Personal plan exclusions

Pre-existing conditions (PECs): Any medical treatment required, relating to an accident or illness which may have occurred before the effective date or to any illness where it was within the knowledge of a member that was suffering from it at the effective date. This also includes chronic illnesses like hypertension, diabetes, osteoarthritis, and dyslipidemia.

Coverage status
Hypertension Covered under an
active PEC extension
Diabetes Covered under an
active PEC extension
Osteoarthritis Covered under an
active PEC extension
Peptic Ulcer Disease Covered under an
active PEC extension
Rheumatoid Arthritis
Complications arising from pre-existing conditions e.g hypertensive heart disease, diabetic foot ulcer, cardiovascular disease, neuropathy, heart failure, heart attack, stroke, heart failure, aneurysm, gastric cancer, osteoporosis, etc.
CT scan
Prothrombin time (PT/INR)
Serum Lithium
Serum Lactate Dehydrogenase
Oral Glucose Tolerance Test (OGTT) Covered under an
active PEC extension
VDRL (Veneral Disease Research Laboratory) Test
Trypanosomes screening
Toxoplasma screening
Skin snip for Microfilaria
Skin scraping for fungi
Leishmania screening
Mantoux/Heaf's Test
Blood culture
Stool Occult Blood
(HBA1C) Covered under an
active PEC extension
Prostate Specific Antigen
G-6PD screening
Thyroid Function tests
Serum Uric Acid Covered under an
active PEC extension
Creatinine phosphokinase
Syphilis Screening
Serum immunoglobulins/Antibodies
Immunofluorescence assay
QBC Malaria Concentration And Fluorescent Staining
Pap Smear and Cytology
Protein Electrophoresis
CSF M/C/S (CSF Analysis)
Semen M/C/S
Serum Creatinine Phosphokinase
Serum Iron
24 Hour Creatinine Clearance
Coomb's Test (Indirect)
Coomb's Test (Direct)
Osmotic Fragility Test
Chlamydia Screening
Seminal Fluid Analysis (SFA)
Sputum Acid Fast Bacilli (AFB) Test
ICU, HDU and ICU-related Care
Antenatal care (including all specialist care and ANC drugs)
Delivery (SVD/normal and complicated)
Delivery (multiple)
Assisted delivery
Therapeutic Abortion (Manual Vacuum Aspiration)
Caesarian section
Fertility Specialist consultation and counselling
Fertility investigations
Care for babies NOT actively on the plan
Incubator care
Special baby unit and neonatal intensive unit
Copper T Intrauterine Device
Injectibles (Depo Provera,Noristerat)
Contraceptive pills
Jadelle implant
Oncologist/ Cancer Specialist visits
Oncological investigations
Cancer-related radiological investigations
Surgical cancer care
Dialysis and all related care
Blood pressure check (hypertension screening)
Blood sugar check (diabetes screening)
Blood cholesterol check
Annual visual acuity Check (using Snellen Chart)
Mammography (for women ≥ 40 years old)
Pap smear
PSA check (for men ≥ 40 years old)
Liver function test
Kidney function tests (E, U, and Cr)
Chest x-ray
Healthcare for pandemics / epidemics / injurires from war or conflict
Autoimmune disorders
Sickle cell anemia and illnesses related to genetic disorders
Plastic / cosmetic surgery and treatments
Birth defects and congential illnesses
Food supplements
Dietary and nutritional supplements
Non-prescription drugs
Experimental drugs and treatments
Healthcare or costs from alcoholism and substance absuse and intoxication
Health care for organ transplant
Spinal cord injuries/treatment
Glaucoma treatment
Speech disorders and learning disabilities
Hormonal replacement therapy
Health care for attempted suicide / intentional injury / high-risk sports
Embalmment, autopsies and mortuary services
All healthcare arising from, or related to exclusions