Terms and Conditions

1. Start date – Your plan effective date is the 1st of the next month if payment is made after the 20th of the month to allow for registration and delivery of membership card/s
2. Maximum principal age is 60 years and dependant age limit is 18 years
3. Family means Principal, Spouse and a maximum of 4 biological children under the age of 18 years
4. At least one adult has to purchase a plan to enable us register a child/minor less than 18 years. We are unable to register only a minor, as we do not enter into contracts with minors
5. Annual wellness checks will be conducted at select HMO Designated Centres and will require prior booking and approval
6. All services * are available at designated centres
7. Avon HMO accredits and contracts healthcare providers to its network, and reserves the right to delist, suspend, or reinstate a provider within its network without prior notice. However, in such cases, the HMO will make available alternative providers for members affected.
8. An enrollee is required to choose a hospital/Clinic from the Avon HMO hospital network as its primary care provider
9. Avon HMO reserves the right to refer an enrollee to a designated hospital/specialist consultant or physician for secondary or tertiary care.
10. Chronic conditions are excluded in the first 24 months of your health plan; some examples of chronic conditions are listed below. Please note that this is not an exhaustive list:
11. Hypertension and Cardiac Related diseases.
12. Diabetes Mellitus and its related conditions
13. Hepatitis B & C
14. Asthma

Waiting periods of between 6 – 24 months may apply to coverage of the following benefits, where purchased:

1. Dental Benefits (6 Months)
2. Wellness Checks (9 Months)
3. Optical Benefits (12 Months)
4. Psychiatric/Mental Disorders & Illnesses – Outpatient Services only (12 Months)
5. Infertility Investigations (12 Months)
6. Minor/ Intermediate Surgical Procedures including Treatment of Hemorrhoids, Fibroids, Hernia, and Adenoidectomy (12 Months)
7. All expenses associated with HIV/AIDS and related conditions (12 Months)
8. Management of Chronic Conditions (24 Months)
9. Maternity and Child Delivery Benefits including: Pregnancy, Childbirth, Maternity Benefits, Abortion, Miscarriage, Antenatal Care, Obstetric Scans, Post Natal Care, Neonatal Care, Caesarean Section Delivery, etc. (18 Months)

EXCLUSIONS: The following conditions/ treatments/services are not covered by any of our health plans. Please refer to your health plan’s detailed benefits

