INTRODUCTION
Welcome to WELLNESS HEALTH MANAGEMENT SERVICES Mobile Application (“Wellness Plus App”).
Please read the following terms and conditions carefully before using this App.
This document is an electronic record in accordance with the definition under the National Information Technology Development Agency Act, 2007 and rules there under as applicable and the amended provisions pertaining to electronic records in various statutes as amended by the National Information Technology Development Agency Act, 2007. This electronic record is generated by a computer system and does not require any physical or digital signatures. By mere use of this app, you shall be contracting with Wellness HMO, a company incorporated under the Companies and Allied Matters Act, 2020 with registered address at 9, Jogunomi Street, Gbagada Phase II Estate, Lagos, Nigeria and these terms and conditions constitute your binding obligations.
For the purpose of these Terms of use, wherever the context so requires, “You” and “Your” shall mean an individual. Whenever you use any of the services provided by the Wellness Plus App, you will be subject to the rules, guidelines, policies, terms and conditions applicable to such service, and they shall be deemed to be incorporated into this Terms and Conditions and shall be considered a part and parcel of this Terms of Use. It is your responsibility to check these Terms and Conditions periodically for change. Your continuous use of the site following the posting of changes will mean that you accept and agree to the changes.
These Terms of use are effective from the 1st day of November, 2021
PERSONAL INFORMATION
A user’s personal information is treated in accordance with our privacy policy and the use of the Wellness Plus App is subject to the terms of agreements signed with Wellness HMO.
MEMBERSHIP ELIGIBILITY
The use of the Wellness Plus App is only available to individuals however, corporate representatives of an individual can transact on behalf of the individual.
Subscription as a member of the Wellness Plus App connotes that you have paid the specified amount known as the premium for the plan opted for by you and this payment will be made on an annual basis or per service and in accordance with the terms mutually agreed by the parties. Please note, that where NO PREMIUM is paid for a particular year, NO SERVICE will be rendered when the risk occurs.
Subscription as a member does not in any way translate to being a shareholder or having a stake in Wellness Plus App.
YOUR ACCOUNT AND REGISTRATION OBLIGATIONS
If you use the Wellness Plus App, you shall be responsible for maintaining the confidentiality of your User ID and Password and you shall be responsible for all activities that occur under your User ID and Password. You agree that if you provide any information that is untrue, inaccurate, not current or incomplete that Wellness HMO has reasonable grounds to suspect that such information is untrue, inaccurate, not current or incomplete, or not in accordance with this Terms and Conditions, Wellness HMO has the right to refuse to provide you with access to the Wellness Plus App, or terminate or block access of your membership with the Wellness Plus App or fail to cover medical expenses when a bodily injury/ or sickness occurs.
CONDITIONS APPLICABLE
These Terms of use shall apply to and govern all plans relating to medical expenses necessarily and reasonably incurred by you to the maximum sum of Medical Limit agreed and as specified in the insurance policy in respect of each and every claim arising out of bodily injury and/or sickness occurring within the period of insurance and for which premium has been paid by client. All your conditions or other terms and conditions or warranties whatsoever whether communicated before or after these terms and conditions are excluded from the contract or any variation thereof unless expressly accepted by the Wellness HMO in writing, and your conditions shall not be regarded as a counter offer.
Unless otherwise stated, the conditions under which Wellness HMO shall operate includes in particular, but without limitation to the following:
1. It shall establish and maintain a network of credible healthcare providers across the nation. Such healthcare providers shall be presented to the Client and reviewed from time to time as may be required.
2. It shall be a pre-enrollment condition for the Subscriber to submit a properly completed Enrolment form along with the photograph and other specified details of Subscribers to be covered.
3. Each Subscriber shall be provided with an enrollee identification card. In emergency situations, a Subscriber shall use the said identification card to receive treatment in any other listed or non-listed healthcare provider while the Wellness HMO shall be notified within 48hrs of the commencement of such treatment; by any of the parties stated in the policy.
4. Where an enrollee subscribes newly or buy Wellness health plan for the first year, there will be a moratorium period (waiting period) of ONE month before access to care commences and NINE months waiting period for maternity(delivery) and surgical operations and procedures.
5. The healthcare provider shall treat a Subscriber only on proper identification which identification documentations shall be provided to the preferred healthcare provider by the Subscriber.
