Home / Existing conditions, renewals & refunds
Before you blame anyone, play this game
100 people. One pot of money. Who should it pay for?
If you were told your health plan won't renew, or that your blood pressure, diabetes or asthma "isn't covered", this page explains exactly why, in plain naira. Then it shows every honest option you have, including how to complain.
The short version
- Clear Value and Clear Advantage are priced for people who are healthy when they join.
- A condition you already had (high blood pressure, diabetes, asthma, sickle cell, pregnancy) is excluded on these plans.
- At renewal, Clearline looks at the year's claims. If they show a condition that existed before you joined and wasn't declared, renewal on the same plan can be declined.
- Clear Elite is the retail plan built for people who already live with a condition. A company group plan is the other route.
- You always have a written path to be heard. It's at the bottom of this page.
Insurance is a game of numbers
Move the slider. Watch the pot.
100 people each pay ₦84,000 for Clear Value. That's a pot of ₦8.4 million for the year. In a normal year, a few of them fall ill and the pot pays. Now let people join who are already on blood-pressure drugs every month.
Illustration, not Clearline's actuarial figures: a healthy member is assumed to claim about ₦60,000 a year on average; a member already on blood-pressure treatment is assumed to need about ₦270,000 a year (₦22,500 a month in drugs and reviews, the middle of the ₦15,000–₦30,000 range below) before any admission.
Why it's not personal
A plan is a promise to 100 people, not one.
An insurance price is set on a guess: most people who join are well, and only a few will fall ill this year. That's why ₦84,000 can buy up to ₦450,000 of care. It works only because the healthy people's money pays for the unlucky few.
A condition you already have isn't a risk any more. It's a certain, monthly cost. If the cheapest plans paid for it, the price would have to rise for everyone, or the plan would run out of money and fail the people who fall ill suddenly. That's the whole reason. Every HMO and insurer in the world works this way. The difference is whether they tell you before you pay.
So here is the honest rule at ClearlineHMO, before you pay: tell us what you have, and we'll put you on the plan that will actually pay for it.
What "pre-existing" means
Any illness, symptom or treatment that started before your cover began, whether or not a doctor had named it yet. Common examples:
- High blood pressure, or taking BP drugs
- Diabetes
- Asthma, sickle cell, epilepsy
- Kidney, heart or thyroid conditions
- Pregnancy that started before cover
If you're not sure, declare it. A declared condition is a conversation. An undeclared one found later is a lost plan.
What it costs without a plan that covers it
Real numbers, not scare stories.
Common drug prices, 2019 vs late 2023
| Medicine | 2019 | Nov 2023 |
|---|---|---|
| Paracetamol (pack) | ₦40 | ₦150 |
| Augmentin 625mg | ₦4,000 | ₦26,000 |
| Beecham Ampiclox | ₦750 | ₦9,000 |
| Coartem | ₦1,600 | ₦3,000 |
Source: SBM Intelligence "Paying the Price on Health" survey, reported by Peoples Gazette, December 2023. Prices have risen further since; check today's price at your pharmacy.
Your own numbers
Should you pay for it yourself, or get Clear Elite?
Honest answer: if all you'll ever need is the monthly drugs, paying yourself can be cheaper. A plan earns its money on the day the drugs stop being enough: the stroke, the kidney problem, the admission. Put in your figures.
Clear Elite: ₦3,000,000 global limit a year, private ward, ICU, CT/MRI, built for people who already have a condition. Confirm what your condition gets in the benefit package before you pay: plans & benefit PDFs.
Every honest option
You already have a condition. Here's what works.
Clear Elite · ₦600,000 a year
The retail plan built for existing and chronic conditions. Declare your condition; Clearline confirms what is covered before you pay.
Get an Elite invoiceSave toward Elite with Save to Cover
Save daily or weekly into your own reference until the premium is complete. Cover starts when it's paid, not while you save, so start early.
See Save to CoverA company group plan
Group plans spread risk across a whole staff, so they are often written to include existing conditions. Ask HR, or send me your HR contact and I'll do the work.
Show my employer the numbersStay on Value or Advantage, condition excluded
Some people keep a cheaper plan for everything else (malaria, accidents, surgery) and pay for their BP care themselves. This works only if Clearline agrees in writing at renewal. Never assume it.
Ask Azuka to request itSee a doctor about your condition now
A licensed doctor by phone or video, from home, while your plan is sorted out.
Talk to a doctorMix plans in one family
Elite for the person with the condition, Clear Value for everyone else. You don't have to put the whole family on the dearest plan.
Build a family invoiceJoining, step by step
How registration works
Renewing, step by step
What happens at renewal, and what we look at
If your renewal was declined, or you feel treated unfairly
Your path to be heard. In writing, with dates.
There's no automatic refund at Clearline, and I won't promise you one. What I promise is a fair hearing, a written answer and every option on the table.
- Talk to me firstWhatsApp Azuka on 0806 838 7128. Tell me what happened. Don't send medical reports on WhatsApp; I'll tell you where to send them safely.
- Your options in writing within 3 working daysUsually: move to Clear Elite with what you've already paid counted toward it (where Clearline approves), stay on your plan with the condition excluded, or a family mix. You choose.
- Clearline reviews your caseIf none of those works for you, I'll put a written request to Clearline for review, including any credit or refund for cover you didn't receive. Each case is decided individually by Clearline.
- Clearline Client ServicesCall 0700 245 245 245, or write to Clearline International Limited, 290 Ikorodu Road, Anthony, Lagos.
- The regulatorIf you're still not satisfied, you can complain to the National Health Insurance Authority (NHIA). Clearline's NHIA code is 003.
These buttons only open WhatsApp with a short message. Nothing about your health is sent to this website or to any advertiser.
Questions people ask me
Straight answers
I paid for a year. Why can't I just renew?
Each renewal is a new year of cover, priced on what the year's claims showed. If they show a condition that started before you joined and wasn't declared, the cheaper plan wasn't priced for it. You aren't being punished: the plan that fits you is a different one.
Can I get a refund?
There's no automatic refund policy. If you received the year of cover you paid for, that premium paid for a year of protection, the same way car insurance is spent even if you never crashed. If you believe you paid for cover you didn't receive, ask through the path above and Clearline will review it.
Isn't Clear Elite just more expensive?
It costs more because it pays for more: up to ₦3,000,000 a year, private ward, ICU, scans, and conditions the cheaper plans exclude. One week in hospital at ₦102,000 a day is ₦714,000, more than a year of Elite.
I didn't know I had high blood pressure when I joined.
Tell me exactly that. A condition first found after you joined is treated differently from one you were already treated for. Clearline decides on the records, so be precise about dates.
Will declaring my condition stop me from being covered?
No. It changes which plan is right. Declaring protects you: you start on a plan that pays for your condition, and nobody can say later that you hid it.
Who sees my health information?
Only ClearlineHMO, for your cover. This website doesn't send health answers to Facebook, Google or any advertiser, and the WhatsApp buttons send nothing until you press send.