1. What is a health plan?
A health plan is a defined schedule of health benefit available to a subscriber (terms and conditions apply) for a defined period of time (usually a month or a year) when they can access the services.
2. Why should I buy a health plan?
It is a risk-free way to guarantee access to healthcare services when required without paying at the point of service.
3. What is the meaning of referral/specialist care?
Our Primary care providers act as gatekeepers and must evaluate each enrolee before undertaking to refer to a secondary or tertiary centre. Referrals must be medically indicated and should be to one of the accredited and designated specialist referral centres on the Health Assur Ltd. Specialist Panel for that State or region.
4. Who is a principal member, enrolee and a dependant?
A principal member is an eligible person who qualifies for coverage under the policy Enrolee means any person eligible to receive Covered Services and whose Benefit Plan has access to the network A dependant is a spouse of the Principal member and up to 4 unmarried children which can be a natural child, stepchild or legally adopted child.
5. What is the meaning of medical emergency?
Medical Emergency means a medical condition resulting from an Accident, or any sudden beginning or worsening of a severe illness that presents an immediate and serious threat to the Enrolee’s health and requires immediate medical attention by a Doctor.
6. What are non-covered services/ exclusions?
Non-Covered Services means services, supplies, products and accommodations that The Company is not required to provide to Enrolees pursuant to this agreement, including but not limited to services which are not authorized by The Company.
7. What is the meaning of upgrade?
Upgrades mean any form of request for change of plan type from the initially purchased plan.
8. What is a pre-existing condition?
Pre-Existing Conditions means any injury, illness, condition or symptom: for which treatment, or medication, or advice, or diagnosis has been sought or received or was foreseeable by the Enrolee prior to the policy commencement date, or which originated or was known to exist by the Policyholder or the Enrolee prior to the policy commencement date whether or not treatment, or medication, or advice, or diagnosis was sought or received.
9. Is it compulsory to attach my passport photograph?
Yes, we require photographs of covered enrolees to produce I.D cards for identification and ensure that they are attended to at their healthcare service provider.
10. Can I choose a hospital that is not on your network of hospitals?
We have partnered with carefully selected, certified and licensed practitioners to ensure comprehensive cover of all health needs. However, in regions where we do not currently cover, we may accredit providers who meet our standards.
11. Am I limited to selecting only one hospital?
All enrolees are encouraged to register with one primary health provider (excluding enrolees on the Flex plan).
12. Are my children covered under this scheme?
The family plan covers one spouse and a maximum of four children.
13. Can I register my 19-year-old son under the scheme?
Children of the principal between the ages of 18-24 who can provide evidence of registration in a tertiary institution (valid I.D card) may be registered on the scheme.
14. Can I register my dependant in different hospitals?
Yes, dependants may be registered at eligible hospitals for their plan type.
15. When can I start visiting the hospital?
From the first day of effective coverage of specific plan purchased.
16. Do I get a refund if I do not go to the hospital during the course of the scheme year?
Pooling of risks ensures that little amounts paid by larger population is used maximally by those who require it and so, we are unable to refund premium. However, corporate organisations with no claims for the year can have 5% no claims discount at renewal.
17. Can I pay premium on a monthly basis?
The payment frequency cycle means the agreed number of times the annual premium is paid by the Company to The Company (Health Assur Ltd.). This is annually or twice yearly.
18. Can I select a different plan for each member of my family?
No, all members of the family must be registered on the same plan.
19. Can I buy a plan for a pre-existing health issue?
Enrolees on the Group Health Insurance plan with total numbers above 50 are automatically covered for pre-existing conditions within the defined scope of benefits.
20. Can I register my ward or parents on the scheme?
Legally adopted children (with proof of adoption) of the principal/spouse below the age of 18 years may be registered onto the principal’s plan.
21. Is pregnancy covered on the scheme?
Yes, for registered enrolees on the family plan under the Group Health insurance plans for employees are eligible for coverage of pregnancy and operative delivery (CS) if they do not have 4 children already registered on the scheme.
22. Can I register online?
Online registration can be done via a registration link sent via email and sms to the email address and phone number supplied by your company for you.
23. Can I change my hospital on the enrolee portal?
A request of change of hospital (within the same band) can be submitted by the 25th via portal to take effect on the first day of the following month.
24. Can I lodge a complaint on the enrolee portal?
Yes, we value feedback and appreciate all suggestions as we strive to improve your customer experience.
25. Can I register a new born child on the portal?
Yes, registered principals with less than 4 children already on the scheme may submit details of a new born child.
26. What do I do if I go to the hospital without my ID card?
We encourage all our registered enrolees to present with their ID cards at the healthcare provider to guarantee access to healthcare services. However, such enrolees may call our care lines for assistance.