6. In the event of requiring urgent emergency evacuation by road, the Subscriber shall be required to give the details contained in the ID card provided such person is in a state of consciousness and capable of giving such information;
7. Where a Subscriber requires a replacement of already issued ID card for members of his family or on the need for replacement due to loss, an additional fee of ₦1000 shall be charged for each replaced or new card issued.
8. Each Subscriber shall have the right to select his healthcare provider from our provider network;
9. In the event of the Subscriber and family being separated, the Subscriber shall be entitled to select another healthcare provider for each member of the family;
10. In the event that the care being required cannot be delivered by the chosen healthcare provider, the Subscriber shall appropriately be referred to a secondary healthcare provider (Specialist) within the HMO’s healthcare providers’ network. Referral outside the network shall only be done when appropriate and expedient;
11. Where referrals are not in emergency situations and/or the Subscriber is not incapacitated, the Subscriber shall be conveyed to the referral center at his /her own cost;
12. In an emergency situation, the Subscriber shall be entitled to receive treatment in any healthcare provider outside the Wellness HMO network and a refund shall be made on production of verified fully filled reimbursement form, original receipts and medical report from the attending hospital or physician that is endorsed by Wellness HMO Officer. Kindly note that the Wellness HMO will be responsible in managing the situation with regards to the professional care needed.
13. A renewal notice shall be sent to a Subscriber at least thirty (30) days before the expiration of this policy.
14. In the event of renewal, payment for the subsequent year must be made one month before the expiration of the existing policy to avoid the deactivation of enrollee in the new policy year.
15. A subscriber shall inform Wellness HMO if at any the payment card expires and has not been renewed, or is limited, revoked or terminated or is no longer associated with your account.
16. Any Subscriber who accesses treatment in an out of network provider for non-emergency treatment shall be responsible for the cost of the treatment unless pre-authorization is given.
17. Secondary referral cases/special cases must be by referral from the general practitioner and shall be communicated to the Wellness HMO for approval. 18. Primary providers shall be the first point of call for all Subscriber with onward referral for specialist cases if required, either by the Primary provider or Wellness HMO.
19. Subscriber who wishes to change his/her primary provider due to negligence or poor care by the service provider must notify the Wellness HMO.
20. Wellness HMO reserves the right to accept or reject any request to provide our plan in its absolute discretion. If acceptance or rejection is not communicated within five (5) working days after receipt of the request, the request shall be deemed accepted.
21. Any subscriber who seeks for refund of premium or payment paid, must send the request for refund notice within 48hours. All requests after 48 hours will not be attended to.
22. Wellness HMO after the receipt of notice of refund, shall refund the premium or payment within seven (7) working days of such notice. Note however that Wellness HMO shall refund 80 percent only of the total premium paid.
23. The exercise by Wellness HMO of any right pursuant to these Terms of use shall be without prejudice to any other right available to it whether hereunder or under any applicable law.
24. Abuse of the scheme by the subscriber can lead to the termination of this contract by Wellness HMO.
DISCLAIMER OF WARRANTY
EXCEPT AS OTHERWISE SET FORTH IN THE WELLNESS PLUS APP INCLUDING WITHOUT LIMITATION THE CONTENT AND SERVICES PROVIDED BY WELLNESS HMO ARE PROVIDED ON AN “AS IN” BASIS FOR INFORMATIONAL PURPOSES ONLY AND WITHOUT WARRANTY OF ANY KIND, EITHER EXPRESSED OR IMPLIED, INCLUDING BUT NOT LIMITED TO, THE IMPLIED WARRANTIES OF MERCHANTABILITY AND FITNESS FOR A PARTICULAR PURPOSE AND NON-INFRINGEMENT. THE APP MAY INCLUDE INACCURACIES, MISTAKES OR TYPOGRAPHICAL ERRORS, WE DO NOT WARRANT THAT THE CONTENT WILL BE UNINTERRUPTED OR ERROR FREE.
To the maximum extent permitted by law, Wellness HMO shall not in any event be liable for indirect, exemplary, special or consequential loss or damages, to the maximum extent permitted by applicable law, our total liability to you for any claim shall not exceed the limit as specified in the policy and to the extent of your disclosure regarding the health of the Subscriber which gave rise to our liability, hence non-disclosure of an existing illness will not be treated under Wellness HMO plan.
