Medical examinations for the purposes of obtaining and maintaining employment.
Medical examinations for the purposes of admission into schools, as a fulfillment of obligation required by schools from time to time, licensing and/or insurance
Including, but not limited to Fetal surgeries, Neuro surgeries, surgeries of the heart and/or liver, Laser,
Organ transplant (including bone marrow transplant), total joint replacement, shunt operations and cardiothoracic surgeries
Including, but not limited to skin care products, care for balding, cosmetic surgery, dentures, teeth whitening, advanced conservative restorations, orthodontic and associated treatment.
Provision of artificial limbs
Home care
Including, but not limited to dental appliances, braces crowns, implants and supplies arising from procedures like surgeries.
Including, but not limited to treatment of bone fractures in traditional bone setting homes, traditional birth attendants and health facilities not registered with the ministry of health
Any treatment that is not officially recognized by orthodox medicine
Treatment of glaucoma, retinal detachment, cataract extraction or any treatment not specifically mentioned in the benefit cover.
Laser eye surgeries
Including, but not limited to Conditions relating to epidemics, Injuries arising from participating in wars, riots, strike and/or civil strife.
Bodily injuries arising from partaking in amateur or professional sports, including, but not limited to mountaineering, motorbike racing.
Aviation incidents (except when patient is travelling solely as a passenger), hand gliding and parachuting, horse racing, and car racing
Reliance HMO plans are not underwritten to cover work-place accidents
All diseases arising from unknown causes are excluded.
Injuries while under the influence of or disablement due wholly or partly to the effect of intoxicating liquor or drugs other than those prescribed by a medical practitioner;
Injuries sustained as a result of a criminal action.
Treatment of drug addiction, attempted suicide and/or willfully inflicted injuries.
Inpatient psychiatric care
Ante-natal care and Delivery services for pregnancies in excess of four, whether the offspring thereof were born under the scheme or not; provided the insurance quota of principal, spouse and four biological children has been filled.
Additional child shall attract a premium to be charged by Reliance HMO.
Antenatal & Delivery services for enrollees other than principal insured or spouse.
All medical expenses incurred outside Nigeria.
This applies even if they are prescribed, recommended, or approved by the person’s attending Physician or dentist.
In order for a treatment, service or supply to be considered Medically necessary, the service or supply must:
be care or treatment which is likely to produce a significant positive outcome as and no more likely to produce a negative outcome than any alternative service
be a diagnostic procedure which is indicated by the health status of the person and be as likely to result in information that could affect the course of treatment as and no more likely to produce a negative outcome than any alternative service
as to diagnosis, care and treatment, be not costlier (taking into account all health expenses incurred in connection with the treatment, service or supply), than any alternative service or supply to meet the above tests.
RELIANCE HMO shall not cover or pay for search and rescue operations if an enrollee is lost in a remote area.
RELIANCE HMO shall not cover or pay for any treatment incurred by or for any new-born in the first 6 weeks of life delivered to mothers not covered or enrolled under this policy.
We only provide automatic cover for specified services, as listed in the benefit schedule, to new-borns in the first 6 weeks of life delivered to Principal Enrollees or Spouses covered by this policy.
RELIANCE HMO shall not cover or pay for any treatment incurred by or for any new-born that is not registered after 6 weeks of birth.
RELIANCE HMO shall not pay for appointments and treatments for sexual dysfunction, as well as virility enhancing drugs.
Children above the age of 18 years. Adults above the age of 65 years.
Solicitation by enrollee of a specific treatment and/or drug where the attending physician has not deemed it appropriate to provide such.
Congenital abnormalities/Birth defects
Congenital abnormalities/Birth defects
Molecular diagnostics and in-utero testing
Complications (or further treatment) arising from treatment of ailments not covered by the scheme
Treatment beyond the limits of a benefit or the total annual benefit
Replacement/Exchange/Swap during a policy year is possible within the first 3 months of the policy year,
provided the exit staff had not accessed care within that first 3 months. No refund of the previous premium paid on the exit staff is allowed.
If any staff joins the company at any time within the period of the scheme, a pro-rated premium is paid on the staff,
Based on the number of months to expiration of the current plan. A full premium is then paid for the staff when a new scheme is commenced in the subsequent year.
Any benefit not explicitly stated in the list of covered services.