1. 1. Birth defects, congenital condition or illness, autoimmune disorders, sickle cell anaemia, conditions and illnesses related to genetic disorders;
   2. Psychiatric Institutionalization;
   3. Any medical service required or injuries sustained as a result of Military, Para Military or Militant service or operations;
   4. Any medical service required or injuries sustained as a result of Hazardous sports including but not limited to water sports, mountaineering, hunting, motor racing, riding or driving in any kind of race and professional participation in leagues of any sport;
   5. Any medical service required or injuries sustained as a result of Air travel except as a fare paying passenger in any aircraft licensed for passenger carrying;
   6. Any medical service required or injuries sustained as a result of War (declared or undeclared), riot, strike, and civil commotion; or acts of God or acts of terrorism;
   7. Any medical service required or injuries sustained as a result of Intentional self-injury, suicide or attempted suicide (whether sane or insane), chronic venereal disease, member’s own criminal act, intoxication, the use of drugs not prescribed by a physician or injury sustained whilst in a state of insanity, alcoholism or costs resulting from dependency on or abuse of drugs or other addictive substances and drug rehabilitation;
   8. Consultations or treatment by chiropractors, acupuncturists, herbalists, complimentary/traditional medical practitioners or unrecognized consultants, hospitals, family doctors, therapists, dental practitioners;
   9. Pre – Existing Conditions. Any medical treatment required, relating to an accident or illness which may have occurred prior to 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
   10. Overseas Treatment/ Investigations;
   11. Organ Surgery and Transplants;
   12. Plastic/Cosmetic Surgeries and/or Treatments;
   13. Embalmment, Autopsies, Mortuary Services;
   14. Cancer Investigation or Treatment such as chemotherapy or radiotherapy;
   15. Investigations not as listed under covered services or Treatments for problems relating to Infertility, e.g. IVF, GIFT, Artificial Insemination; and Virility Enhancing Drugs;
   16. Neonatal Care not listed under services
   17. Speech Disorders
   18. Treatment of Obesity & Weight Loss
   19. Elective Caesarean Section
   20. Renal Dialysis
   21. Dental Surgical Extraction not as listed under cover services
   22. Herbal Drugs, Non-Prescription Drugs, Food Supplements, Dietary and Nutrition Supplements, Experimental Drugs and Treatments;
   23. Dental treatment unless otherwise stated to be covered by the specific plan
   24. Optical services unless otherwise stated to be covered by the specific plan
   25. Hearing tests or costs of hearing aids;
   26. Any injury, illness or disease specified as an exclusion and complications caused by a condition that is excluded or follow up treatments or investigations that are due to a condition that is excluded;
   27. Home Care, Domiciliary Care;
   28. Joint Replacements;
   29. Supply of Prosthesis (Artificial Limbs, Dental Prosthesis);
   30. Hormonal Replacement Therapy;
   31. Speech Disorders, Learning Difficulties, Behavioural &
   32. Developmental Problems;
   33. Treatment of Obesity & Weight Loss;
   34. Elective Caesarean Section;
   35. Burns greater than 9%
   36. All expenses in respect of illnesses/conditions that were subject to waiting periods when the member and dependants joined the plan
   37. Treatment protocols that are not normal, customary or standard practice within Nigeria
   38. Any other medical service not listed in the table of benefits on the health plan
   39. Any condition, treatment, procedure, or service that is related, is in connection with, or is required as a follow-up to an exclusion.

Exclusions – Life Starter Plan

There are conditions/ services/ treatments that are not covered by the Life Starter Plan. These include:

1. Management of Chronic conditions such as Hypertension, Diabetes, Asthma, Arthritis, etc
2. Antenatal Care & Delivery
3. Immunizations
4. Neonatal Care
5. Intensive Care Services
6. Neonatal Intensive Care or Special Baby Care Unit
7. Renal Dialysis
8. Advanced Investigations such as MRI Scans, CT Scans, EEG, Myelogram, ECHO
9. Psychiatric Institutionalization
10. Fertility Investigation or Treatment
11. Organ Surgery and Transplant
12. Cosmetic and Plastic Treatment
13. Drug and Alcohol Abuse and Rehabilitation
14. Embalmment/Autopsy and Mortuary services
15. Dietary and Nutrition Supplements
16. Cancer Investigation or Treatment
17. Supply of Prosthesis (Artificial limbs, Dental prosthesis)
18. Hormonal Replacement Therapy
19. Treatment of Obesity
20. Overseas Treatment
21. Home Care, Domiciliary Care
22. Herbal Drugs, Non-Prescription Drugs
23. Dental Care not as listed
24. Speech Disorders
25. Learning Difficulties
26. Consultation with unrecognized Consultants, Hospitals, Family Doctors, Therapists, Dental Practitioners or Complimentary/Traditional Medicine Practitioners
27. Elective Caesarean Section
28. Congenital Abnormalities & Conditions (e.g., sickle cell anaemia)
29. Burns greater than 9%
30. Treatment protocols that are not standard practice within Nigeria
31. Any treatment or procedure that is required as a follow up to any of the previously listed excluded services
32. Any other medical service not listed in the table of benefits

Exclusions – Life Plus Plan

There are conditions/ services/ treatments that are not covered by the Life Plus Plan. These include:

