Venus Medicare Limited
1 plan · 3 documents across the knowledge base
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SLA (Service Level Agreement)not approved1 doc
- SLA commencement / effective date— 25 February 2025 — the Agreement is dated 25 February 2025 on page 2 (opening line), and clause 9.1 ties the effective date to that page-1/front date. Term is one (1) year, renewing automatically for subsequent one-year terms.
- Pre-Authorization thresholdno value
- Services always needing Pre-Authorizationno value
- Claim submission deadline— 30 days after completion of services. Submission frequency (daily, weekly, fortnightly or monthly) is the Provider's choice.
- Payment timeline— Not exceeding thirty (30) days from submission of all clean claims/invoice. Note the separate deposit mechanism in clause 4.1: VML places a deposit with the Provider from which fees are deducted, the Provider notifies VML at 80% utilisation, and VML tops up; where the deposit is exhausted before notification, VML pays the excess plus the top-up.
- Exclusionsno value
- Co-payment rulesno value
- Emergency treatment rules— In an emergency the Provider may request Pre-Authorization AFTER stabilising the patient, but must do so within 24 hours of commencement of care (Clause 1.19). Emergency is defined in Clause 1.10 as a sudden or unexpected onset of a condition requiring medical or surgical care which, absent that care, could reasonably be expected to cause serious physical impairment or death — listing heart attacks, severe chest pain, cerebrovascular accidents, haemorrhaging, poisonings, major burns, loss of consciousness, serious breathing difficulties, spinal injuries, and other acute conditions as determined by the admitting consultant. Emergency is also an express exception to the pre-service eligibility-verification payment bar in Clause 1.9.
- Dispute / reconciliation process— Two stages: (1) amicable settlement by mutual discussion; (2) if unresolved within 14 days of the commencement of those discussions, referral to arbitration under the Arbitration and Mediation Act 2023, seat in Abuja (or another suitable place in Nigeria as agreed). The award is final and binding save for arbitrator misconduct or error on the face of the award. The clause survives termination. Clause 10.7 separately obliges both parties to meet and confer in good faith on encounters/claims and authorization problems.
- Tariff reference and review cycle— The price list is the "Agreed Tariff Rates (Annexure 1)", and the rate applied is the one in force at the time the service was rendered (Clause 4.1). There is no fixed periodic review cycle; review is initiated on notice: the Provider must give VML 1 month's written notice of intention to review, VML must consent in writing before implementation, and the revision is executed as an addendum with no retroactive effect (Clause 2.18). Where a covered service is not listed in Annexure 1 and this is discovered at the point of care, the Provider must inform VML and agree a price in advance of providing the service (Clause 4.2). Annexure 1 itself is not part of the supplied document — the officer needs the signed Annexure 1 tariff schedule and any executed addenda to know the operative prices.
- Scheme type (fee-for-service / capitation)— Fee-for-Service is the adopted reimbursement methodology. Capitation is possible only if separately agreed between the Parties under a separate agreement for that purpose — no such capitation agreement is in the supplied document.
- Termination / notice period— Sixty (60) calendar days' written notice, with or without cause, effective at the end of the Contract Year (Clause 9.2). The Provider may also terminate on 60 days' written notice for the specified grounds in Clause 9.3.1, which include VML's habitual negligence or continued failure to pay claims duly invoiced under Clause 2.17. VML may terminate immediately on written notice for the Clause 2.11 events (except 2.11(g)), for non-compliance with Clause 2.4, or where it determines a Beneficiary's health, safety or welfare is jeopardised (Clause 9.3). Separately, the Provider must give not less than thirty (30) days' prior notice before suspending, withholding or withdrawing services for breach (Clause 2.4). On termination, the Provider must complete all Treatment in Progress and is paid at the most current Agreed Tariff Rates until transfer of Beneficiaries or an alternate payment source is found (Clause 9.4(b)); records must be kept at least five (5) years (Clause 9.4(c)).
Tariffnot approved1 doc · 2069 prices
- Tariff effective datenot found
- Priced service list— 2069 priced services
- Price review cycleno value
- Currencynot found
Plans (1 documented)
Date register
Every date in this provider's knowledge base, and how it was arrived at. Variation here is the usual reason two documents disagree.
01 Jan 2025Plan — GOLD FAMILY CAT. 2B (NR)
GOLD FAMILY CAT. 2B benefit table (typed)
Date from: entered by the officer
🚩 No dateSLA
2025-02-25-NMSL-VenusMedicare-SLA.pdf
Cannot be shown to have applied on any date of service. Set the date on the document to clear this.
🚩 No dateTariff
venus-tariff-UNDATED.xlsx
Cannot be shown to have applied on any date of service. Set the date on the document to clear this.
Plans
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- GOLD FAMILY CAT. 2B (NR)Open knowledge
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