Your Guide to Accessing Care with RiviaCare
Our Healthcare Model
Rivia Clinic Ltd (“Rivia”) is a licensed healthcare provider, not a health plan or insurance company.
We exist to make healthcare equitable and accessible where traditional models have failed. And we want to work with you, our trusted member, as a partner in fixing that system.
How We Deliver Your Care
- We have an in-house team of experienced doctors and nurses providing actual care coordination and navigation to our members.
- We own and operate healthcare facilities in Ghana across locations like Dzorwulu, Labone, North Kaneshie, Koforidua, and Tse Addo.
- We partner with other facilities and doctors for referrals. They include: University of Ghana Medical Center, Inkoom Hospital, Afrah International Hospital, Resolve Medical Centre, and Nuffield Clinic, among others.
- Our on-site labs and pharmacies work alongside partners such as Synlab Ghana and Druggix Pharmacy for lab services and medications (including home delivery and sample collection)
- All medical bills come directly from Rivia, you won’t submit receipts or claim forms because we are your care provider
- Your employer pays Rivia directly through a membership package
- We coordinate every step of your care seamlessly so you can focus on your health
Required Care Coordination Process
Before Receiving Any Care:
You must first contact your Rivia care team or assigned doctor, except in emergencies or after 10 PM.
Ways to reach us:
- Phone call
- WhatsApp message
- Scheduled Video consultation
Hours of Access: 6:00 AM – 10:00 PM, daily
What Happens Next
A Rivia doctor will:
- Assess your health concerns and symptoms
- Offer immediate advice or treatment
- Require and coordinate lab sample collection and medication prescription and/or delivery
- Refer you to an appropriate health facility or specialist if need be, or where applicable
- Follow up on your progress and develop a treatment plan
Emergencies: When You Don’t Need to Call First
If you are experiencing a life-threatening emergency, go straight to the nearest hospital, even if not in the Rivia Network.
Common Emergencies Include:
Cardiovascular:
- Chest pain with shortness of breath
- Suspected heart attack or stroke
- Severe irregular heartbeat with dizziness
Respiratory:
- Difficulty breathing or choking
- Blue lips or fingertips
- Severe allergic reactions
Neurological:
- Seizures (especially first-time or lasting long)
- Sudden unconsciousness or confusion
Injury & Trauma:
- Heavy bleeding
- Broken bones
- Serious burns
- Eye or spinal injuries
Other Acute Situations:
- Severe abdominal pain with vomiting or fever
- Drug poisoning or overdose
- High fever (over 39°C) with serious symptoms
- Pregnancy-related emergencies (e.g., bleeding, early labor)
After-Hours Emergencies (10 PM – 6 AM):
- Call our 24/7 emergency line
- Go to an approved 24-hour partner facility
- Notify your Rivia care team within 24 hours of any emergency visit
Service Coverage Explained
Your RiviaCare membership is divided into three main areas of care. Each area has a specific coverage limit, depending on your plan. Here’s what they mean:
1. Outpatient Care
This covers everyday medical services that don’t require you to stay in a hospital overnight.
What’s Included:
- Consultations with general practitioners or specialists
- Diagnostics and lab tests (e.g., blood work, scans, x-rays)
- Prescribed medications
- Minor procedures (e.g., wound care, injections, nebulisation)
Where You’ll Receive This:
- At a Rivia facility or referred partner clinic during the day
2. Inpatient Care
This covers care that requires admission to a hospital for at least one night or more.
What’s Included:
- Hospital room and stay
- In-hospital treatments and nursing
- IV fluids, oxygen, or inpatient medications
- Monitoring and supportive care
- Admission for medical conditions (e.g., severe infections, asthma crisis, pregnancy complications)
Where You’ll Receive This:
- At Rivia partner hospitals or facilities with overnight care capacity
3. Surgeries
This includes surgical procedures, whether done as a day procedure or during a hospital stay.
What’s Included:
- Minor surgeries (e.g., abscess drainage, cyst removal)
- Major surgeries (e.g., hernia repair, appendectomy, caesarean section)
- Pre-surgical assessments
- Theatre costs and anesthesia
- Post-surgical follow-ups
Important:
- Surgeries above GHS 5,000 or non-emergency surgeries require pre-approval
- You’ll be referred to trusted surgical partners or facilities approved by Rivia
Note:
Your membership plan defines how much benefit you have for each of these areas. For example, if your total coverage is GHS 10,000:
- GHS 5,000 might be for Outpatient
- GHS 3,000 for Inpatient
- GHS 2,000 for Surgeries
Your Rivia Care Team will always help you understand how much of your benefit you’ve used and what’s remaining.
Your Membership Responsibilities
You Must:
- Contact us before receiving non-emergency care
- Attend appointments and take medications as prescribed
- Inform us of any emergency care within 24 hours
- Share health updates that affect your care
You Must Not:
- Seek care at non-approved facilities without coordination
- Share your membership benefits with non-approved dependents or friends
- Use emergency services for non-urgent issues
- Ignore treatment plans or Rivia medical advice
- Submit false or misleading health information. We will not be held responsible for any consequences.
What Happens If You Don’t Follow the Care Delivery Process
- You may have to pay the full cost of care out of pocket
- Your benefits may be temporarily suspended
- Future care may require stricter review
- Repeated (2 or 3 occasions ) violations may lead to the cancellation of your membership
Services That Require Pre-Approval
You need Rivia’s approval before accessing these services:
- Hospital admissions longer than 5 days (for your RiviaCare benefits to apply)
- Surgeries that cost more than GHS 5,000
- Repeat diagnostic tests within 30 days
- Referrals outside of our network
- Brand medications when effective alternatives/generics exist
- Any treatment at a non-partner facility
See the full Service Exclusions & Pre-Approval List here
How Your Benefits Work
- Benefits are based on your membership tier
- Coverage applies only to approved services and the specific service coverage according to your RiviaCare plan.
- Annual limits reset each year and do not roll over
- Benefits only apply when you seek care with us
Important Notes:
- Services must be medically necessary
- We follow evidence-based guidelines
- Generic medications are preferred
- Rivia will always recommend cost-effective treatment options
Our Commitment to You
Quality of Care:
- Access to licensed doctors and nurses
- Prompt appointments and service
- Seamless care from consultation to follow-up
- 24/7 emergency guidance
Transparency of Service:
- Clear communication about your benefits
- No surprise charges
- Easy access to your care records
- Honest conversations about your care options
Contact & Support
- Care Line: +233 24 725 7966
- WhatsApp: +233 24 725 7966
- Email: care@riviaco.com
- Emergency Hotline: +233 24 725 7966
- Office Hours: Monday–Friday, 8:00 AM – 6:00 PM
Dispute Resolution
If you disagree with a decision about your care or benefits:
- Contact Rivia Member Support within 30 days through experience@riviaco.com, or call +233 24 725 7966
- Submit a request for formal review with supporting documents
- Ask for an independent medical review if needed from a licensed third-party provider.
- Final appeals are reviewed by the Rivia Medical Board
Your Privacy Matters
Your health information is:
- Protected under Ghana’s Data Protection laws, and we are licensed
- Only shared with healthcare professionals involved in your care
- Used strictly for care delivery and coordination
- Available to you upon request
We are People Caring for People
Rivia is more than a care provider, we’re your healthcare family. Our model works because we work with you, not behind you. Together, we’re creating a future where quality healthcare is personal, fair, and always within reach.
Have questions or need support? Call, message, or visit us anytime.
We are people, caring for people.