Group Mediclaim Policy | Prestige Assurance PLC

Corporate Health Insurance

Comprehensive Health Cover for Your Entire Workforce

The Group Mediclaim Policy is a collective health insurance plan providing medical cover for a group of people — typically the employees of an organisation and their eligible dependants. It delivers the same comprehensive benefits as an individual Mediclaim policy, structured and priced as a single group policy for the employer, giving every member access to quality healthcare without financial burden.

Cashless Hospitalisation — direct settlement with 2,500+ empanelled hospitals, no upfront payment required by the employee
Family Floater Option — extend cover to spouse, children, and dependent parents under a shared sum insured
No Pre-policy Medical Test — entire group enrolled without individual medical examinations for most standard plans
NAICOM Licensed — fully regulated and compliant with Nigerian insurance law, with a dedicated TPA claims desk

2,500+

Empanelled Hospitals

Family Floater

Spouse, Children & Parents

11 Illnesses

Critical Care Cash Benefit

NAICOM

Licensed — LIC 040

Policy Benefits

What the Group Mediclaim Covers

Six core benefit categories designed to protect your employees at every stage of a medical event — from admission through recovery.

Inpatient Hospitalisation

Full cover for room rent, boarding, nursing, surgeon fees, anaesthesia, blood, oxygen, and operation theatre charges during hospitalisation.

Room rent up to 1% of Sum Insured per day
ICU/ICCU up to 2% of Sum Insured per day
Pre- and post-hospitalisation expenses
Day-care procedures included

Hospital Cash Benefit

Daily incidental allowance paid directly to the insured member during hospitalisation — no invoices required, covering out-of-pocket incidentals.

0.1% of Sum Insured per day
Payable for up to 10 days per claim
Paid directly without receipts
Covers transport and incidental costs

Critical Illness Cash

A lump-sum cash payout upon first diagnosis of any of 11 listed critical illnesses — providing immediate financial support during severe health events.

10% of Sum Insured on diagnosis
Cancer, heart attack, stroke covered
Organ transplant, kidney failure
Paid in addition to hospitalisation

Surgical & Specialist Cover

Covers the full cost of surgical procedures, specialist consultations, and anaesthesia both as in-patient and qualified day-care operations.

Surgeon, anaesthetist, consultant fees
Major and minor operations
Specialist referral costs
Post-surgery nursing care

Diagnostic & Pharmacy

Covers laboratory tests, X-rays, MRI, CT scans, pathology, and prescribed medicines both before admission and during inpatient stay.

Pre-admission diagnostic tests
Medicines and consumables
Imaging: X-ray, MRI, CT scan
Pathology and blood work

Maternity & Newborn Cover

Optional maternity benefit covering normal and caesarean delivery expenses, plus newborn baby cover from day one of life up to the policy limit.

Normal and C-section delivery
Pre- and post-natal consultations
Newborn cover from day one
Subject to waiting period (9 months)

Network & Limits

Coverage Limits & Hospital Network

Key financial parameters and network access that define the strength of your group health policy.

2,500⁺

Empanelled Hospitals

Nationwide network of cashless hospitals, specialist clinics, and diagnostic centres across Nigeria and India via TPA

1^%

Room Rent / Day

Room rent covered up to 1% of your Sum Insured per day for standard ward, twin sharing, or single occupancy

2^%

ICU / ICCU / Day

Intensive care and critical care unit costs covered at up to 2% of Sum Insured per day — no sub-limits on treatment

0.1^%

Hospital Cash / Day

Daily cash benefit paid directly — 0.1% of Sum Insured per day, for up to 10 days, no receipts required

Policy Terms

What Is Covered & What Is Not

A clear view of the policy boundaries ensures you select the right Sum Insured and benefit structure for your organisation.

Covered

Inpatient hospitalisation for illness or injury requiring admission for more than 24 hours
Pre-hospitalisation expenses up to 30 days before and post-hospitalisation up to 60 days after discharge
Day-care procedures that do not require 24-hour admission due to technological advancement
Emergency ambulance charges for transport to the nearest empanelled hospital
Critical illness cash benefit on first diagnosis of any of the 11 listed conditions

Excluded

Pre-existing diseases during the first year of cover unless explicitly waived in the group scheme terms
Cosmetic, aesthetic, or elective procedures not arising from accidental injury or illness
Self-inflicted injuries, substance abuse, or treatment arising from intoxication
Experimental treatments, unproven therapies, or procedures not recognised by standard medical practice
War, nuclear risk, or any condition arising from armed conflict or radioactive contamination

Accommodation Limits & Sub-Limits

Room rent is capped at 1% of Sum Insured per day for standard accommodation and 2% per day for ICU/ICCU. Where the actual room rent exceeds the limit, all associated expenses (surgeon fees, specialist charges, etc.) are proportionately reduced. Employers may opt for a higher room-rent waiver endorsement for senior staff grades.

Protect Your Workforce's Health Today

From a team of 10 to a corporation of thousands — Prestige Assurance has the group health underwriting capacity to keep every employee covered, every day.

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