Terms of Service

Please read them carefully before agreeing to proceed as you will be bound by these terms and the terms contained in the policy document after a successful purchase.

General Conditions: Applies to All Plans.

Chronic ailments and pre-existing conditions as well as the following conditions: Diabetes, Hypertension, Arthritis, Sickle Cell Anaemia; pregnancy and maternity care have a one year waiting period and will not be covered or provided in the first year of the commencement of any of the plans. On renewal, these conditions will be covered subject to the health insurance plan limits provided the Enrollee remains enrolled with Health4Moni for a period of one consecutive year.

The maximum age limit for Dependant is 25 year.

Exclusions.

1. Cosmetic Surgery or treatment
2. Teeth Whitening
3. Dental Prosthesis
4. Domiciliary/Hospice Care
5. Alternative /Unorthodox medicine
6. Neonatal care is not listed under neonatal services
7. Self-inflicted injuries
8. Congenital abnormalities
9. Conditions caused by an act of war, an epidemic, or an enrollee participating in a riot
10. Services primarily for weight reduction or treatment of obesity
11. Treatment of substance abuse
12. Infertility- All investigations and treatment
13. Orthodontics
14. Advanced radiological investigations (e.g. C.T. scan, Myelogram, EEG)
15. Advanced and Complex investigations (e.g. Marrow biopsy, skeletal survey)
16. Prosthetic devices such as cardiac pacemaker, orthopedic implants
17. Management of Chronic Renal Failure (Dialysis and Transplant Surgery)
18. Induced Abortion
19. Laser Treatments
20. Transplants
21. Complex major Surgeries (e.g. Heart, Brain, and Great blood vessels).
22. Neurological surgeries.
23. Management of Cancers
24. Professional Sports and wilful exposure to needless danger
25. Infectious and contagious diseases in an epidemic
26. All procedures, management, and investigations not covered by the plans

Cover Limit

The overall cover limit refers to the maximum annual reimbursement by Health4Moni to cater for the care and treatment of an Enrolee. These limits are plan and provider-category-specific. Specific monetary or benefit limits may apply for specific services such as optical, dental, and surgical procedures. In addition, some services are capped or restricted based on length of stay or number of procedures dispensed.

Waiting period The standard waiting period is 10 working days and during this period, you will have no access to the covered services and the plan purchased will only become active 10 days after completion of registration.

Right to Cancel Policy

Health4Moni is at liberty to cancel the cover of an Enrolee who has misled it or breached any term of the health insurance policy, given incorrect, incomplete, or misleading information, failed to provide any reasonable information which Health4Moni has requested for, conspired with a third party to obtain undue benefit from this Policy, or submitted a claim which is in any respect fraudulent or unfounded. In any of these circumstances, Health4Moni shall have the right to cancel the Enrolee’s cover from the date of commencement (without refund of any portion of the unused premium) and shall recover from the Enrolee any benefit it might have paid to such claim/

Cancellation/Termination by an Enrolee is only possible within the first 30 days of the commencement of the policy. An Enrolee that decides to cancel/terminate this Health Insurance Policy must notify Health4Moni in writing and the Enrolee shall be entitled to a refund of the premium paid less (1) any amounts incurred on their behalf as medical and other expenses (2) an administrative charge of 30% of the premium paid. No refund shall apply in case of termination/cancellation made by an Enrollee after 30 days of the commencement of the policy.

Cancellation/Termination by Health4Moni

Health4Moni may terminate the Policy by sending 30 days' notice by registered letter to an Enrolee at their last known address, to their known e-mail address or phone number. In such an event, Health4Moni will refund to the Enrolee an amount equal to the pro-rata value of their unused premium. Unused premium refers to the difference between the premium paid and the medical cost incurred as at the effective date of termination which includes amounts reported and amounts yet to be reported but which were incurred prior to the date of termination.

Treatment prior to Date of Commencement

Health4Moni will not cover or pay for any treatment that was given before an Enrolee’s commencement date of cover or after cancellation/termination of cover or during any period for which Health4Moni is yet to receive premiums.

Treatment that is not covered under the Benefit Schedule

Health4Moni will not cover or pay for any treatment that is not specifically covered under the Benefit Schedule of the Policy. Similarly, all plans do not cover Consultations with unrecognized/unorthodox consultants, hospitals, family doctors, therapists, dental practitioners, or complementary medicines practitioners. In the same vein, complications from such unrecognized/unorthodox places are not covered under any of the plans.

Transferability

The plans are person-specific and non-transferable.

Confidentiality

Health4Moni is committed to protecting the information of its Enrolees and it is bound by law and regulatory standards to maintain the privacy of its Enrolees’ medical information and records. Health4Moni also holds its employees, providers, consultants and business associates to strict policies and procedures protecting Enrolee’s information. The Information collected from an Enrolee at enrolment and other transactions would include an Enrolee’s biodata as well as an Enrolee’s medical information through claims and utilization data submitted from healthcare providers. Health4Moni can also access an Enrolee’s medical records in furtherance of its role under the health plans and you hereby consent to our access of your medical records and information accordingly.

Categorization of Healthcare Facilities

Healthcare Providers are categorized by Health4Moni for the benefit of ease of access to care by its Enrolees. Health4Moni reserves the right to review this categorization from time to time without prior recourse to an Enrolee. This could include (but is not limited to) the addition and deletion of healthcare providers from the general list and/or from a specific plan provider list. At the point of filling out your proposal form, you shall be required to select your preferred hospital(s) from the list of in-network hospitals accessible on your plan. PLEASE NOTE that we will not be liable to pay for care accessed from an in-network hospital that is not available on the list of hospitals associated with your plan. In the event we choose to make payment for care received from an in-network hospital not on your plan, our payment shall be limited only to what it would have cost us to pay if you had accessed the services from an in-network hospital accessible on your plan.

Liability

Health4Moni shall not be liable for any damages or losses that may arise from an Enrollee’s failure to pay premiums as and when due.

Refunds

Enrollees are required to access care within Health4Moni's network of Providers and not pay out of pocket for covered services. Reimbursement may only apply for extreme cases of an emergency requiring an enrollee to access care in a non-network Hospital, Health4Moni should be notified of such emergencies within 72 hours of occurrence for approval through its contact centre. Refund will be made by Health4Moni upon the Enrollee providing the following documents within 30 days of encounter:

• 1. Copy of medical report from the Healthcare practitioner indicating a history of the medical condition, diagnosis, and treatment administered
• 2. Original Receipt for having made payment indicating the costs separately for consultation, each investigation, each procedure, and each Drug and the quantity dispensed.
• 3. Pre-authorisation number received from Health4Moni.

Supply of drugs & medication

All Enrolees are covered for drugs recommended during their treatment for covered services except for excluded items.

Notices or Demands

Any notices or demands required to be given under this Agreement, or given in connection with it, shall be in writing and shall be given by electronic means. Should the Enrollee require or where Health4Moni deems the same expedient, such notice can also be issued in hard copy and delivered by personal delivery or courier service delivery to the last known address of the other party. Changes in address have to be communicated to the other party otherwise, notifications will continue to be delivered to the last known address and remain legally enforceable. Health4Moni can be contacted at any time through its customer care: (07032245125); or send an email to health4moni@gmail.com