WAITING PERIODS: Waiting periods of between 6 - 24 months may apply to coverage of the following benefits, where purchased:

• Dental Benefits (6 Months)
• Wellness checks (9 months)
• Optical Benefits (12 Months)
• Psychiatric/Mental Disorders & Illnesses - Outpatient Services only (12 Months)
• Infertility Investigations (12 Months)
• Minor/ Intermediate Surgical Procedures including Treatment of Hemorrhoids, Fibroids, Hernia, and Adenoidectomy (12 Months)
• All expenses associated with HIV/AIDS and related conditions (12 Months)
• Management of Chronic Conditions (24 Months)
• Maternity and Child Delivery Benefits including: Pregnancy, Childbirth, Maternity Benefits, Abortion, Miscarriage, Antenatal Care, Obstetric Scans, Post Natal Care, Neonatal Care, Caesarean Section Delivery, etc. (18 Months) Limits apply

EXCLUSIONS: The following conditions/ treatments/services are not covered by any of our health plans. Please refer to your health plan's detailed benefits

• Birth defects, congenital condition or illness, autoimmune disorders, sickle cell anaemia, conditions and illnesses related to genetic disorders;
• Psychiatric Institutionalization;
• Any medical service required or injuries sustained as a result of Military, Para Military or Militant service or operations;
• Any medical service required or injuries sustained as a result of Hazardous sports including but not limited to water sports, mountaineering, hunting, motor racing, riding or driving in any kind of race and professional participation in leagues of any sport;
• Any medical service required or injuries sustained as a result of Air travel except as a fare paying passenger in any aircraft licensed for passenger carrying;
• Any medical service required or injuries sustained as a result of War (declared or undeclared), riot, strike, and civil commotion; or acts of God or acts of terrorism;
• Any medical service required or injuries sustained as a result of Intentional self-injury, suicide or attempted suicide (whether sane or insane), chronic venereal disease, member's own criminal act, intoxication, the use of drugs not prescribed by a physician or injury sustained whilst in a state of insanity, alcoholism or costs resulting from dependency on or abuse of drugs or other addictive substances and drug rehabilitation;
• Consultations or treatment by chiropractors, acupuncturists, herbalists, complimentary/traditional medical practitioners or unrecognized consultants, hospitals, family doctors, therapists, dental practitioners;
• Pre - Existing Conditions. Any medical treatment required, relating to an accident or illness which may have occurred prior to the effective date or to any illness where it was within the knowledge of a member that was suffering from it at the effective date;
• Overseas Treatment/ Investigations;
• Organ Surgery and Transplants ;
• Plastic/Cosmetic Surgeries and/or Treatments;
• Embalmment, Autopsies, Mortuary Services;
• Cancer Investigation or Treatment such as chemotherapy or radiotherapy;
• Investigations not as listed under covered services or Treatments for problems relating to Infertility, e.g. IVF, GIFT, Artificial Insemination; and Virility Enhancing Drugs;
• Neonatal Care not listed under services
• Speech Disorders
• Treatment of Obesity & Weight Loss
• Elective Caesarean Section
• Renal Dialysis
• Dental Surgical Extraction not as listed under cover services
• Herbal Drugs, Non-Prescription Drugs, Food Supplements, Dietary and Nutrition Supplements, Experimental Drugs and Treatments;
• Dental treatment unless otherwise stated to be covered by the specific plan
• Optical services unless otherwise stated to be covered by the specific plan
• Hearing tests or costs of hearing aids;
• Any injury, illness or disease specified as an exclusion and complications caused by a condition that is excluded or follow up treatments or investigations that are due to a condition that is excluded;
• Home Care, Domiciliary Care;
• Joint Replacements;
• Supply of Prosthesis (Artificial Limbs, Dental Prosthesis);
• Hormonal Replacement Therapy;
• Speech Disorders, Learning Difficulties, Behavioural & Developmental Problems;
• Burns greater than 9%;
• All expenses in respect of illnesses/conditions that were subject to waiting periods when the member and dependants joined the plan
• Treatment protocols that are not normal, customary or standard practice within Nigeria
• Any other medical service not listed in the table of benefits on the health plan
• Any condition, treatment, procedure, or service that is related, is in connection with, or is required as a follow-up to an exclusion.

Please refer to your health plan's detailed benefits

Declaration:

Any misrepresentation or non-disclosure of material or factual information will render all obligations under by the scheme null and void. In addition, any payment made by Avon HMO will be recoverable from the member.

1. I/We, the undersigned member(s) & dependents where applicable:
   1. Hereby apply for myself, & and co-members/family members (where applicable) to be registered on the Avon HMO Scheme and have read, understood and agree to abide by the Rules of the Scheme;
   2. Warrant that the contents of this application and any other documents which may be required in support thereof are true, correct and complete;
   3. Understand that answers provided herein form the basis of this contract and any misrepresentation of such or non-disclosure of any information which is material to the assessment of this application shall render the contract to which this application relates null and void and all premiums paid shall be forfeited;
   4. Understand and accept that no benefit will be payable by the Scheme unless they are satisfied as to the validity of a claim and have received all requirements which they may deem necessary including the results of medical examinations and tests that they may require me to undertake;
   5. Acknowledge and accept that the Scheme reserves the right to cancel membership of the Scheme if any due premium is not paid on the due date;
   6. Acknowledge and accept that the subscription to the Scheme is non-refundable and non-transferable.
2. Accepting that I am curtailing my right to privacy but in order to facilitate the assessment of the risks and the consideration of any medical claim, I irrevocably authorize;
   1. The Scheme to obtain from any person, whom I hereby so authorize and direct to give, any information which the Scheme deems necessary;
   2. I further authorize and instruct the Scheme and any hospital concerned to give away information relating to myself to the Medical Case Managers appointed by the Scheme;
   3. I understand and accept that the above authorization constitute a partial waiver of and my right to privacy