Health Care Plans
KWHIA offers three distinct State-sponsored health care plans to residents of Kwara State (indigent or not)
Informal Health Plan
N15,500
This is plan is for the informal sectors such as artisans, farmers and the self-employed. It is open to all individuals and/or families of those in the organized and unorganized informal sector groups.
Formal Health Plan
N18,000
This is plan is for all civil servants and private corporate employers and employees in the State, who shall make contributions as determined by the KWHIA. They include Private sector organizations with more than 5 employees in Kwara State and all Civil Servants (Local and State ) in Kwara State.
Equity Health Plan
Subsidized
This is plan is for all for the low-income families and vulnerable groups in Kwara State as defined by the Law. Other criteria for eligibility shall be approved by the State Executive Council based on the recommendation of the Governing Board of KWHIA.
Informal Health Plan
N15,500
This is plan is for the informal sectors such as artisans, farmers and the self-employed. It is open to all individuals and/or families of those in the organized and unorganized informal sector groups.
Formal Health Plan
N18,000
This is plan is for all civil servants and private corporate employers and employees in the State, who shall make contributions as determined by the KWHIA. They include Private sector organizations with more than 5 employees in Kwara State and all Civil Servants (Local and State ) in Kwara State.
Equity Health Plan
Subsidized
This is plan is for all for the low-income families and vulnerable groups in Kwara State as defined by the Law. Other criteria for eligibility shall be approved by the State Executive Council based on the recommendation of the Governing Board of KWHIA.
Health Plan Package Benefits
| BENEFIT | DETAILS | CARE LEVEL |
|---|---|---|
| CONSULTATION | Consultation | P |
| NEONATAL CARE | Perinatal care for the following conditions: Ophthalmia neonatorum, Infections, mild to moderate sepsis, physiological jaundice, use of phototherapy, Incubator care for new-born | P |
| EYECARE | Treatment of minor eye ailments including: Simple bacterial, fungal and parasitic eye infections Ophthalmia Neonatorum | P |
| REGISTRATION | Registration | P/S |
| CHRONIC CARE | Hypertension, Diabetes type 2 | P/S |
| INPATIENT CARE | Maximum days of hospital stay - 5 nights. Pre-authorization required from KWHIA In case of prolonged stay. In case of extended stay, due diligence will be carried out by KWHIA after which permission and authorization is granted for prolonged stay. | P/S |
| MATERNAL CARE | Family planning counselling services Presumptive malaria treatment drugs Identification of danger signs affecting pregnant women Vaccination Foetal growth monitoring Monitoring of danger signs Postnatal care for first 6 weeks | P/S |
| EMERGENCY CARE | Establishing an intravenous (Infusion) line, Simple tracheostomy, Management of convulsion, Control of bleeding, Cardio-pulmonary resuscitation, Assisted respiration (e.g., Ambubag, etc.), Immobilization fractures (using splints, neck collars, etc.) to ease transportation of patients, Aspiration of mucus plug to clear airways | P/S |
| OBSTETRIC/ GYNACOLOGY | Normal deliveries, Multiple delivery, assisted deliveries and caesarean sections including admission. Emergency situations (typically excluded except to save the life of patient: Evacuation of uterus (Dilatation and curettage) Hysterectomy, in case of postpartum hemorrhage Emergency Salpingectomy to Repair of Uterus; Cervical tear | P/S |