RESTRICTION OF LIABILITY
Subscribers can have access to maternity after the one-month moratorium period that applies to all subscribers however the limit on surgical operation shall be applied to the request of a need for caesarian section at the point of delivery.
The parties agree and understand that the following healthcare delivery services are excluded from the scope of services to be provided by Wellness HMO.
1. Treatment of medical and surgical conditions not expressly stated in the policy.
2. The policy shall exclude the treatment of chronic renal failure to a certain limit of sessions
3. Treatment of all Cancers
4. Immunizations outside the scope stated in the policy.
5. Treatment of chronic organ disease e.g chronic liver disease, heart and kidney.
6. Pre-existing critical illnesses that are not declared during enrollment shall not be covered under the plan.
7. Artificial heart implantation and all organ transplants;
8. All forms of high-tech surgeries e.g. elective cosmetic surgeries, laser surgeries, laparoscopic surgeries and procedures, etc.
9. Self-inflicted injuries, drug addiction or alcoholism or treatment occasioned by the abuse and/or influence of alcohol or hard drugs;
10. Provision of hearing aids
11. Treatment of congenital anomaly/birth defects;
12. Treatment by alternative medicine and other unorthodox medical practice;
13. Provision of dentures, braces, capping, cosmetic dental procedures and other advanced restorative dental procedures;
14. Treatment resulting from participating in war and/or on the outbreak of war where such participation is voluntary, participating in riots, strike, civil commotion or any illegal act;
15. Treatment resulting from participating in motor racing, motorcycle racing and/or other high-risk sports;
16. Treatment outside Nigeria
17. Definitive treatment of Acquired Immune Deficiency Syndrome (AIDS), AIDS Related Complex Syndrome (ARCS) and all diseases caused by and/or related to Human Immunodeficiency Virus (HIV).
18. Treatment arising from occupational accidents, this is covered under the Client’s workmen compensation policy.
19. Treatment in the event of national epidemics.
20. Treatment of tuberculosis. Subscriber will be referred to government-designated specialized center.
21. Nigerian Federal Government identified notifiable diseases following confirmation of diagnosis. All such cases, according to government health policy, shall be referred to appropriate Infectious Disease Hospital for further management.
22. Treatment of infertility by artificial insemination or other high technology procedures.
Nothing in this Term of use shall confer on a third party any benefit or the right to enforce any of these Terms of use.
INTELLECTUAL PROPERTY
All copyright, trademarks and other intellectual property rights contained therein the Wellness Plus App shall remain at all times the exclusive right of Wellness HMO and its licensors. You or any other person shall not copy, distribute or cause to be published any part or the whole content of the Wellness Plus App unless licensed by any of our licensors to do so. Therefore, limited access is granted only for personal information use and not for commercial purposes.
INDEMNITY CLAUSE
The Healthcare providers shall indemnify and hold harmless Wellness HMO from any and all claims, causes of action, liabilities, losses, damages, penalties, assessment, judgements, awards or costs including reasonable attorney’s fees and costs, arising out of, resulting from or relating to;
1. The breach of this agreement by healthcare providers.
2. The negligent acts or omissions of healthcare providers or any employees or agent of healthcare providers in the performance of their obligations under this Agreement.
FORCE MAJEURE
Wellness HMO shall not be liable for any failure or delay in performance of its obligation under these Terms of use arising out of or caused directly or indirectly by events outside reasonable control which includes but not limited to the following; acts of God; earthquakes; fires; flood; wars; civil or military disturbances; acts of terrorism; sabotage; strikes; epidemics; riots; power failure; computer failure and such other circumstances not foreseeable and beyond the reasonable control of Wellness HMO’s and not involving Wellness HMO’s fault or negligence.
BREACH
Without limiting other remedies, Wellness HMO may limit your activity, immediately remove your information, suspend or terminate your membership, and or refuse to provide you with access to the Wellness Plus App in the event, but not limited to:
1. If you breach the Terms and Conditions, or Privacy Policy or other rules and policies, if any;
2. If Wellness Healthcare Group is unable to verify or authenticate any information you provide;
3. If it is believed that your actions may cause legal liability for you, other users of the Wellness Plus App.
CONTACT
If you have any questions or comments about us, please contact in Wellness Healthcare Group or write us on;
Address; 9A, Jogunomi Steet, Gbagada Estate Phase II, Lagos
Phone no; 0700WELLNESS (070093556377), 08143290066 (Whatsapp only)
Email address: info@wellnesshealthcare.com.ng
APPLICABLE LAW
These Terms and Conditions, and the rights and obligations of the parties to the Contract shall be governed, interpreted and construed by the Nigerian Laws without regards to its conflict of law provisions.
