PROPOSAL

FOR HEALTH MAINTENANCE SERVICES

Our health plans
provide you with

Matchless
Service

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Table of
Contents
WHO WE ARE 03

COMPETITIVE 04
ADVANTAGE
KEY VALUE DRIVERS 06

HEALTH PLANS AND BENEFITS 09

IINTERNATIONAL HEALTH INSURANCE 22

CALL CENTRE 27

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 WHO WE ARE
• Nationally Accredited HMO
• Strategic Investor & Partner – St. Nicholas Hospitals – The flagship network:
• St. Nicholas Hospital Campbell
• St. Nicholas Hospital – Victoria Island
• St. Nicholas Hospital – Lekki
• St. Nicholas Hospital - Maryland
• Experienced leadership team
• Over 650 Hospitals

• VISION -To be the Nigerian HMO of choice”.

• MISSION – With effective technology, we provide our members with seamless access to superior
healthcare services.

MetroHealth HMO is committed to providing matchless service using ahead-of-curve technology.

Our goal is to eliminate the issues faced by most healthcare organizations that still deploy
manual processes. Our operations are powered by a Cloud Based Technology platform that
enables our operational processes match international best practices.

• OUR CORE VALUES:

• Integrity
• Innovation
• Nimbleness
• Excellence
• Reliability
• Teamwork 4
THE BOARD

Senator Olatokunbo Ogunbanjo - Chairman

Dr. Dapo Majekodunmi - Director
Dr. Ebun Bamgboye - Director
Mrs. Folake Akinkugbe - Director
Prof. (Mrs) Y. A. Aken’Ova - Director
Mr. Oboden V. Ibru - Director
Mr. Philip Ikeazor - Director
Mr. Shehu Abubakar - Director
Mr. Jero Omare–Ogah - MD/CEO

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HEALTH SERVICE DIFFERENTIATORS

• ACCESS TO TELEMEDICINE SERVICES

• Provides convenient and accessible care for • CLOUD BASED TECHNOLOGY PLATFORM
members • Real – Time Interaction with caregivers
• Eliminates risk of exposure to Coronavirus and other • Data Integrity
hospital acquired infections
• Eliminates Clinician waiting time delays. • WORKPLACE SAFETY PROGRAMMES
• Trauma Management / Counselling
• LIFESTYLE & WELLNESS PROGRAMMES • Work Life Balance Issues
• Gym Memberships
• ACTIVE QUALITY MANAGEMENT PROGRAMME

• FREE DIALYSIS • LIFETIME DISCOUNT FOR ALL CHILDREN DELIVERED

• 8 Free Dialysis interventions UNDER THE SCHEME
• Discounted and Flexible payment terms for kidney
transplant
• FREE AMBULANCE SERVICES
• USE OF DIGITAL TECHNOLOGY / CORE BACK END • Intra - State
HEALTH ECO-SYSTEM PROCESSING PLATFORM FOR
• On-Line Registration
• HR Portal • DISEASE MANAGEMENT SCREENING PROGRAMME
• Real-Time Interface with Hospitals
• OUT – OF – STATION CARE
• FREE VISION SCREENING
• Drivers Vision Certification
• Visual Acuity/Fundoscopy
• Color Vision/Night Vision Test
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• ST. NICHOLAS HOSPITAL – Strategic Partner
Corporate Health Plans
SN MEDICAL BENEFITS DETAILS MINI MIDI MAXI PPP

1. Telemedicine

2. Lifestyle Benefits: Discounted Access to Gym

• Registration
3. General Out- Patient Care
• General Consultations

•Obstetrician &
4. Specialist Consultations Refer to
Gynaecologist stated Annual
- Type 1
•General/ Family Physician Limits
•Cardiologist
Paediatrician 6 8
•General Surgery
• Dermatologist
•Ophthalmologist
•Orthopaedic surgeon
• Haematologist
10 12
5. Specialist Consultations • Maxillofacial surgery Refer to
– (Type 2) • Neurosurgery stated Annual
• ENT Surgery Limits
• Urologist
• Gastroenterology
• Endocrinology
• Oncology

6. Drugs Provision of prescribed

drugs and medications for
covered conditions
red dot represent services that are not covered in each plan

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Corporate Health Plans
SN MEDICAL DETAILS MINI MIDI MAXI PPP
BENEFITS
In-Patient Care •Admission for the treat- Accommoda- Semi-private Single Room Single Room
7. General Ward
Accomodation Type ment of covered conditions Ward
tion type
• Feeding of enrolees for
the duration of admission
for the treatment of
covered conditions

•Provision of medical care,

nursing care, and
prescribed medication and
consumables during the
period of admission for
the treatment of covered
conditions.