| COMMON AILMENTS | Malaria and other acute uncomplicated illnesses Diarrheal diseases Acute respiratory tract infection Acute gastrointestinal infections Voluntary counselling & testing for HIV Uncomplicated pneumonia Simple anemia Simple skin diseases infestation Other uncomplicated bacteria, fungal, parasitic and viral infections and illnesses. First aid Acute exacerbations for conditions such as arthritis and minor musculoskeletal diseases Emergency care Yearly check-up including physical examination, blood pressure, vision testing | P/S |
| SURGICAL SERVICES (A) | Minor surgeries: Circumcision, Ear-piercing, Incision and drainage Lumpectomy and Suturing of lacerations | P/S |
| LABORATORY INVESTIGATIONS AND DIAGNOSTIC TESTS | Malaria Parasite, Widal, Full Blood Count, PCV, Urinalysis, ESR, Fasting or Random Blood sugar Pregnancy test (urine), Microscopy (sputum and stool) HIV screening test, VDRL, Blood group, cross matching | P/S |
| SPECIALIST CONSULTATION | Consultation with specialists such as surgeons, gynecologist, pediatricians, physicians and other specialists defined in the benefits package | S |
| SURGICAL SERVICES (B) | Intermediate surgeries: Herniorrhaphy; Appendectomy | S |
| CHILDHOOD ILLNESSES | Routine child immunization as provided by NPI Assessment of nutritional status Common childhood illness diagnosis and treatment Feeding problems, nutritional advice and health education, etc. Under-five growth monitoring | S |
| RADIOLOGICAL INVESTIGATIONS (A) | Upper limb: Hand/Finger, Wrist, Forearm (Radius & Ulnar), Elbow, Humerus, Shoulder, Clavicle | S |
| RADIOLOGICAL INVESTIGATIONS (B) | Lower limb: Foot/Toe, Ankle/Leg(Tibula,Fibula), Knee, Femur/Thigh, Hip, Pelvis(AP), Pelvis & Hip | S |
| RADIOLOGICAL INVESTIGATIONS (C) | Thorax: Chest (PA/AP), Chest (PA/LATERAL), Chest for ribs (Oblique), Apical/Lordotic, Sternum | S |
| RADIOLOGICAL INVESTIGATIONS (D) | Vertebrae: Cervical Spine, Lateral Neck. (Soft tissue), Thoracic Spine, Thoraco-Lumbar Spine, Lumbar Spine, Lumbo-Sacral Spine, Sacrum, Coccyx, Sacro-iliac Joint (S.1.5), Cervical Spine (Oblique) | S |
| RADIOLOGICAL INVESTIGATIONS (E) | Skull: Skull series 2 views, Skull series all views, Skull series sinuses | S |
| RADIOLOGICAL INVESTIGATIONS (F) | Soft tissue: Abdominal and barium studies, Plain Abdominal and barium studies, Supine + erect Barium swallow, Barium enema, Ultrasound, Intravenous pyelogram, cyst urethrogram | S |
| BENEFIT | DETAILS | CARE LEVEL |
|---|---|---|
| REGISTRATION | Registration | P/S |
| CONSULTATION | Consultation | P |
| SPECIALIST CONSULTATION | Consultation with specialists such as surgeons, gynecologist, pediatricians, physicians and other specialists defined in the benefits package | S |
| CHRONIC CARE | Hypertension, Diabetes type 2 | P/S |
| INPATIENT CARE | Maximum days of hospital stay – 5 nights. Pre-authorization required from KWHIA In case of prolonged stay. In case of extended stay, due diligence will be carried out by KWHIA after which permission and authorization is granted for prolonged stay. | P/S |
| MATERNAL CARE | Family planning counselling services Presumptive malaria treatment drugs Identification of danger signs affecting pregnant women Vaccination Foetal growth monitoring Monitoring of danger signs Postnatal care for first 6 weeks | P/S |
| EMERGENCY CARE | Establishing an intravenous (Infusion) line, Simple tracheostomy, Management of convulsion, Control of bleeding, Cardio-pulmonary resuscitation, Assisted respiration (e.g., Ambubag, etc.), Immobilization fractures (using splints, neck collars, etc.) to ease transportation of patients, Aspiration of mucus plug to clear airways | P/S |
| OBSTETRIC/ GYNACOLOGY | Normal deliveries, Multiple delivery, assisted deliveries and caesarean sections including admission. Emergency situations (typically excluded except to save the life of patient: Evacuation of uterus (Dilatation and curettage) Hysterectomy, in case of postpartum hemorrhage Emergency Salpingectomy to Repair of Uterus; Cervical tear | P/S |