SEVERABILITY
If any of these Terms and conditions is determined to be void unlawful, or unenforceable the validity and enforceability of the remaining Terms and condition shall not thereby be affected or impaired.
A user’s personal information is treated in accordance with our privacy policy and the use of the Wellness Plus App is subject to the terms of agreements signed with Wellness HMO.
MEMBERSHIP ELIGIBILITY
The use of the Wellness Plus App is only available to individuals however, corporate representatives of an individual can transact on behalf of the individual.
Subscription as a member of the Wellness Plus App connotes that you have paid the specified amount known as the premium for the plan opted for by you and this payment will be made on an annual basis or per service and in accordance with the terms mutually agreed by the parties. Please note, that where NO PREMIUM is paid for a particular year, NO SERVICE will be rendered when the risk occurs.
Subscription as a member does not in any way translate to being a shareholder or having a stake in Wellness Plus App.
YOUR ACCOUNT AND REGISTRATION OBLIGATIONS
If you use the Wellness Plus App, you shall be responsible for maintaining the confidentiality of your User ID and Password and you shall be responsible for all activities that occur under your User ID and Password. You agree that if you provide any information that is untrue, inaccurate, not current or incomplete that Wellness HMO has reasonable grounds to suspect that such information is untrue, inaccurate, not current or incomplete, or not in accordance with this Terms and Conditions, Wellness HMO has the right to refuse to provide you with access to the Wellness Plus App, or terminate or block access of your membership with the Wellness Plus App or fail to cover medical expenses when a bodily injury/ or sickness occurs.
CONDITIONS APPLICABLE
These Terms of use shall apply to and govern all plans relating to medical expenses necessarily and reasonably incurred by you to the maximum sum of Medical Limit agreed and as specified in the insurance policy in respect of each and every claim arising out of bodily injury and/or sickness occurring within the period of insurance and for which premium has been paid by client. All your conditions or other terms and conditions or warranties whatsoever whether communicated before or after these terms and conditions are excluded from the contract or any variation thereof unless expressly accepted by the Wellness HMO in writing, and your conditions shall not be regarded as a counter offer.
Unless otherwise stated, the conditions under which Wellness HMO shall operate includes in particular, but without limitation to the following:
1. It shall establish and maintain a network of credible healthcare providers across the nation. Such healthcare providers shall be presented to the Client and reviewed from time to time as may be required.
2. It shall be a pre-enrollment condition for the Subscriber to submit a properly completed Enrolment form along with the photograph and other specified details of Subscribers to be covered.
3. Each Subscriber shall be provided with an enrollee identification card. In emergency situations, a Subscriber shall use the said identification card to receive treatment in any other listed or non-listed healthcare provider while the Wellness HMO shall be notified within 48hrs of the commencement of such treatment; by any of the parties stated in the policy.
4. Where an enrollee subscribes newly or buy Wellness health plan for the first year, there will be a moratorium period (waiting period) of ONE month before access to care commences and NINE months waiting period for maternity(delivery) and surgical operations and procedures.
5. The healthcare provider shall treat a Subscriber only on proper identification which identification documentations shall be provided to the preferred healthcare provider by the Subscriber.
6. In the event of requiring urgent emergency evacuation by road, the Subscriber shall be required to give the details contained in the ID card provided such person is in a state of consciousness and capable of giving such information;
7. Where a Subscriber requires a replacement of already issued ID card for members of his family or on the need for replacement due to loss, an additional fee of ₦1000 shall be charged for each replaced or new card issued.
