| 1. GEMINI HEALTH CARE |
| Gemini Health Care is the first Health Maintenance
Organisation (HMO) to be established in Ghana after
the promulgation of the National Health Insurance Act,
2003 (Act 650). It is sponsored by the Gemini Life Insurance
Company (GLICO), the leading private life insurance
company in Ghana.
As an HMO, the Organisation provides comprehensive
medical services to its enrolled members for a fixed,
prepaid fee or premium. What this means is that the
Organisation is involved in both delivery and financing
of health services to its enrolled membership population.
Gemini Health Care is pleased to introduce onto the
Ghanaian market its first product, the GLICO HEALTHPLAN. |
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| 2. ABOUT THE GLICO HEALTHPLAN |
The GLICO HealthPlan is a comprehensive health
insurance scheme which provides cover for both out-patient
and in-patient care through a network of affiliated
service providers. The scheme provides a choice of
a suitable and flexible benefit package with a full
range of options as well as choice of Doctors, Clinics,
Laboratories, and Pharmacies within the affiliated
Provider Network.
It is specially designed to suit the mutual needs
of corporate institutions, non-governmental organisations
and international agencies, informal sector groups,
families and individuals and the Plan’s Service
Provider Network.
Ghanaian expatriates abroad can also enroll their
relations and dependant residing in Ghana on the scheme.
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| 3. AFFILIATED PROVIDER NETWORK |
| The GLICO HealthPlan operates with a network of carefully
selected; reputable service providers across the country
who have been contracted to provide services for the
enrolled members of the scheme. In addition, the Plan
has collaborative links with the Ghana Health Service
for the use of Government Hospitals, Polyclinics and
Health Centres nationwide. These linkages enable beneficiaries
to access the scheme throughout the country. |
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| 4. GENERAL SCHEME BENEFITS |
The GLICO HealthPlan will generally pay for the following
services:
GP and Specialist Consultation
Prescription Drugs
Surgical and Medical Treatment
Diagnostic Tests (Lab, X-rays, Ultrasound, etc.)
Hospital Accommodation
Eye and Basic Dental Care
Referrals to Tertiary Institutions
Maternity Care and optics (optional) |
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| 5. GLICO HEALTHPLAN PACKAGES |
| The GLICO HealthPlan offers three packages –
a standard package, an enhanced package and an enhanced-plus
package. Each package provides for both out-patient
and in-patient care. The packages include: |
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| 5a. STANDARD PACKAGE |
Offers cover at relatively low premiums.
Offers benefits of up to ¢3 million per annum
for out-patient services and ¢10 million per
any one admission for in-patient services.
Covered services include doctors’ and specialist
consultation, drugs, laboratory tests and X-rays,
dental care, surgical and medical treatment and hospital
accommodation (general ward). |
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5b. ENHANCED PACKAGE
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Combines first-class service with customer comfort
Offers benefits of up to ¢10 million per annum
for out-patient services and ¢20 million per
any one admission for in-patient services.
Provides cover for CT scan, optics, ambulance service
and hospital accommodation (side ward) in addition
to the services covered under the standard package.
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| 5c. ENHANCED PLUS PACKAGE |
Combines first-class service with ultimate customer
comfort.
Offers benefits of up to ¢12.5 million per
annum for out-patient services and ¢30 million
per any one admission for in-patient services.
Provides cover for MRI, CT scan, optics, ambulance
service, hospital accommodation (private ward) in
addition to the services covered under the standard
package as well as use of special health facilities
such as Nyaho Clinic, Trust Hospital and Medlab. |
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| 6. OPTIONAL BENEFITS |
| The optional benefits currently available are maternity
services and optics. The maternity benefits include
pre-natal care, delivery and post-natal care up to six
weeks following delivery. The optic service includes
the provision of spectacles up to specified limits |
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| INTERNATIONAL PACKAGE |
| 7. SUNKWA HEALTH INSURANCE PACKAGE (SHIP) |
This is a special package designed to help Ghanaians
living abroad to purchase the health insurance plan
for their dependants and relatives residing in Ghana.
Offers benefits of up to ¢10 million per annum
for out-patient services and ¢25million per any
one admission for in-patient services.
Covered services include doctors’ and specialist
consultation, drugs, CT scan, laboratory tests and
X-rays, dental care, optical care, surgical and medical
treatment, spectacles, ambulance service and hospital
accommodation (side ward). Referrals to Tertiary Institutions
are also covered.
Call your loved ones abroad (USA, Canada, Europe
etc.) to enroll you on the Sunkwa Health Insurance
Package (SHIP) for quality healthcare and convenience.
SUNKWA! (Strive for Life!). |
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8. HOW TO ACCESS BENEFITS UNDER THE PLAN
|
You select and register with a clinic/hospital
from our Provider Network.
You are issued with a photo ID card (for exclusive
use).
You are required to present the membership card to
your provider to receive the service.
No payment at point of service is required.
In cases of hospitalization, you would be required
to sign a form as proof of having received service. |
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| 9. MEDICAL EMERGENCIES |
| In medical emergency situations, the nearest participating
clinic/hospital could be used whether it is the selected
clinic of the insured or not. Other health facilities
or government hospitals may also be used when necessary.
Be sure to notify GLICO HealthPlan and the primary service
provider within one week. |
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| 10. WHY CHOOSE GLICO HEALTHPLAN |
Because the plan Complies fully with the NHIS Act,
2003 (Act 650);
Operates with a network of reputable service providers
nationwide;
Has a Quality Assurance Review Board to ensure quality
healthcare;
Offers choice of suitable benefit package at an affordable
cost;
Listens to your recommendations and addresses concerns;
and
Gives you value for money. |
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