Surgical Appliances, Medicines & Drugs, Dialysis, Chemotherapy and Radiotherapy.

o   All expenses incurred for donor in respect of organ transplant.

o   Artificial Limbs, Cost of Prosthetic devices implanted during surgical procedure like pacemaker, Relevant laboratory / Diagnostic test, X-Ray.

o   Post hospitalization benefits not exceeding 30 days

o   Post hospitalization benefits not exceeding 30 days

HOSPITAL CASH

o   We will pay Hospital Cash at the rate of 0.1% of the Sum Insured, for each day of Hospitalization, admissible under the Policy subject to maximum of 1% of sum insured.

CRITICAL CARE BENEFITS

o   If any insured person is diagnosed with any critical illness, 10% of sum insured will be paid as additional benefit

o   Any payment under critical care benefit would be in addition to the sum insured

o   This benefit will be paid once in the life of any insured person

o   The list of covered critical illness is available in the prospectus/policy document.

AMBULANCE CHARGES

o   Ambulance charges, upto 1% of sum insured shall be available for emergency extraction from anywhere to hospital or hospital to hospital.

SPECIAL COVERAGE

o   Cataract claims, upto maximum of N150,000

o   Congenital internal disease shall be covered after 24 months of continuous coverage.

o   Congenital external disease shall be covered after 48 months of continuous coverage.

o   Health Maintenance Organization (HMO) policy holders shall get a discount of 5% once the premium conditions above are fulfilled.

NEW BORN BABY COVER:

o   New born baby is also covered under the sum insured, within the terms of the policy without paying additional premium if the mother has a continuous coverage for more than 24 months.

REQUIREMENTS

o  Pre-acceptance Medical Check-up is required for proposers from the age of 45 and above.

o  Once the Insured Person crosses the age of 65 years, the applicable premium on renewal will be loaded by 5 % per year. This loading is applicable on premium for the age band of 60 – 65 years.

TIME BOUND EXCLUSION

o   Treatment of any pre-existing disease shall be covered after 48 months of continuous coverage

o   Any illness contracted during the first 30 days of the commencement date of this policy.

o   Twenty four months waiting for specified diseases listed in the policy documents

o   Forty eight months waiting for age related diseases listed in the policy document.

CLAIMS MANAGEMENT:

We have option to use Third Party Administrator (TPA) or service directly by our policy issuing office

·         Where applicable, we shall provide cashless service from the network hospital approved by the company.

·         Notice of claim to be given within 24 hours.

·         In case of reimbursement, claim form along with all relevant original documents to be submitted within 7 days from the date of discharge

·         Prestige reimburses the insured on due verification.

CLAIMS PROCEDURE (CASHLESS IN INDIA):

·         The insured notifies us and the designated TPA in India.

·         Insured can opt to visit network hospitals available in India and request for cashless settlement.

·         The TPA shall be providing cashless facilities to the designated hospital as per entitled limits in terms of Indian Rupees.

REIMBURSEMENT

·         In case the insured visited any other approved hospital outside the network, he shall make payment first and send all the original medical bills and other relevant documents to Insurer.

·         The Insurer shall reimburse the insured in Nigerian Naira

This write-up is only a guide to the customers.

For details, please go through the terms and conditions of the policy.