Ever wondered what HMO stands for and how it works? In short, an HMO, or Health Maintenance Organization, is a type of health insurance plan that emphasizes preventative care and uses a network of doctors and hospitals. In this blog post, we will dive deeper into HMOs, explaining how they function and how they might benefit you.
What is an HMO?
A health maintenance organization (HMO) is a health insurance plan that uses a network of doctors and hospitals to provide health insurance coverage for a monthly or annual fee.
HMO is an acronym for ‘Health Maintenance Organisations’ in Nigeria. These organizations are charged with the responsibility of managing the provision of standard healthcare 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
HMOs primarily serve companies with at least five employees. They offer healthcare plans to companies for their employees and their families. Here’s the process breakdown:
- Network & Plans: Each HMO has a network of approved hospitals and clinics. They offer various healthcare plans with different coverage levels and costs (premiums).
- Company Chooses Plan: Companies choose a plan (or multiple plans) for their employees based on budget and desired coverage.
- Enrollment & Payment: Employees choose a specific plan from the company’s options. The company pays the premium to the HMO, covering enrolled employees for a set period (usually a year).
- Seeking Care: Employees use in-network hospitals/clinics from the HMO’s list(e.g Hygeia HMO, Avon HMO)
- Treatment & Payment: The HMO directly pays the hospitals for covered services used by employees.
What does the HMO premium cover?
HMO plans cover almost everything as regards 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 work best.
An HMO plan has many benefits and covers all but is 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 mentioned above. The services are dependent on the choice of plan for a given period.
Why is HMO in Nigeria a better option?
There are several reasons why you should choose an HMO plan instead of traditional health insurance, and they include the following
- There is high coordination between the HMO provider, and the healthcare provider makes it easy for clients to access healthcare services
- It is cheaper to maintain and easy to administer
- Many HMO plans do not have deductibles
- It is often the best choice in the case of an emergency.
How to Apply for HMO in Nigeria?
Enrolling in a Health Maintenance Organization (HMO) in Nigeria can be a great way to manage your healthcare needs. Here’s a breakdown of the process, making it simple and informative:
- Pick Your Plan: Research HMOs and pick one with hospitals you like and coverage that fits your needs (family, individual, etc.).
- Enroll Yourself: Visit the HMO office with your ID, contact info, and (if employed) proof of income. Choose a plan and pay the fee. You’ll get an ID for HMO-approved hospitals.
- Employer Handles It? If your company offers HMOs, ask HR. They might register you and deduct costs from your salary.
- Add Family (Optional): Bring marriage certificate (spouse) and any needed documents for dependents when enrolling them.
- Pay Your Way: Choose monthly payments through your bank or a one-time payment – the HMO will explain the options.
Frequently Asked Questions
Is HMO Compulsory in Nigeria?
HMO is not compulsory in Nigeria but we recommend you buy it for yourself and your household. Health Maintenance Organizations (HMOs) play a significant role in providing healthcare services in Nigeria.
HMOs act as intermediaries between healthcare providers and individuals covered by health insurance, coordinating and managing the delivery of healthcare services.
They strive to ensure that policyholders have access to quality healthcare and facilitate the settlement of claims between insurers and healthcare providers.
It is important to note that the specific details and requirements of health insurance coverage, including the involvement of HMOs, may vary depending on the type of insurance plan, the insurance provider, and other factors.
Therefore, it is advisable to consult with relevant authorities, insurance companies, or healthcare providers to obtain accurate and up-to-date information.
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)