1. Additional Immunizations other than listed
2. Advanced Investigations such as MRI Scans, CT Scans, EEG, Myelogram, ECHO
3. Psychiatric Institutionalisation
4. Fertility Investigation other than listed or treatment such as IVF, ICSI, GIFT, etc
5. Organ Surgery and Transplant
6. Cosmetic and Plastic Treatment
7. Drug and Alcohol Abuse and Rehabilitation
8. Embalmment/Autopsy and Mortuary services
9. Dietary and Nutrition Supplements
10. Cancer Investigations or treatment such as Chemotherapy, Radiotherapy, etc
11. Supply of Prosthesis (Artificial limbs, Dental prosthesis)
12. Hormonal Replacement Therapy
13. Treatment of Obesity
14. Overseas Treatment
15. Home Care, Domiciliary Care
16. Herbal Drugs, Non-Prescription Drugs
17. Dental Care not as listed
18. Speech Disorders
19. Learning Difficulties
20. Consultation with unrecognized Consultants, Hospitals, Family Doctors, Therapists, Dental Practitioners or Complimentary/Traditional Medicine Practitioners
21. Elective Caesarean Section
22. Congenital Abnormalities & Conditions (e.g., sickle cell anaemia)
23. Burns greater than 9%
24. Treatment protocols that are not standard practice within Nigeria
25. Any treatment or procedure that is required as a follow up to any of the previously listed excluded services
26. Any other medical service not listed in the table of benefits

Exclusions – Premium Life Plan

There are conditions/ services/ treatments that are not covered by the Premium Life Plan. These include:

1. Psychiatric Institutionalisation
2. Fertility Investigation other than listed or treatment such as IVF, ICSI, GIFT, etc
3. Organ Surgery and Transplant
4. Cosmetic and Plastic Treatment
5. Drug and Alcohol Abuse and Rehabilitation
6. Embalmment/Autopsy and Mortuary services
7. Dietary and Nutrition Supplements
8. Cancer Investigations or treatment such as Chemotherapy, Radiotherapy, etc
9. Supply of Prosthesis (Artificial limbs, Dental prosthesis)
10. Hormonal Replacement Therapy
11. Treatment of Obesity
12. Overseas Treatment
13. Home Care, Domiciliary Care
14. Herbal Drugs, Non-Prescription Drugs
15. Dental Care not as listed
16. Speech Disorders
17. Learning Difficulties
18. Consultation with unrecognized Consultants, Hospitals, Family Doctors, Therapists, Dental Practitioners or Complimentary/Traditional Medicine Practitioners
19. Elective Caesarean Section
20. Congenital Abnormalities & Conditions (e.g. sickle cell anaemia)
21. Burns greater than 9%
22. Treatment protocols that are not standard practice within Nigeria
23. Any treatment or procedure that is required as a follow up to any of the previously listed excluded services

Any other medical service not listed in the table of benefits

Exclusions – Boss Life Plan

There are conditions/ services/ treatments that are not covered by the The Boss Life Plan. These include:

1. Psychiatric Institutionalisation
2. Fertility Investigation other than listed or treatment such as IVF, ICSI, GIFT, etc.
3. Organ Surgery and Transplant
4. Cosmetic and Plastic Treatment
5. Drug and Alcohol Abuse and Rehabilitation
6. Embalmment/Autopsy and Mortuary services
7. Dietary and Nutrition Supplements
8. Cancer Investigations or treatment such as Chemotherapy, Radiotherapy, etc.
9. Supply of Prosthesis (Artificial limbs, Dental prosthesis)
10. Hormonal Replacement Therapy
11. Treatment of Obesity
12. Overseas Treatment
13. Home Care, Domiciliary Care
14. Herbal Drugs, Non-Prescription Drugs
15. Dental Care not as listed
16. Speech Disorders
17. Learning Difficulties
18. Consultation with unrecognized Consultants, Hospitals, Family Doctors, Therapists, Dental Practitioners or Complimentary/Traditional Medicine Practitioners
19. Elective Caesarean Section
20. Congenital Abnormalities & Conditions (e.g., sickle cell anaemia)
21. Burns greater than 9%
22. Treatment protocols that are not standard practice within Nigeria
23. Any treatment or procedure that is required as a follow up to any of the previously listed excluded services
24. Any other medical service not listed in the table of benefits