Teachers’ & Workers
Health Plan

Claims will be paid for you up to the overall benefit level in each plan of the Insurance year, subject to the terms and conditions of the plan.

GH¢29,000.00

Accredited Service Providers recognised by the Health Facilities Regulatory Agency (HeFRA) and NHIA across the 16 regions of the country.

Out-patient services are medical procedures or tests that can be done in a medical centre without staying overnight. They include:

♦ Consultation (General Practitioner / Specialist)
♦ Laboratory Investigations (Labs)
♦ Prescribed drugs (both generic & branded)
♦ Diagnostic Tests such as MRI Scan, CT Scan, X-Rays, Imaging, Ultrasound, etc
♦ Treatment related to Acute, Non-Acute, and Chronic Medical Condition
♦ Minor Surgical Procedures (Dressings)
♦ Dental Care - Filling, Pain Relief, Extractions, etc - Subsidy of GH¢100.00 per year.
♦ Spectacles – Subsidy on the frame & lens to a limit of GH¢100.00 (2 years / 1 yr waiting period).
♦ Maternity – Ante-Natal and Post-Natal care after the twelfth month of membership.
♦ The following limits apply to all accredited facilities (hospitals / clinics, pharmacies, diagnostic centres, etc.) across the country:
◊ Maximum Out-Patient visits per month to a hospital will be two (2) times with a maximum cover of GH¢220.00 per visit.*
◊ Maximum Out-Patient cover per prescription or lab request is GH¢100.00 (relative to visit)
◊ Maximum limits: MRI – GH¢600.00* | CT Scan – GH¢300.00* | Myomectomy - GH¢1,500.00 | EOU - GH¢500.00 (Abortion is not covered by the scheme)

NB: Any additional cost to the stated limits will be borne by the member.

ANNUAL OUT-PATIENT LIMIT - GH¢4,000.00

In-patient services refer to the procedures that require the patient to be admitted at the hospital. They include:

♦ Consultation (General Practitioner / Specialist)
♦ Maternity – Deliveries (Assisted or Normal or Complications) are covered to a limit of GHC2,200.00 (1yr).
♦ Admission cases are paid to a limit of GHC1,200.00 per admission (once a month).
♦ All medical conditions requiring surgeries are covered to a limit of GHC2,200.00 per procedure.
♦ Nursing Care
♦ Prescribed Drugs & Infusions
♦ Diagnostic Tests such as MRI Scan, CT Scan, X-Rays, Pathology, Imaging, Ultrasound, etc. and other
procedures
♦ Intensive Care Unit (ICU) Costs
♦ Theatre Costs
♦ Anesthetists’ Fees
♦ Hospital Accommodation (not exceeding 30 days annually | Daily maximum limit of GHC100.00)
♦ Hospital feeding (where applicable)

NB: Benefits pertaining to any pre-existing condition (known or unknown) (eg. Hernia, fibroid, etc.) that would require surgical intervention or hospitalization commences after the twelfth month of membership.

ANNUAL IN-PATIENT LIMIT - GH¢25,000.00