Welcome to RiviaCare
Service Exclusions
Rivia Clinic Ltd is a licensed care provider. We provide healthcare services to SMEs and their employees. Through the RiviaCare membership program, we offer employee health benefits that are valid only when you seek care from us.
Below are the conditions, services, and situations that are either not covered under your RiviaCare membership or require prior approval from us before your benefits can be used.
Services and Conditions Not Covered by RiviaCare
The following categories of care are excluded from your standard RiviaCare membership and are not eligible for benefit use.
1. Beauty & Cosmetic Services
These are not medically necessary and will not be covered:
- Skin lightening
- Plastic surgery for appearance (e.g., nose reshaping, liposuction)
- Cosmetic dental work (e.g., teeth whitening, veneers)
2. Fertility & Family Planning
We do not cover fertility enhancement or reproductive services such as:
- Fertility treatments (IVF, IUI)
- Egg or sperm freezing
- Surrogacy-related procedures
3. Chronic Illness Management
Ongoing care for the following chronic medical conditions is not covered under your standard plan. If you are living with any of these conditions, please speak to your Rivia Doctor to discuss care options:
- Diabetes (Type 1 or 2)
- Hypertension (High Blood Pressure)
- Asthma (chronic)
- Epilepsy
- Thyroid disorders (e.g., hypothyroidism)
- Chronic kidney or liver disease
- Chronic heart conditions (e.g., heart failure, arrhythmia)
4. Long-Term or High-Cost Care
These services are beyond the scope of the membership and require separate financial arrangements:
- Kidney dialysis
- Organ transplants
- Long-term private nursing care at home
5. Unapproved or Experimental Treatments
We do not cover therapies that are not widely approved or scientifically supported:
- Herbal medicine mixtures
- Detox kits or alternative healing treatments
- CBD or cannabis-based products (unless prescribed and approved)
- Clinical trial medications
6. Care Received Outside Ghana
RiviaCare benefits do not apply to any healthcare services accessed outside of Ghana, even in emergencies.
7. Non-Essential Medications
These include:
- Medications for cosmetic or performance purposes (e.g., weight loss, bodybuilding)
- Sexual health boosters (e.g., Viagra, unless medically necessary)
- Wellness supplements (e.g., Wellman/Wellwoman, multivitamins, tonics)
- Brand-name medications where generics are available
Services That Require Pre-Approval
To ensure your care is medically necessary and coordinated properly, the following services must be approved by your Rivia Doctor first. If you get them without prior approval, your benefits may not apply:
1. Repeat Tests Within 30 Days
If you are doing the same lab or scan more than once in a 30-day period, it must be reviewed and approved.
2. Hospital Admissions Beyond 5 Days
If you are admitted to a hospital and your stay exceeds 5 days, your RiviaCare team will need to review and approve the extended stay for your benefits to apply to the additional days.
3. Surgeries Costing Over GHS 5,000
All high-cost or elective surgeries over this threshold must be reviewed by Rivia for your benefits to apply. And your surgery benefit amount is determined on a case-by-case basis.
4. Brand-name or Imported Medications
These must be reviewed before approval:
- Any medication not on Rivia’s essential list
- Imported medications not approved by the Ghana Food and Drugs Authority
- Brand-name prescriptions from third-party doctors
5. Multiple Specialist Visits for the Same Condition
If you’re seeing more than one specialist for the same issue within a short time, for example, two weeks, it must be pre-approved. And your benefits may not apply if the multiple visits are not clinically necessary, as determined by your Rivia Doctor.
Important Notes for Members
- Your benefits only apply when care is coordinated through your Rivia Doctor or Care Team.
- If you bypass this process (except during true emergencies), your benefits may not be used.
- We do not reimburse for services accessed at non-approved facilities or without our coordination. This is because we are not an insurance company or a financial services provider.