8. Each Subscriber shall have the right to select his healthcare provider from our provider network;
9. In the event of the Subscriber and family being separated, the Subscriber shall be entitled to select another healthcare provider for each member of the family;
10. In the event that the care being required cannot be delivered by the chosen healthcare provider, the Subscriber shall appropriately be referred to a secondary healthcare provider (Specialist) within the HMO’s healthcare providers’ network. Referral outside the network shall only be done when appropriate and expedient;
11. Where referrals are not in emergency situations and/or the Subscriber is not incapacitated, the Subscriber shall be conveyed to the referral center at his /her own cost;
12. In an emergency situation, the Subscriber shall be entitled to receive treatment in any healthcare provider outside the Wellness HMO network and a refund shall be made on production of verified fully filled reimbursement form, original receipts and medical report from the attending hospital or physician that is endorsed by Wellness HMO Officer. Kindly note that the Wellness HMO will be responsible in managing the situation with regards to the professional care needed.
13. A renewal notice shall be sent to a Subscriber at least thirty (30) days before the expiration of this policy.
14. In the event of renewal, payment for the subsequent year must be made one month before the expiration of the existing policy to avoid the deactivation of enrollee in the new policy year.
15. A subscriber shall inform Wellness HMO if at any the payment card expires and has not been renewed, or is limited, revoked or terminated or is no longer associated with your account.
16. Any Subscriber who accesses treatment in an out of network provider for non-emergency treatment shall be responsible for the cost of the treatment unless pre-authorization is given.
17. Secondary referral cases/special cases must be by referral from the general practitioner and shall be communicated to the Wellness HMO for approval. 18. Primary providers shall be the first point of call for all Subscriber with onward referral for specialist cases if required, either by the Primary provider or Wellness HMO.
19. Subscriber who wishes to change his/her primary provider due to negligence or poor care by the service provider must notify the Wellness HMO.
20. Wellness HMO reserves the right to accept or reject any request to provide our plan in its absolute discretion. If acceptance or rejection is not communicated within five (5) working days after receipt of the request, the request shall be deemed accepted.
21. Any subscriber who seeks for refund of premium or payment paid, must send the request for refund notice within 48hours. All requests after 48 hours will not be attended to.
22. Wellness HMO after the receipt of notice of refund, shall refund the premium or payment within seven (7) working days of such notice. Note however that Wellness HMO shall refund 80 percent only of the total premium paid.
23. The exercise by Wellness HMO of any right pursuant to these Terms of use shall be without prejudice to any other right available to it whether hereunder or under any applicable law.
24. Abuse of the scheme by the subscriber can lead to the termination of this contract by Wellness HMO.
DISCLAIMER OF WARRANTY
EXCEPT AS OTHERWISE SET FORTH IN THE WELLNESS PLUS APP INCLUDING WITHOUT LIMITATION THE CONTENT AND SERVICES PROVIDED BY WELLNESS HMO ARE PROVIDED ON AN “AS IN” BASIS FOR INFORMATIONAL PURPOSES ONLY AND WITHOUT WARRANTY OF ANY KIND, EITHER EXPRESSED OR IMPLIED, INCLUDING BUT NOT LIMITED TO, THE IMPLIED WARRANTIES OF MERCHANTABILITY AND FITNESS FOR A PARTICULAR PURPOSE AND NON-INFRINGEMENT. THE APP MAY INCLUDE INACCURACIES, MISTAKES OR TYPOGRAPHICAL ERRORS, WE DO NOT WARRANT THAT THE CONTENT WILL BE UNINTERRUPTED OR ERROR FREE.
To the maximum extent permitted by law, Wellness HMO shall not in any event be liable for indirect, exemplary, special or consequential loss or damages, to the maximum extent permitted by applicable law, our total liability to you for any claim shall not exceed the limit as specified in the policy and to the extent of your disclosure regarding the health of the Subscriber which gave rise to our liability, hence non-disclosure of an existing illness will not be treated under Wellness HMO plan.
RESTRICTION OF LIABILITY
Subscribers can have access to maternity after the one-month moratorium period that applies to all subscribers however the limit on surgical operation shall be applied to the request of a need for caesarian section at the point of delivery.
The parties agree and understand that the following healthcare delivery services are excluded from the scope of services to be provided by Wellness HMO.
