Foremost Health Maintenance Organisations in Nigeria.
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Standard Plan

Subscription Form

Subscription Confirmation

Please complete all relevant sections on all fields in BLOCK LETTERS

N64,680 / Annum
N64,680 / Annum

CONFIRM SUBMITTED DETAILS ARE ACCURATE
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PERSONAL DETAILS SECTION


DEPENDANTS SECTION


HEALTH HISTORY


HOSPITAL DETAILS


PAYMENT SECTION

WAITING PERIOD
Notwithstanding the scope of the benefits listed under your Health Plan, the following waiting period conditions apply;
  1. Optical, ophthalmic and dental services will be covered after 12 months are completed on the scheme.
  2. The following conditions/procedures will be covered when -:
    1. (i) Elective surgical interventions will be covered after 12 months are completed on the scheme and (ii) Maternity-related services will be covered after 18 months are completed on the scheme.
  3. Cover for newly-diagnosed chronic illnesses commences after 24 months are completed on the scheme
  4. Pre-existing medical and surgical conditions are not covered by the scheme.
NOTE: Commencement of the scheme is tied to the submission of signed contract paper.

Click here to view all General Exclusions

Kindly review your application and confirm all information supplied is correct. By submitting this form you agree to our terms and conditions and our Privacy Policy