Basic Plan
Covered Services
Primary Healthcare Consultations
These are routine visits to a designated primary healthcare provider for:
- General medical examinations
- Diagnosis and treatment of common illnesses
- Follow-up consultations
- Basic health advice and preventive care
- Referrals to higher levels of care when necessary
Basic Medications & Treatment
Coverage usually includes:
- Common prescription medications listed in the HMO’s approved drug formulary
- Treatment of minor illnesses such as:
- Malaria
- Typhoid fever (where clinically diagnosed)
- Respiratory tract infections
- Diarrheal diseases
- Minor skin infections
- Basic injections and dressings
Limitations: Only approved drugs are covered. Branded or specialized medications may require additional payment.
Essential Lab Tests
Typically covered tests include:
- Malaria parasite test
- Full Blood Count (FBC)
- Urinalysis
- Blood sugar test
- Pregnancy test
- Basic stool examination
- Routine diagnostic tests required for common illnesses
Outpatient Care Services
These include:
- Doctor consultations
- Nursing services
- Basic medical procedures performed without hospital admission
- Minor wound treatment
- Monitoring and management of uncomplicated health conditions
Access to HMO Network
Members can receive care at accredited hospitals, clinics, and healthcare centers within the HMO’s network, subject to:
- Registration with a primary healthcare provider
- Referral procedures where applicable
- Availability of covered services at the chosen facility
Not Covered Services
Specialist Consultations
Not usually covered without referral or additional payment:
- Cardiologists
- Neurologists
- Dermatologists
- Orthopedic specialists
- ENT specialists
Major Surgeries
Not covered, including:
- Appendectomy
- Hernia repair
- Orthopedic surgeries
- Cancer-related surgeries
Chronic Disease Management
Limited or not covered:
- Hypertension management
- Diabetes management
- Kidney disease treatment
- Long-term cardiac care
Advanced Diagnostic Tests
Usually excluded:
- CT Scan
- MRI
- Mammography
- Endoscopy
- Specialized hormone tests
Dental Services
Typically excluded:
- Tooth extraction
- Fillings
- Dentures
- Root canal treatment