1. Treatment of medical and surgical conditions not expressly stated in the policy.
2. The policy shall exclude the treatment of chronic renal failure to a certain limit of sessions
3. Treatment of all Cancers
4. Immunizations outside the scope stated in the policy.
5. Treatment of chronic organ disease e.g chronic liver disease, heart and kidney.
6. Pre-existing critical illnesses that are not declared during enrollment shall not be covered under the plan.
7. Artificial heart implantation and all organ transplants;
8. All forms of high-tech surgeries e.g. elective cosmetic surgeries, laser surgeries, laparoscopic surgeries and procedures, etc.
9. Self-inflicted injuries, drug addiction or alcoholism or treatment occasioned by the abuse and/or influence of alcohol or hard drugs;
10. Provision of hearing aids
11. Treatment of congenital anomaly/birth defects;
12. Treatment by alternative medicine and other unorthodox medical practice;
13. Provision of dentures, braces, capping, cosmetic dental procedures and other advanced restorative dental procedures;
14. Treatment resulting from participating in war and/or on the outbreak of war where such participation is voluntary, participating in riots, strike, civil commotion or any illegal act;
15. Treatment resulting from participating in motor racing, motorcycle racing and/or other high-risk sports;
16. Treatment outside Nigeria
17. Definitive treatment of Acquired Immune Deficiency Syndrome (AIDS), AIDS Related Complex Syndrome (ARCS) and all diseases caused by and/or related to Human Immunodeficiency Virus (HIV).
18. Treatment arising from occupational accidents, this is covered under the Client’s workmen compensation policy.
19. Treatment in the event of national epidemics.
20. Treatment of tuberculosis. Subscriber will be referred to government-designated specialized center.
21. Nigerian Federal Government identified notifiable diseases following confirmation of diagnosis. All such cases, according to government health policy, shall be referred to appropriate Infectious Disease Hospital for further management.
22. Treatment of infertility by artificial insemination or other high technology procedures.
Nothing in this Term of use shall confer on a third party any benefit or the right to enforce any of these Terms of use.
INTELLECTUAL PROPERTY
All copyright, trademarks and other intellectual property rights contained therein the Wellness Plus App shall remain at all times the exclusive right of Wellness HMO and its licensors. You or any other person shall not copy, distribute or cause to be published any part or the whole content of the Wellness Plus App unless licensed by any of our licensors to do so. Therefore, limited access is granted only for personal information use and not for commercial purposes.
INDEMNITY CLAUSE
The Healthcare providers shall indemnify and hold harmless Wellness HMO from any and all claims, causes of action, liabilities, losses, damages, penalties, assessment, judgements, awards or costs including reasonable attorney’s fees and costs, arising out of, resulting from or relating to;
1. The breach of this agreement by healthcare providers.
2. The negligent acts or omissions of healthcare providers or any employees or agent of healthcare providers in the performance of their obligations under this Agreement.
FORCE MAJEURE
Wellness HMO shall not be liable for any failure or delay in performance of its obligation under these Terms of use arising out of or caused directly or indirectly by events outside reasonable control which includes but not limited to the following; acts of God; earthquakes; fires; flood; wars; civil or military disturbances; acts of terrorism; sabotage; strikes; epidemics; riots; power failure; computer failure and such other circumstances not foreseeable and beyond the reasonable control of Wellness HMO’s and not involving Wellness HMO’s fault or negligence.
BREACH
Without limiting other remedies, Wellness HMO may limit your activity, immediately remove your information, suspend or terminate your membership, and or refuse to provide you with access to the Wellness Plus App in the event, but not limited to:
1. If you breach the Terms and Conditions, or Privacy Policy or other rules and policies, if any;
2. If Wellness Healthcare Group is unable to verify or authenticate any information you provide;
3. If it is believed that your actions may cause legal liability for you, other users of the Wellness Plus App.
CONTACT
If you have any questions or comments about us, please contact in Wellness Healthcare Group or write us on;
Address; 9A, Jogunomi Steet, Gbagada Estate Phase II, Lagos
Phone no; 0700WELLNESS (070093556377), 08143290066 (Whatsapp only)
Email address: info@wellnesshealthcare.com.ng
APPLICABLE LAW
These Terms and Conditions, and the rights and obligations of the parties to the Contract shall be governed, interpreted and construed by the Nigerian Laws without regards to its conflict of law provisions.
SEVERABILITY
If any of these Terms and conditions is determined to be void unlawful, or unenforceable the validity and enforceability of the remaining Terms and condition shall not thereby be affected or impaired.