8. Admission days Refers to the maximum 21 Days 24 Days 28 Days 30 Days

cumulative days allowed
per annum for each day

9. Physiotherapy • Physiotherapeutic Refer to

services the
•Provision of prescribed Maximum 10 20 30 40
physiotherapeutic
number of
appliances e.g. Soft and
hard cervical collar, Sessions per
Crutches annum

10. X-Rays & Other • Radiological and other As clinically

Diagnostic Tests diagnosis test required
• Plain X- rays of the
limbs, spine, abdomen,
pelvis, chest, skull
• Contrast studies
• Ultrasound scan of
Abdomen and pelvis
•Rest Electrocardiogram
(ECG)

red dot represent services that are not covered in each plan

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Corporate Health Plans
SN MEDICAL DETAILS MINI MIDI MAXI PPP
BENEFITS
Laboratory • Histopathology As clinically
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Investigations • Haematological required
. investigations
•Microbiological
investigations
•Serology
•Clinical chemistry

• CT Scan
12. Advanced &
• MRI Scan
Complex
• EEG 2 3 4
Investigations • Echocardiography
(MRI excluded)
Limits specified represent an
aggregation of the
above

13. Accidents and • Emergency room services As clinically

Emergencies limited to resuscitation or required
lifesaving interven
tions in cases where
definitive management is
an exclusion

14. Ambulance and Intrastate evacuation only.

Evacuation Health facility/Health
services Facility and
Roadside/Health facility

Intensive Care Admission and care in the 24 hours 48 hours

15.
Services intensive care unit

red dot represent services that are not covered in each plan

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Corporate Health Plans
SN MEDICAL DETAILS MINI MIDI MAXI PPP
BENEFITS
Minor • Wound dressings Annual
16.
Surgeries • Suturing of minor cuts Surgical
and lacerations,
Limit
• Incision and drainage of
Abscesses.

Intermediate •Minor wound debridement Annual

17.
Surgeries •Lump excision
Surgical Limit
•Hernia repairs
•Appendectomy Caesarean
•Surgery for haemorrhoids section for N200,000 N500,000 N750,000 N1, 000,000
•Endoscopy MetroMini plan
•Surgery for ectopic is covered up to
pregnancy a limit of
•Caesarean section N100,000
18. Major Surgeries General surgeries such as Annual
Laparotomy
Surgical Limit
• Gynaecologic surgeries
like Hysterectomy
• ENT surgeries like
Adenotonsillectomies

19. Antenatal Care •Antenatal care including

& prescribed drugs
Delivery •Management of pregnancy
complications
• Normal delivery
•Assisted delivery
•Post natal care – (6 weeks
Post Delivery)

Chronic Hypertension, Diabetes,

20.
Diseases Asthma, Tuberculosis,
HIV, Glaucoma, Arthritis,
treatment of Hepatitis,
Sickle cell disease.

red dot represent services that are not covered in each plan

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Corporate Health Plans
SN MEDICAL DETAILS MINI MIDI MAXI PPP
BENEFITS
21. Neonatal Care •Cord care, Physiologic No Limit
jaundice, Ophthalmia
neonatorum
•Immunization services
within the first two (2)
weeks including BCG and
oral polio
•Circumcision
• Ear piercing
• Incubator Care, NICU 48 hours 72 hours

22. Immunization (i) Routine Immunizations

BCG, Measles, DPT, Oral
Polio, Vitamin A supple-
mentation, yellow fever,
Hepatitis B, Pentavalent
vaccine

23. Immunization (ii) •Additional immunization for

0 - 5 years
•MMR, Pneumococcal
vaccine
• Rotavirus

24. Immunization (iii) Additional Immunizations

(6yrs and
above) (Meningitis, Yellow
Fever, Hepatitis B)

25. Paediatric Care Treatment of common No Limit

childhood diseases like
malaria, and other uncom-
plicated
febrile illnesses, diarrheal
diseases, Upper respiratory
tract infection

red dot represent services that are not covered in each plan

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Corporate Health Plans
SN MEDICAL DETAILS MINI MIDI MAXI PPP
BENEFITS
26. Family Planning •Counselling As clinically
• Provision of Commodities required
e.g. IUCD (Copper T)
• Injectable
• Implant e.g. Implanon

27. Eye • Basic eye examination

• Refraction
• Biennial Optical glasses N7,000 N22,000 N30,000 N40,000
•Tonometry 1 2 2 2
•Central Visual Field

