As a national Health Maintenance Organization, our target market falls under the category of both social health insurance and private health insurance. We also sell customised health plans to meet individual needs. In addition, we offer various health plans for individuals, families and companies. These health plans cover a range of benefits including specialists’ consultations and surgeries. The benefit under each plan differ so that you can choose the one which best suits your needs and budget.

Our product is called the ProHealth Card. The Card is sold at an actuarially determined amount called the premium. The Card bears the passport photograph and personal information (including bio-data) of the holder. It entitles the holder over a 12 months period to receive defined sets of healthcare services at designated facilities without having the responsibility to pay for them either at the point of use or at a later date.

The health cover provided by the ProHealth Card elapses after a period of 12 calendar months, except if renewed by the payment of a new premium.

The ProHealth Card provides real assurance of financial protection and access to quality healthcare in the unforeseen event of future ill-health (based on the agreed product plan).

Eligibility for the ProHealth Product

Individuals and their dependants (Children less than 18 years) or employers of individuals in the private and public sectors (group insurance) of the economy are eligible for our unique ProHealth Card.

The benefit packages in all of these products have been designed to meet and even surpass the most comprehensive of the HMO products currently in the market.

Contributors

When you make a choice of any of the PROHEALTH cards, the contributions (premiums) are paid to PROHEALTH HMO annually at least 30 days prior to commencement of healthcare benefits. This would allow time for all enrolment processes to be completed.

ProHealth Private Health Insurance Features

NHIS Standard Benefit Plan

Primary Healthcare Services:

1. Access to curative services for common ailments including consumables as out-patient care
2. Essential drugs from NHIS accredited pharmacy providers + needed provision of pharmaceutical care by the pharmacists; beneficiary is expected to pay 10% of the total cost of drugs (co-payment)
3. Routine laboratory investigations
4. Health education to prevent and control health problems such as counselling and testing for HIV/AIDS + health education;
5. Maternal and child care services;
6. Primary eye care, dental and mental services
7. Accident and emergency services.

Secondary Healthcare Services:

1. Specialist care for medical, surgical, paediatrics, obstetrics and gynaecology, internal medicine, psychiatry, ENT,
2. Ophthalmology, management of HIV/AIDS, etc.
3. Hospitalization in general wards, Cumulative 15 days/year
4. Physiotherapy for restorative and rehabilitative services
5. Radiology/Medical imaging and diagnostic laboratory services
6. All prescribed pharmaceuticals from FMOH essential drugs lists + co-payment.

Tertiary Healthcare Services:

All referrals from Primary and Secondary healthcare services.

Flat Premium Rate for Family Cover

In a group of families, there is an expected variation in the household sizes. While some families might be starting with no children, others may already have up to 6 children. Standard regulatory requirement is that a family cover should include: The insured, the spouse, and a maximum of four (4) children under the age of 18yrs. However, dependants above the age of 18years will be added on request for a 10% increase on the family premium.

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