This plan covers the following services; AXA MANSARD PERSONAL GOLD PLAN Cover & Exclusions EMERGENCY CARE: Initial stabilization and care, it also covers intensive care if required INTENSIVE CARE (covered up to 5days): Admission and care in a specialized unit where access to a high level of medical care and monitoring would be provided for critical cases. EVACUATION: Ambulance services are covered under this plan; it includes evacuation from site of injury to hospital and from hospital to hospital. OUTPATIENT COMPONENT: General consultations Specialist consultations Provision of prescribed drugs and medications for covered condition INPATIENT COMPONENT: Comprising of admission for the treatment of covered conditions in a private ward Feeding of enrollees for the duration of admission Provision of medical care, nursing care, and prescribed medication and consumables during the duration of admission PHYSIOTHERAPY Physiotherapy services up to approved limits 15 Sessions DIAGNOSTIC SERVICES a. Radiological services Plain X-rays of the limbs, spine, abdomen, pelvis, chest, skull Contrast studies Ultrasound scan b. Laboratory services Histopathology Hematological investigations Microbiological investigations Serology
Clinical chemistry ADVANCED INVESTIGATIONS -ON EMERGENCY CT Scan (Computed Tomography) MRI Scan (Magnetic Resonance Imaging) ANTE NATAL CARE AND DELIVERY Antenatal care including prescribed drugs up to agreed hospital tariffs Antenatal procedures including Shirodkar's operation Management of pregnancy complications Normal delivery Assisted vacuum or forceps delivery Caesarian section FAMILY PLANNING SERVICES - Pills, injectable, IUCD, Vasectomy, Tubal Ligation FERTILITY SERVICES (INVESTIGATION ONLY): Counseling, USS, SFA, HSG& Hormonal Assay NEONATAL SERVICES AND PAEDIATRIC CARE Neonatal care including sepsis, cord care, physiologic jaundice, opthalmia neonatorum Circumcision Ear piercing Well baby clinic at 6 weeks Routine Immunizations BCG, Measles, DPT, Oral Polio, Vitamin A supplementation Additional Immunizations for 0-5years Pneumococcal vaccine & Hepatitis, MMR & Rotavirus. Treatment of common childhood diseases like malaria, and other uncomplicated febrile illnesses, diarrheal diseases, Upper respiratory tract infection MINOR, INTERMEDIATE AND MAJOR SURGICAL PROCEDURES Wound dressing 2 P a g e
Suturing of minor cuts and lacerations Incision and drainage of abscesses Minor ENT (Ear, Nose, Throat) procedures like ear syringing Minor wound debridement Lump excision Hernia repairs Appendectomy Closed reduction and manipulation of simple fractures and dislocations Surgery for haemorrhoids Endoscopy ENT procedures like Antral washouts, Tonsillectomy Surgery for ectopic pregnancy Myomectomy Elective Orthopedic Surgery DENTAL CARE- N60,000.00 Primary dental care including Examination Basic dental treatment Simple amalgam or composite filling Scaling and polishing Non-surgical extractions Pain therapy drugs Dental Surgical Extraction Root canal EYE CARE Basic eye examination Refraction Biennial optical lenses (up to N 15,000) 3 P a g e
HEALTH SCREENING AT DESIGNATED CENTRES Physical examination BMI, Urinalysis PCV Blood pressure Blood sugar Genotype Lung/Pulmonary function test Chest x-ray, serum cholesterol Cervical smears every 2 years for women > 30 years PSA for men above 40 yrs HIV/AIDS CARE AND TREATMENT Voluntary counseling and testing Pre-treatment assessment Monitoring REGION OF COVER: Nigeria & India PLAN SPECIFIC EXCLUSIONS: AXA Mansard Gold Plan: The exclusions on this plan include: Orthodontic services and dental Implants GENERAL EXCLUSIONS: The following exclusions are applicable on all the plans Cosmetic Surgery Teeth Whitening Dental Prosthesis Domiciliary/Hospice Care 4 P a g e
Alternative /Unorthodox medicine Neonatal care not listed under neonatal services Self-inflicted injuries Congenital abnormalities Conditions caused by an act of war, an epidemic or enrollee participating in a riot Services primarily for weight reduction or treatment of obesity Treatment of substance abuse Infertility- All investigations and treatment. Orthodontics. Advanced radiological investigations (e.g. C.T. scan, Myelogram, EEG). Advanced and Complex investigations (e.g. Marrow biopsy, skeletal survey). Prosthetic devices such as cardiac pacemaker, orthopedic implants. Management of Chronic Renal Failure (Dialysis and Transplant Surgery). Induced Abortion. Laser Treatments. Transplants. Complex major Surgeries (e.g. Heart, Brain and Great blood vessels). Neurological surgeries. Management of Cancers Professional Sports and wilful exposure to needless danger Infectious and contagious diseases in an epidemic All procedures, management and investigations not covered by the plans The following pre-existing or chronic conditions will be excluded in the first 24 months of the inception of the policy, however this list is not exhaustive only includes common ones: Hypertension and Cardiac related diseases. Diabetes and its complications. 5 P a g e
Hepatitis B & C. Kidney related conditions. Hemoglobinopathies Peptic Ulcer Disease. Asthma. Epilepsy and Seizure disorders. Glaucoma and Cataract. Arthritis. Pregnancy All treatment related to Antenatal, Natal or Postnatal period. E.t.c. 6 P a g e