| NEONATAL CARE | Perinatal care for the following conditions: Ophthalmia neonatorum, Infections, mild to moderate sepsis, physiological jaundice, use of phototherapy, Incubator care for new-born | P |
| COMMON AILMENTS | Malaria and other acute uncomplicated illnesses Diarrheal diseases Acute respiratory tract infection Acute gastrointestinal infections Voluntary counselling & testing for HIV Uncomplicated pneumonia Simple anemia Simple skin diseases infestation Other uncomplicated bacteria, fungal, parasitic and viral infections and illnesses. First aid Acute exacerbations for conditions such as arthritis and minor musculoskeletal diseases Emergency care Yearly check-up including physical examination, blood pressure, vision testing | P/S |
| SURGICAL SERVICES (A) | Minor surgeries: Circumcision, Ear-piercing, Incision and drainage Lumpectomy and Suturing of lacerations | P/S |
| SURGICAL SERVICES (B) | Intermediate surgeries: Herniorrhaphy; Appendectomy | S |
| CHILDHOOD ILLNESSES | Routine child immunization as provided by NPI Assessment of nutritional status Common childhood illness diagnosis and treatment Feeding problems, nutritional advice and health education, etc. Under-five growth monitoring | S |
| EYECARE | Treatment of minor eye ailments including: Simple bacterial, fungal and parasitic eye infections Ophthalmia Neonatorum | P |
| LABORATORY INVESTIGATIONS AND DIAGNOSTIC TESTS | Malaria Parasite, Widal, Full Blood Count, PCV, Urinalysis, ESR, Fasting or Random Blood sugar Pregnancy test (urine), Microscopy (sputum and stool) HIV screening test, VDRL, Blood group, cross matching | P/S |
| RADIOLOGICAL INVESTIGATIONS (A) | Upper limb: Hand/Finger, Wrist, Forearm (Radius & Ulnar), Elbow, Humerus, Shoulder, Clavicle | S |
| RADIOLOGICAL INVESTIGATIONS (B) | Lower limb: Foot/Toe, Ankle/Leg(Tibula,Fibula), Knee, Femur/Thigh, Hip, Pelvis(AP), Pelvis & Hip | S |
| RADIOLOGICAL INVESTIGATIONS (C) | Thorax: Chest (PA/AP), Chest (PA/LATERAL), Chest for ribs (Oblique), Apical/Lordotic, Sternum | S |
| RADIOLOGICAL INVESTIGATIONS (D) | Vertebrae: Cervical Spine, Lateral Neck. (Soft tissue), Thoracic Spine, Thoraco-Lumbar Spine, Lumbar Spine, Lumbo-Sacral Spine, Sacrum, Coccyx, Sacro-iliac Joint (S.1.5), Cervical Spine (Oblique) | S |
| RADIOLOGICAL INVESTIGATIONS (E) | Skull: Skull series 2 views, Skull series all views, Skull series sinuses | S |
| RADIOLOGICAL INVESTIGATIONS (F) | Soft tissue: Abdominal and barium studies, Plain Abdominal and barium studies, Supine + erect Barium swallow, Barium enema, Ultrasound, Intravenous pyelogram, cyst urethrogram | S |
| BENEFIT | DETAILS | CARE LEVEL |
|---|---|---|
| REGISTRATION | Registration | P/S |
| CONSULTATION | Consultation | P |
| MATERNAL CARE | Family planning counselling services Presumptive malaria treatment drugs Identification of danger signs affecting pregnant women Vaccination Foetal growth monitoring Monitoring of danger signs Postnatal care for first 6 weeks | P/S |
| EMERGENCY CARE | Establishing an intravenous (Infusion) line, Simple tracheostomy, Management of convulsion, Control of bleeding, Cardio-pulmonary resuscitation, Assisted respiration (e.g., Ambubag, etc.), Immobilization fractures (using splints, neck collars, etc.) to ease transportation of patients, Aspiration of mucus plug to clear airways | P/S |
| OBSTETRIC/ GYNACOLOGY | Normal deliveries, Multiple delivery, assisted deliveries and caesarean sections including admission. Emergency situations (typically excluded except to save the life of patient: Evacuation of uterus (Dilatation and curettage) Hysterectomy, in case of postpartum hemorrhage Emergency Salpingectomy to Repair of Uterus; Cervical tear | P/S |
