Legal
Terms & Conditions
Novo Health Africa is a National Health Maintenance Organization providing health care across Nigeria and accredited by the National Health Insurance Scheme (NHIS) with the objective to provide health care delivery solutions through the continuum of care
General Exclusions and Service Caveats
Treatment of persons not registered in the scheme.
Treatment including delivery outside network of participating facilities.
Occupational Industrial injuries
Injuries resulting from: Natural disasters e.g. earthquakes, landslides, etc. Conflicts, social unrest, riots, wars, etc.
Epidemics
Drug/substance abuse and addiction
Other Terminal illnesses not stated in the plan
Domiciliary/Hospice care
Periodic Medical check-ups unrelated to illness
Transplant and cosmetic surgeries
Open heart surgery
Neurosurgery
Provision of Hearing aids and associated appliances
Treatment of leprosy
Auto Immune
Congenital abnormalities involving major/extensive surgical repairs e.g. Separation of Siamese twins
Chronic congenital defects e.g. Hirchsprung disease
In-Vitro Fertilization & Fertility Treatment
Dentures, Crowns, bridges, Implants
Maxillo-facial surgeries
Alternative/Un-orthodox treatment
Dental prosthesis
Self-inflicted injuries
Gender reassignment
Hormone replacement therapy
Stem cell or bone marrow transplant
Adult Immunization
All treatment not covered under the scope of the health services
1. By clicking “Buy Now”, “Submit”, I understand and agree that: (a) all statements and answers I have given are complete and true to the best of my knowledge and belief; (b) the insurance I hereby apply for will be effective only when Novo Health Africa approves this Application. Evidence of such approval will be the issuance of ID Card(s), which will be delivered to the group or beneficiary (ies). The effective date will be 4 weeks after payment confirmation; and (c) if my beneficiaries’ health has changed from what is indicated on the Beneficiary Identification Form to the effective date of coverage, I will notify Novo Health Africa of the change immediately. Any beneficiary (ies) who knowingly presents a false or fraudulent claim within the contestable period or payment of a loss or benefit or knowingly presents false information in an Application for insurance is guilty of a crime and may be subject to fines and/or imprisonment under Nigerian law. I further understand that, in the event of fraud or misrepresentation, this information may be used to reduce or deny a claim, void coverage, or void the group contracts within the contestable period, if such misrepresentation affects Novo Health Africa’s acceptance of risk.
2. By clicking “Buy Now”, “Submit” on this application, I authorize: (a) Any physician, medical practitioner, hospital, clinic, medically related facility or other institution who provided treatment or service to my beneficiary(ies) at any time, (including billing service), having medical information which includes, but is not limited to, identification, medical history, diagnosis, prognosis, consultations, advice, treatments, services, dates of treatments and/or services, test results including X-rays, summary reports, without limitation to period of treatment, diagnostic or therapeutic information, history or type of injury or illness (including pregnancy and treatment or service, if any, for mental or nervous conditions, alcohol abuse or drug abuse), and (b) Any insurance or reinsuring company, service or prepaid benefit plan, plan administrator, consumer reporting agency, employer or personal or business associates having non-medical information about me, my beneficiary, concerning eligibility and claim administration to disclose to Novo Health Africa, or their representatives (including the claims department) all such information. I understand that when used for the purposes of obtaining information in connection with claims for benefits, utilization review, quality improvement, health care operations or other activities as permitted by law, this Authorization is valid during the Policy term or pendency of the claims for benefits, whichever is longer. I understand that I may request and receive a copy of this authorization.
3. No person, except an agent of Novo Health Africa, is authorized to vary or modify a contract. I further understand and agree that Novo Health Africa, its directors, officers, employees, and agents shall not be liable for any injury, damage, or expense (including attorney’s fees) that I or any of my beneficiaries suffer as a result of any improper advice, action, or omission on the part of any health care provider.
We implore you to fully cooperate with the module stated above.
Thank you
Novo Health Africa