27. What do I do when I need to see a specialist?
The primary care provider acts as a gate keeper and will examine all registered enrolees to determine the need for specialist care.
28. Is there a limit to the amount the hospital can spend on me?
No, the capitation is the fixed amount paid for all registered enrolees per month and not a limit of expenditure per actual patient.
29. Am I required to pay an additional amount for medical services at the hospital?
No, all enrolees are not required to pay an additional amount for covered medical services.
30. How do I access care at the diagnostic or other tertiary services?
Primary healthcare providers will provide referral forms for the diagnostic or other tertiary services as required.
31. How do I get the address of the referral centre?
The Primary healthcare providers will provide referral forms with full details of the referral centre.
32. How often can I change my hospital?
Enrolees can change their registered hospital as often as required. However, the change will take effect on the first day of the following month.
33. How do I access care during an emergency?
Registered enrolees can present at any of the primary healthcare providers on the Health Assur network during emergencies and or whilst out of their usual station. Contact care line for details.
34. If I am outside my state or area of resident, can I visit any hospital registered with my Health Assur Ltd.?
In the unlikely events that there is no primary network healthcare provider in that region, enrolees are encouraged to use any licensed provider and submit medical reports and original receipts for re-imbursement at our discretion.
35. Does my employer have access to my confidential medical history?
A duly signed Release Form is required from the enrolee before the release of medical information concerning medical diseases, conditions, drug testing & screenings and medical reports to the Client (Policy Holder) unless compelled to do so by a court of law in accordance with the laws of the Federal Republic of Nigeria.
36. What happens if my enrolee I.D card is used for impersonation?
The utilization of the membership card by any person other than the Enrolee, with the knowledge or consent of the Enrolee, is an abuse of the benefits of the Health Scheme plan and will be treated by the Company as a case of fraud.
37. What are my rights?
Your rights are as detailed in the Client Service Level Agreement and also on the legal section of the website. By using our services, you signify your agreement to our terms and conditions, however Health Assur Ltd. reserves the right to change these terms and conditions.
38. How does Pharmacy benefit work?
In response to frequent complaints of poor quality of drugs and time wastage at the health care providers, Health Assur has introduced the option of filling prescriptions received at the provider directly at the pharmacy. Enrolees present at the pharmacy with a valid Health Assur ID card and prescription from their registered Primary healthcare provider.
39. Do I always have to get my drugs from the pharmacy?
No, it is an option introduced for enrolee’s convenience but patients can elect to collect their prescription at the hospital as usual. Also, patients on admission will receive their medication at the healthcare providers’.
40. How do I know the address of the pharmacy I am registered to?
All enrolees are registered at the nearest pharmacy to their selected Primary Healthcare provider, however, for convenience they can retrieve their prescription at any of our registered pharmacies nationwide. Reach out to our contact centre or check www.healthassur.com for details.
41. What if the prescribed drug is not readily available in the pharmacy?
The pharmacy will offer you the option to have the medication picked up later at a specified date OR deliver the medication directly to you OR inform Health Assur so we can provide an alternative pharmacy or delivery directly to you.
42. Can I go to the pharmacy to get my anti-hypertensive drug refill without having to go to the hospital first?
For those on our Chronic Conditions Register, who have previously been on long term medication, they can go directly to the pharmacy to collect their medication.
43. How often can I change the pharmacy I am registered to?
You can go to any of our registered pharmacy at any time.
44. Can I be registered with more than one pharmacy?
Yes, you may go to any of our registered pharmacies at your convenience.
45. Can I pay more to purchase a drug that is not in the prescription?
Health Assur will cover/be liable only for the prescription directly issued from the doctor at enrolee’s Primary Healthcare provider which fall within the scope of cover as defined in the Schedule of benefits for the plan they are enrolled under.
46. Is it compulsory to get my medication the same day it was prescribed?
No, it is advisable to get it as soon as possible and if longer than 48hours, the prescription may need to be re-validated before it can be filled.
47. Does my plan cover my antihypertensive drugs?
Details of plan coverage are as stated in schedule of benefits for the policy period.
48. Does my plan cover HIV/AIDS treatment?
Health Assur Ltd provides medication for the management of the HIV/AIDS complex but this is only at designated healthcare providers and not at the pharmacies.
49. Can the pharmacist give me a drug that is not on the prescription form?
The pharmacy provides direct pharmaceutical care and based on history of adverse reactions, drug interactions or non-availability, the pharmacist may provide a more suitable alternative for that particular enrolee in place of what was prescribed. However, they WILL NOT prescribe an entirely new medication.
50. Can I go to the pharmacy to get drugs without going to the hospital?
No, except for those previously registered on the Chronic Medication Register.