| NEONATAL CARE* | Perinatal care for the following conditions: Ophthalmia neonatorum, Infections, mild to moderate sepsis, physiological jaundice, use of phototherapy, Incubator care for new-born | P |
| COMMON AILMENTS | Malaria and other acute uncomplicated illnesses Diarrheal diseases Acute respiratory tract infection Acute gastrointestinal infections Voluntary counselling & testing for HIV Uncomplicated pneumonia Simple anemia Simple skin diseases infestation Other uncomplicated bacteria, fungal, parasitic and viral infections and illnesses. First aid Acute exacerbations for conditions such as arthritis and minor musculoskeletal diseases Emergency care Yearly check-up including physical examination, blood pressure, vision testing | P/S |
| SURGICAL SERVICES (A) | Minor surgeries: Circumcision, Ear-piercing, Incision and drainage Lumpectomy and Suturing of lacerations | P/S |
| SURGICAL SERVICES (B) | Intermediate surgeries: Herniorrhaphy; Appendectomy | S |
| CHILDHOOD ILLNESSES | Routine child immunization as provided by NPI Assessment of nutritional status Common childhood illness diagnosis and treatment Feeding problems, nutritional advice and health education, etc. Under-five growth monitoring | S |
| EYECARE | Treatment of minor eye ailments including: Simple bacterial, fungal and parasitic eye infections Ophthalmia Neonatorum | P |
| LABORATORY INVESTIGATIONS AND DIAGNOSTIC TESTS | Malaria Parasite, Widal, Full Blood Count, PCV, Urinalysis, ESR, Fasting or Random Blood sugar Pregnancy test (urine), Microscopy (sputum and stool) HIV screening test, VDRL, Blood group, cross matching | P/S |
| RADIOLOGICAL INVESTIGATIONS (A) | Upper limb: Hand/Finger, Wrist, Forearm (Radius & Ulnar), Elbow, Humerus, Shoulder, Clavicle | S |
| RADIOLOGICAL INVESTIGATIONS (B) | Lower limb: Foot/Toe, Ankle/Leg(Tibula,Fibula), Knee, Femur/Thigh, Hip, Pelvis(AP), Pelvis & Hip | S |
| RADIOLOGICAL INVESTIGATIONS (C) | Thorax: Chest (PA/AP), Chest (PA/LATERAL), Chest for ribs (Oblique), Apical/Lordotic, Sternum | S |
| RADIOLOGICAL INVESTIGATIONS (D) | Vertebrae: Cervical Spine, Lateral Neck. (Soft tissue), Thoracic Spine, Thoraco-Lumbar Spine, Lumbar Spine, Lumbo-Sacral Spine, Sacrum, Coccyx, Sacro-iliac Joint (S.1.5), Cervical Spine (Oblique) | S |
| RADIOLOGICAL INVESTIGATIONS (E) | Skull: Skull series 2 views, Skull series all views, Skull series sinuses | S |
| RADIOLOGICAL INVESTIGATIONS (F) | Soft tissue: Abdominal and barium studies, Plain Abdominal and barium studies, Supine + erect Barium swallow, Barium enema, Ultrasound, Intravenous pyelogram, cyst urethrogram | S |
Informal Health Plan (N15,500)
| BENEFIT | DETAILS | CARE LEVEL |
|---|---|---|
| CONSULTATION | Consultation | P |
| NEONATAL CARE | Perinatal care for the following conditions: Ophthalmia neonatorum, Infections, mild to moderate sepsis, physiological jaundice, use of phototherapy, Incubator care for new-born | P |
| EYECARE | Treatment of minor eye ailments including: Simple bacterial, fungal and parasitic eye infections Ophthalmia Neonatorum | P |
| REGISTRATION | Registration | P/S |
| CHRONIC CARE | Hypertension, Diabetes type 2 | P/S |
| INPATIENT CARE | Maximum days of hospital stay - 5 nights. Pre-authorization required from KWHIA In case of prolonged stay. In case of extended stay, due diligence will be carried out by KWHIA after which permission and authorization is granted for prolonged stay. | P/S |
| MATERNAL CARE | Family planning counselling services Presumptive malaria treatment drugs Identification of danger signs affecting pregnant women Vaccination Foetal growth monitoring Monitoring of danger signs Postnatal care for first 6 weeks | P/S |
