CUSTOMIZED HEALTH PLAN
A health plan fully designed by both the HMO and the enrollee (entity). It is solely based on the budget and the services to be provided.
|
BENEFIT PACKAGE |
CUSTOMIZED |
| Out Patient treatment | √ |
| Admissions / In Patient care | √ |
| Accidents and Emergencies | √ |
| Radiological Investigations | √ |
| Laboratory Investigations | √ |
| Physiotherapy | √ |
| Minor Surgeries & Procedures | √ |
| Intermediate Surgeries & Procedures e.g. Removal of lumps, Hernioraphy, appendectomy, entopic pregnancy, e.t.c | √ |
| Major Surgeries & Procedures e.g. Endocrine, Thoracic, Abdominal, O & G Surgeries, e.t.c | √ |
| Advanced and complex investigations (CT Scan, MRI Scan) | √ |
| Prescribed Medications | √ |
| Routine Immunizations(NPI Schedule) | √ |
| Additional Immunization for 0-5 years (Hepatitis B, MMR, Pneumococal) | √ |
| Antenatal care + Delivery (Normal/Assisted/Caesarean Section) | √ |
| Eye test and care excluding provision of spectacles and surgeries | √ |
| Eye Glasses ( cost limit) | √ |
| Primary and Secondary Dental care | √ |
| Intensive Care Services | √ |
| Cancer care | √ |
| HIV/AIDS care | √ |
| Preventive Healthcare, Counseling | √ |
| Health Promotion Talks | √ |
| Emergency life saving procedures. | √ |
CONDITIONS COVERED ON CASE MANAGEMENT BASIS. We operate an open enrollment for all potential clients/enrollees. Although there are no general exclusions for our health plans, treatment can be covered for the under listed conditions on a case management basis. Once the diagnosis is made, the beneficiary or employer is notified and option of treatment and cost are provided. Chronic Renal Dialysis. Complex surgery. Gynecology investigations and treatment for infertility. Screening and comprehensive health assessment. Artificial limbs and dental prosthesis. Mental illness in excess of 21 days. False teeth and dentures.