28. Dental •Examination Total annual

•Amalgam/Composite limit for
Filling dental N20,000 N30,000 N60,000 N75,000
•Scaling & Polishing services
•Pain Therapy Drugs
•X-Rays
•Non-Surgical Extraction
•Surgical Extraction
•Root Canal Therapy
•Bridges & Crowns

•Consultation with
29. Cancer Care Annual Limit
Oncologist
•Chemotherapy N500,000
•Radiotherapy
•Cytotoxic Drugs
•Pain Therapy

30. Selective Annual Limit

Screening N45,000

red dot represent services that are not covered in each plan

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Corporate Health Plans
SN MEDICAL DETAILS MINI MIDI MAXI PPP
BENEFITS
31. Health Education •Health education and
and Promotion disease prevention.
•Health promotion
information and materials.

32. Kidney Dialysis Condition must not be a 8 Sessions 8 Sessions 8 Sessions 8 Sessions
pre-existing condition

***A pre-existing condition is any condition for which the patient has already received medical advice or
treatment prior to enrollment in a new medical insurance plan.

red dot represent services that are not covered in each plan

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 METRO TELEMEDICINE
VALUE OFFERING

• We provide convenient and accessible care to our members

• Eliminates risk of exposure to Coronavirus and other hospital acquired infections
• Improves patient experience, satisfaction and overall quality of care

OUR TELEMEDICINE SERVICES OFFERING:- FEATURES:

Telemedicine is simply remote doctor - patient • Access to GP and specialists

consultation. • Delivery via app and voice only phones
• 24 hour call centre manned by Doctors
• Remote clinical monitoring
• Health education, health tips
• Network of pharmacy and laboratory outlets

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Exclusions To All Plans
1. Services primarily for weight reduction, treatment of obesity, speech disorders, learning

difficulties, behavioural and developmental problems.

2. Non-medical counselling, nutritional counselling, herbal drugs, food supplements, experimental

drugs, virility enhancing drugs and assisted reproduction.

3. Orthodontic services, dental implants.

4. Treatment of mental, emotional or functional nervous disorders, psychological testing and

treatment of substance abuse, self-inflicted injuries and suicide attempts.

5. Artificial ventilation and use of ventilator.

6. Transplant surgery, joint replacement and prosthetic limbs.

7. Post-acute rehabilitation services at home, domiciliary services and supply of durable medical

equipment/appliances.

8. Management and correction of congenital abnormalities.

9. Consultations with unregistered and unrecognized clinicians.

10. An eye surgery solely for the purpose of correcting refractive defects of the eye such as near

sightedness (myopia), astigmatism and/or farsightedness (presbyopia).

11. Any service, treatment, procedure or investigation not listed explicitly as being covered.

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Partial Client
Profile:

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Corporate Premium Rates

PLAN NAME PLAN TYPE Price List (₦) Price List (₦)
(Individual/Annum) (Family size of 6)

Individual
METROMINI & Family
₦33,250:00 ₦182,875:00

Individual ₦55,000:00 ₦302,500:00

METROMIDI & Family

Individual ₦90,000:00 ₦496,200:00

METROMAXI & Family

Individual
METROPPP ₦250,000:00 ₦1,375,000:00
& Family

The foregoing premiums have been actuarially determined. They have taken cognisance of recurring
and non-recurring claims, have been based on a community rated retrospective rating methodology
and have been stated net of with-holding taxes. The premiums shall not suffer any additional
withholding taxes thereto. Family size: 6 maximum

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Call Centre
•MetroHealth operates a 24/7 call center manned by trained
personnel
•The call center supports member and provider call lines to
enable access to care and pre authorisation when
necessary
•Call center features include agent call monitoring, record-
ing, call waiting etc which manages the call flow

OTHER FEATURES INCLUDE:

• Inbound and Outbound Service
• Audio, video, and web conferencing, including
Interactive
• voice response (IVR)

• Instant messaging (IM) and presence

• Real-time and Historical data reporting
• Automatic Call Distribution (ACD)

Response CATEGORY CLINICAL/OR OTHER NATURE RESPONSE TIME

Threat to life e.g. Cardiac

Time To Call
Red • Immediate
Arrest, Myocardial Infarct • Ambulance dispatch (with nurse
trained in emergency resuscitation)

Centre Calls Amber Treatment to be delivered on Target:- (10 – 20 Minutes)

site

•Dealt with promptly

Green Administrative/Queries
•Reported/Documented resolution
within 45 minutes

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Thank
you!

CONTACT US

Head Office:
14th Floor, St. Nicholas House,
26 Catholic Mission Street, Lagos

@metrohealthhmo @metrohealthng
@metrohealthhmo

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