| EMERGENCY CARE | Establishing an intravenous (Infusion) line, Simple tracheostomy, Management of convulsion, Control of bleeding, Cardio-pulmonary resuscitation, Assisted respiration (e.g., Ambubag, etc.), Immobilization fractures (using splints, neck collars, etc.) to ease transportation of patients, Aspiration of mucus plug to clear airways | P/S |
| OBSTETRIC/ GYNACOLOGY | Normal deliveries, Multiple delivery, assisted deliveries and caesarean sections including admission. Emergency situations (typically excluded except to save the life of patient: Evacuation of uterus (Dilatation and curettage) Hysterectomy, in case of postpartum hemorrhage Emergency Salpingectomy to Repair of Uterus; Cervical tear | P/S |
| COMMON AILMENTS | Malaria and other acute uncomplicated illnesses Diarrheal diseases Acute respiratory tract infection Acute gastrointestinal infections Voluntary counselling & testing for HIV Uncomplicated pneumonia Simple anemia Simple skin diseases infestation Other uncomplicated bacteria, fungal, parasitic and viral infections and illnesses. First aid Acute exacerbations for conditions such as arthritis and minor musculoskeletal diseases Emergency care Yearly check-up including physical examination, blood pressure, vision testing | P/S |
| SURGICAL SERVICES (A) | Minor surgeries: Circumcision, Ear-piercing, Incision and drainage Lumpectomy and Suturing of lacerations | P/S |
| LABORATORY INVESTIGATIONS AND DIAGNOSTIC TESTS | Malaria Parasite, Widal, Full Blood Count, PCV, Urinalysis, ESR, Fasting or Random Blood sugar Pregnancy test (urine), Microscopy (sputum and stool) HIV screening test, VDRL, Blood group, cross matching | P/S |
| SPECIALIST CONSULTATION | Consultation with specialists such as surgeons, gynecologist, pediatricians, physicians and other specialists defined in the benefits package | S |
| SURGICAL SERVICES (B) | Intermediate surgeries: Herniorrhaphy; Appendectomy | S |
| CHILDHOOD ILLNESSES | Routine child immunization as provided by NPI Assessment of nutritional status Common childhood illness diagnosis and treatment Feeding problems, nutritional advice and health education, etc. Under-five growth monitoring | S |
| RADIOLOGICAL INVESTIGATIONS (A) | Upper limb: Hand/Finger, Wrist, Forearm (Radius & Ulnar), Elbow, Humerus, Shoulder, Clavicle | S |
| RADIOLOGICAL INVESTIGATIONS (B) | Lower limb: Foot/Toe, Ankle/Leg(Tibula,Fibula), Knee, Femur/Thigh, Hip, Pelvis(AP), Pelvis & Hip | S |
| RADIOLOGICAL INVESTIGATIONS (C) | Thorax: Chest (PA/AP), Chest (PA/LATERAL), Chest for ribs (Oblique), Apical/Lordotic, Sternum | S |
| RADIOLOGICAL INVESTIGATIONS (D) | Vertebrae: Cervical Spine, Lateral Neck. (Soft tissue), Thoracic Spine, Thoraco-Lumbar Spine, Lumbar Spine, Lumbo-Sacral Spine, Sacrum, Coccyx, Sacro-iliac Joint (S.1.5), Cervical Spine (Oblique) | S |
| RADIOLOGICAL INVESTIGATIONS (E) | Skull: Skull series 2 views, Skull series all views, Skull series sinuses | S |
| RADIOLOGICAL INVESTIGATIONS (F) | Soft tissue: Abdominal and barium studies, Plain Abdominal and barium studies, Supine + erect Barium swallow, Barium enema, Ultrasound, Intravenous pyelogram, cyst urethrogram | S |
Formal Health Plan (N18,000)
| BENEFIT | DETAILS | CARE LEVEL |
|---|---|---|
| REGISTRATION | Registration | P/S |
| CONSULTATION | Consultation | P |
| SPECIALIST CONSULTATION | Consultation with specialists such as surgeons, gynecologist, pediatricians, physicians and other specialists defined in the benefits package | S |
| CHRONIC CARE | Hypertension, Diabetes type 2 | P/S |
| INPATIENT CARE | Maximum days of hospital stay – 5 nights. Pre-authorization required from KWHIA In case of prolonged stay. In case of extended stay, due diligence will be carried out by KWHIA after which permission and authorization is granted for prolonged stay. | P/S |
