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HMO – Meaning and How it Works

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Choosing from an array of health insurance plans from an insurance company is mostly limited to a specific type of health issues. However, HMO plans make things more convenient, and it broadens the scope of benefits for the beneficiary of the scheme.

HMO stands for Health Management Organizations in Nigeria. These organizations are charged with the responsibility of managing the provision of standard health care services via a network of hospitals under the plan. They serve as a middleman between the hospital and clients seeking healthcare services.

How HMO works in Nigeria

The users of HMO are companies with at least five employees. The Health Management Organization offers its services to companies seeking to provide healthcare services for its employees as well as their families. The arrangement works in the following way

  1.  The HMO company has a list of Healthcare service provider that can serve its clients (companies). 
  2. The HMO offers its services to companies seeking to provide healthcare for its employees. The services are offered under different product plans.
  3. An agreement is made depending on the type(s) of HMO plan the company’s employees opt for including the premium attached to it.
  4. The company agrees to pay the premium, which will cover the employees of the company based on their choice of products. Their choice of products is subject to the conditions of that plan for a stipulated time which is usually a year. 
  5. The employee selects a hospital from the list of healthcare service providers of HMOs like Hygeia HMO, Avon HMO, and so on.
  6. When an employee or any person eligible under the HMO scheme falls ill, the hospital is liable to attend to the patient if that was the choice of the healthcare provider as well as other considerations.
  7. The hospitals are often paid upfront regardless of whether the patient uses it or not.
Read this -  5 Things to consider before choosing HMO Provider

What does the HMO premium cover?

HMO plans covers almost everything as regards to healthcare services ranging from medical checkups to major or minor surgery. However, there are restrictions based on the type of plan you opt for. Many HMO organizations would group their services into different categories, and the customer would have to select which plans works best. 

An HMO plan has many benefits and covers all but not limited to the following services mentioned below.

  • Ambulance Service
  • Dental care
  • Optical care 
  • General Outpatient and in-house specialist consultation
  • Admissions
  • Accident and Emergencies
  • Prescribes Medicines and Drugs
  • Physiotherapy
  • Scans
  • Antenatal and childbirth
  • Minor Surgeries and procedures
  • X-rays, Laboratory & Diagnostic Test

However, not all the plans offer the services as mentioned above. The services are dependent on the choice of plan for a given period.

Why is HMO a better option?

There are several reasons why you should choose an HMO plan instead of traditional health insurance, and they include the following

  1. There is high coordination between the HMO provider, and the healthcare provider makes it easy for clients to access healthcare services
  2. It is cheaper to maintain and easy to administer
  3. Many HMO plans do not have deductibles
  4. It is often the best choice in the case of emergency

Conclusion

Government officials and Civil Servants are also covered by a similar HMO scheme which is administered and managed by the NHIS (National Health Insurance Scheme)

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