+

√ indicates services which are covered
x indicates services not covered under the specific plan

 EXCLUSIONS:

he following are excluded from the HyMat Plans:

1. Cervical Cerclage
2. Epidural Services
3. Episiotomy Repair
4. Management of Complications during pregnancy and delivery including but not limited to hypertension, diabetes, abnormal bleeding during pregnancy not covered by the ante-natal package
5. Antenatal care outside the enrollee’s selected hospital
6. Routine inpatient and outpatient treatment including but not limited to other specialist consultations, the supply of medication, investigations other than what is covered under the Antenatal care at the preferred provider.
7. Family Planning services
8. Any other treatment, service, procedure, or investigation not listed in the schedule of covered medical services

 NOTE

1. There will be a waiting period of 7 days after registration. Plan purchased becomes active 7 days after the purchase date.
2. Change of Provider:

• The enrollee is not allowed to change providers for Ante-natal Care after being checked in at the selected Provider
• Where enrollee decides to change providers for delivery after Antenatal Care has commenced, Hygeia will only pay for the delivery costs and subsequent postnatal and baby care costs and will not be liable to pay for any other antenatal care at the new provider

3. Upgrades:

• Where a twin delivery is expected the enrollee will pay a top-up to upgrade the plan to twin delivery (in line with the upgrade terms and conditions). Otherwise, Hygeia will only pay for one delivery and the enrollee pays the difference at the hospital.
• The enrollee is allowed to upgrade her plan at the latest One month to her delivery date. After that, no upgrade is allowed
• An enrollee who pays for Normal Vaginal Delivery will not be able to top up later than 30 days to delivery date at the hospital even in an emergency

4. Refunds

• The enrollee is entitled to a refund of 40% of the premium paid in the event that delivery happens at another provider on an emergency basis. All other benefits still apply
• The enrollee is entitled to a refund of 30% of the premium paid in the event of Vaginal Delivery where the HyMat Plus Plan has been purchased.

5. Miscarriages and Still-Births

• Where a miscarriage occurs and the enrollee requires an evacuation, this will be covered under the plan. The enrollee will only be entitled to a refund of 50% of the premium paid.
• Where a still-birth occurs, the enrollee will still be managed on the plan and eligible for post-natal care. The enrollee will not be entitled to any refund.

NOTE

Maximum principal age limit is 50 years