| MATERNAL CARE | Family planning counselling services Presumptive malaria treatment drugs Identification of danger signs affecting pregnant women Vaccination Foetal growth monitoring Monitoring of danger signs Postnatal care for first 6 weeks | P/S |
| EMERGENCY CARE | Establishing an intravenous (Infusion) line, Simple tracheostomy, Management of convulsion, Control of bleeding, Cardio-pulmonary resuscitation, Assisted respiration (e.g., Ambubag, etc.), Immobilization fractures (using splints, neck collars, etc.) to ease transportation of patients, Aspiration of mucus plug to clear airways | P/S |
| OBSTETRIC/ GYNACOLOGY | Normal deliveries, Multiple delivery, assisted deliveries and caesarean sections including admission. Emergency situations (typically excluded except to save the life of patient: Evacuation of uterus (Dilatation and curettage) Hysterectomy, in case of postpartum hemorrhage Emergency Salpingectomy to Repair of Uterus; Cervical tear | P/S |
| NEONATAL CARE | Perinatal care for the following conditions: Ophthalmia neonatorum, Infections, mild to moderate sepsis, physiological jaundice, use of phototherapy, Incubator care for new-born | P |
| COMMON AILMENTS | Malaria and other acute uncomplicated illnesses Diarrheal diseases Acute respiratory tract infection Acute gastrointestinal infections Voluntary counselling & testing for HIV Uncomplicated pneumonia Simple anemia Simple skin diseases infestation Other uncomplicated bacteria, fungal, parasitic and viral infections and illnesses. First aid Acute exacerbations for conditions such as arthritis and minor musculoskeletal diseases Emergency care Yearly check-up including physical examination, blood pressure, vision testing | P/S |
| SURGICAL SERVICES (A) | Minor surgeries: Circumcision, Ear-piercing, Incision and drainage Lumpectomy and Suturing of lacerations | P/S |
| SURGICAL SERVICES (B) | Intermediate surgeries: Herniorrhaphy; Appendectomy | S |
| CHILDHOOD ILLNESSES | Routine child immunization as provided by NPI Assessment of nutritional status Common childhood illness diagnosis and treatment Feeding problems, nutritional advice and health education, etc. Under-five growth monitoring | S |
| EYECARE | Treatment of minor eye ailments including: Simple bacterial, fungal and parasitic eye infections Ophthalmia Neonatorum | P |
| LABORATORY INVESTIGATIONS AND DIAGNOSTIC TESTS | Malaria Parasite, Widal, Full Blood Count, PCV, Urinalysis, ESR, Fasting or Random Blood sugar Pregnancy test (urine), Microscopy (sputum and stool) HIV screening test, VDRL, Blood group, cross matching | P/S |
| RADIOLOGICAL INVESTIGATIONS (A) | Upper limb: Hand/Finger, Wrist, Forearm (Radius & Ulnar), Elbow, Humerus, Shoulder, Clavicle | S |
| RADIOLOGICAL INVESTIGATIONS (B) | Lower limb: Foot/Toe, Ankle/Leg(Tibula,Fibula), Knee, Femur/Thigh, Hip, Pelvis(AP), Pelvis & Hip | S |
| RADIOLOGICAL INVESTIGATIONS (C) | Thorax: Chest (PA/AP), Chest (PA/LATERAL), Chest for ribs (Oblique), Apical/Lordotic, Sternum | S |
| RADIOLOGICAL INVESTIGATIONS (D) | Vertebrae: Cervical Spine, Lateral Neck. (Soft tissue), Thoracic Spine, Thoraco-Lumbar Spine, Lumbar Spine, Lumbo-Sacral Spine, Sacrum, Coccyx, Sacro-iliac Joint (S.1.5), Cervical Spine (Oblique) | S |
| RADIOLOGICAL INVESTIGATIONS (E) | Skull: Skull series 2 views, Skull series all views, Skull series sinuses | S |
| RADIOLOGICAL INVESTIGATIONS (F) | Soft tissue: Abdominal and barium studies, Plain Abdominal and barium studies, Supine + erect Barium swallow, Barium enema, Ultrasound, Intravenous pyelogram, cyst urethrogram | S |
Equity Health Plan (Subsidized)
| BENEFIT | DETAILS | CARE LEVEL |
|---|---|---|
| REGISTRATION | Registration | P/S |
| CONSULTATION | Consultation | P |
