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Welcome
Health Plans
Introduction
Corporate Health Plan
Retail and SME Health Plan
Sweet Sixties
Mellow 70s
International Health Plan
Diaspora Health Plans
Get a Quote
Benefits
Products and Services
Metro Telemedicine
Pre-Employment Screening
About
About MetroHealth HMO
Leadership Team
Board of Directors
Testimonials
Providers
Blog
Support
FAQs
Contact Us
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Corporate Plan Form
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Step
1
of
11
Sub-plans
Benefits & Prices
Pick a sub-plan of choice
*
Metro Mini
Metro Midi
Metro Maxi
Metro PPP
Company Name
*
Staff ID
*
Principal's Personal Details
Surname
*
First Name
*
Middle Name
Gender
*
Please select
Please select
Male
Female
Date of Birth
*
E.g: 04 June 1982
Marital Status
*
Please select
Please select
Single
Married
Type of coverage
*
Please select
Please select
Individual
Individual & Spouse
Individual & Family
Any pre-existing medical condition?
*
Yes
No
State Conditions
*
Principal's passport photo
*
Drop Passport photo here or click to select
% Completed
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Supported formats: jpg, png | Photo size limit: 1 mb
Principal's Contact Details
Email
*
Phone
*
Residential Address
*
State
*
Local Government
*
Principal's Health Care Provider
1. Search for Health Care Provider (Mini)
*
Type any: State | City | Town | Name of Hospital | Street | Landmark
1. Search for Health Care Provider (Midi)
*
Type any: State | City | Town | Name of Hospital | Street | Landmark
1. Search for Health Care Provider (Maxi)
*
Type any: State | City | Town | Name of Hospital | Street | Landmark
1. Search for Health Care Provider (PPP)
*
Type any: State | City | Town | Name of Hospital | Street | Landmark
How Many Dependants?
*
Please select
Please select
0
1
2
3
4
5
Spouse Details
Please note that it is very important that each dependent selects a Primary Care Provider. All Medical and Health Care needs must be provided or arranged by the Primary Care Provider.
Surname
*
First Name
*
Middle Name
Gender
*
Please select
Please select
Male
Female
Date of Birth
*
E.g: 04 June 1982
Any pre-existing medical condition?
*
Yes
No
State Conditions
*
2. Search for Health Care Provider (Mini)
*
Type any: State | City | Town | Name of Hospital | Street | Landmark
2. Search for Health Care Provider (Midi)
*
Type any: State | City | Town | Name of Hospital | Street | Landmark
2. Search for Health Care Provider (Maxi)
*
Type any: State | City | Town | Name of Hospital | Street | Landmark
2. Search for Health Care Provider (PPP)
*
Type any: State | City | Town | Name of Hospital | Street | Landmark
Spouse's passport photo
*
Drop Passport photo here or click to select
% Completed
0
Supported formats: jpg, png | Photo size limit: 1 mb
Dependant 1 Details
Surname
*
First Name
*
Middle Name
Gender
*
Please select
Please select
Male
Female
Date of Birth
*
E.g: 04 June 1982
Any pre-existing medical condition?
*
Yes
No
State Conditions
*
3. Search for Health Care Provider (Mini)
*
Type any: State | City | Town | Name of Hospital | Street | Landmark
3. Search for Health Care Provider (Midi)
*
Type any: State | City | Town | Name of Hospital | Street | Landmark
3. Search for Health Care Provider (Maxi)
*
Type any: State | City | Town | Name of Hospital | Street | Landmark
3. Search for Health Care Provider (PPP)
*
Type any: State | City | Town | Name of Hospital | Street | Landmark
Dependant 1 passport photo
*
Drop Passport photo here or click to select
% Completed
0
Supported formats: jpg, png | Photo size limit: 1 mb
Dependant 2 Details
Surname
*
First Name
*
Middle Name
Gender
*
Please select
Please select
Male
Female
Date of Birth
*
E.g: 04 June 1982
Any pre-existing medical condition?
*
Yes
No
State Conditions
*
4. Search for Health Care Provider (Mini)
*
Type any: State | City | Town | Name of Hospital | Street | Landmark
4. Search for Health Care Provider (Midi)
*
Type any: State | City | Town | Name of Hospital | Street | Landmark
4. Search for Health Care Provider (Maxi)
*
Type any: State | City | Town | Name of Hospital | Street | Landmark
4. Search for Health Care Provider (PPP)
*
Type any: State | City | Town | Name of Hospital | Street | Landmark
Dependant 2 passport photo
*
Drop Passport photo here or click to select
% Completed
0
Supported formats: jpg, png | Photo size limit: 1 mb
Dependant 3 Details
Surname
*
First Name
*
Middle Name
Gender
*
Please select
Please select
Male
Female
Date of Birth
*
E.g: 04 June 1982
Any pre-existing medical condition?
*
Yes
No
State Conditions
*
5. Search for Health Care Provider (Mini)
*
Type any: State | City | Town | Name of Hospital | Street | Landmark
5. Search for Health Care Provider (Midi)
*
Type any: State | City | Town | Name of Hospital | Street | Landmark
5. Search for Health Care Provider (Maxi)
*
Type any: State | City | Town | Name of Hospital | Street | Landmark
5. Search for Health Care Provider (PPP)
*
Type any: State | City | Town | Name of Hospital | Street | Landmark
Dependant 3 passport photo
*
Drop Passport photo here or click to select
% Completed
0
Supported formats: jpg, png | Photo size limit: 1 mb
Dependant 4 Details
Surname
*
First Name
*
Middle Name
Gender
*
Please select
Please select
Male
Female
Date of Birth
*
E.g: 04 June 1982
Any pre-existing medical condition?
*
Yes
No
State Conditions
*
6. Search for Health Care Provider (Mini)
*
Type any: State | City | Town | Name of Hospital | Street | Landmark
6. Search for Health Care Provider (Midi)
*
Type any: State | City | Town | Name of Hospital | Street | Landmark
6. Search for Health Care Provider (Maxi)
*
Type any: State | City | Town | Name of Hospital | Street | Landmark
6. Search for Health Care Provider (PPP)
*