| MATERNAL CARE | Family planning counselling services Presumptive malaria treatment drugs Identification of danger signs affecting pregnant women Vaccination Foetal growth monitoring Monitoring of danger signs Postnatal care for first 6 weeks | P/S |
| EMERGENCY CARE | Establishing an intravenous (Infusion) line, Simple tracheostomy, Management of convulsion, Control of bleeding, Cardio-pulmonary resuscitation, Assisted respiration (e.g., Ambubag, etc.), Immobilization fractures (using splints, neck collars, etc.) to ease transportation of patients, Aspiration of mucus plug to clear airways | P/S |
| OBSTETRIC/ GYNACOLOGY | Normal deliveries, Multiple delivery, assisted deliveries and caesarean sections including admission. Emergency situations (typically excluded except to save the life of patient: Evacuation of uterus (Dilatation and curettage) Hysterectomy, in case of postpartum hemorrhage Emergency Salpingectomy to Repair of Uterus; Cervical tear | P/S |
| NEONATAL CARE* | Perinatal care for the following conditions: Ophthalmia neonatorum, Infections, mild to moderate sepsis, physiological jaundice, use of phototherapy, Incubator care for new-born | P |
| COMMON AILMENTS | Malaria and other acute uncomplicated illnesses Diarrheal diseases Acute respiratory tract infection Acute gastrointestinal infections Voluntary counselling & testing for HIV Uncomplicated pneumonia Simple anemia Simple skin diseases infestation Other uncomplicated bacteria, fungal, parasitic and viral infections and illnesses. First aid Acute exacerbations for conditions such as arthritis and minor musculoskeletal diseases Emergency care Yearly check-up including physical examination, blood pressure, vision testing | P/S |
| SURGICAL SERVICES (A) | Minor surgeries: Circumcision, Ear-piercing, Incision and drainage Lumpectomy and Suturing of lacerations | P/S |
| SURGICAL SERVICES (B) | Intermediate surgeries: Herniorrhaphy; Appendectomy | S |
| CHILDHOOD ILLNESSES | Routine child immunization as provided by NPI Assessment of nutritional status Common childhood illness diagnosis and treatment Feeding problems, nutritional advice and health education, etc. Under-five growth monitoring | S |
| EYECARE | Treatment of minor eye ailments including: Simple bacterial, fungal and parasitic eye infections Ophthalmia Neonatorum | P |
| LABORATORY INVESTIGATIONS AND DIAGNOSTIC TESTS | Malaria Parasite, Widal, Full Blood Count, PCV, Urinalysis, ESR, Fasting or Random Blood sugar Pregnancy test (urine), Microscopy (sputum and stool) HIV screening test, VDRL, Blood group, cross matching | P/S |
| RADIOLOGICAL INVESTIGATIONS (A) | Upper limb: Hand/Finger, Wrist, Forearm (Radius & Ulnar), Elbow, Humerus, Shoulder, Clavicle | S |
| RADIOLOGICAL INVESTIGATIONS (B) | Lower limb: Foot/Toe, Ankle/Leg(Tibula,Fibula), Knee, Femur/Thigh, Hip, Pelvis(AP), Pelvis & Hip | S |
| RADIOLOGICAL INVESTIGATIONS (C) | Thorax: Chest (PA/AP), Chest (PA/LATERAL), Chest for ribs (Oblique), Apical/Lordotic, Sternum | S |
| RADIOLOGICAL INVESTIGATIONS (D) | Vertebrae: Cervical Spine, Lateral Neck. (Soft tissue), Thoracic Spine, Thoraco-Lumbar Spine, Lumbar Spine, Lumbo-Sacral Spine, Sacrum, Coccyx, Sacro-iliac Joint (S.1.5), Cervical Spine (Oblique) | S |
| RADIOLOGICAL INVESTIGATIONS (E) | Skull: Skull series 2 views, Skull series all views, Skull series sinuses | S |
| RADIOLOGICAL INVESTIGATIONS (F) | Soft tissue: Abdominal and barium studies, Plain Abdominal and barium studies, Supine + erect Barium swallow, Barium enema, Ultrasound, Intravenous pyelogram, cyst urethrogram | S |
Health Plan Exclusions
• Specialized surgeries (Brain, kidney transplant)
• In vitro fertilization (IVF)
• Hormone replacement therapy
• Congenital abnormalities/Birth defects
• Self-inflicted injuries
• Drug addiction
• Provision of prosthesis
• Cancer Management/Treatment
