One of the best choices you can make is buying health insurance. You never know what will happen the next minute and that makes securing your access to healthcare a very smart move.
However, choosing a health insurance provider or Health Management Organisation (HMO) in Nigeria is not exactly easy.
Think of it as walking in a dark room with your eyes closed. Everyway difficult isn’t it?
This is because there isn’t much information available especially to you.
It is however important that you have good knowledge of health insurance as it involves your life and your money. Two things you definitely don’t joke with.
In this post, we will be shedding light on how to choose a health insurance provider. Six important factors we should consider are:
1. Their Premium Insurance Plans Versus Your Demographics
When it comes to making choices, you always have to compare. Just like picking an article or something at the market, you have to compare with available options and your preference.
When you are comparing health plans, you should be looking at your age, marital status or family situation and if your dependents are covered, coverage for any pre-existing health conditions you may have, etc.
Note that the more ‘baggage’ you have the higher your premiums. This is a fair trade-off, in the long run, to be honest.
Look at your pocket and balance that with what works for you.
2. The Insurance Company’s Parent Organisation
Once upon a time, a number of reputable banks went into the business of financing health care. GTBank set up GT Assure (formally Mansard and now AXA Mansard), UBA set up Marina Medical Services (MMSL).
Based on the CBN directives (regulations), these banks have over the years had to divest these arms of their operations.
That notwithstanding, the structure and culture of excellence from their parent companies still remain within the fabric of these insurance companies.
As a business move, some big-name hospitals have also had to set up their own Health Management Organisations (HMO). The Reddington set up Red Care, Lagoon is affiliated with Hygeia HMO (Set up in 1984), Avon Medical Services-Avon HMO.
Shh… let me let you in on a secret; they will be partial to their babies or ‘flagship hospitals’ as they are fondly called.
No matter how efficient HMO A is, you will get relatively smoother services and less red tape from HMO A (which was started by Hospital A, its parent company) when receiving services from Hospital A than you would in a non-affiliated Hospital B.
Some multinationals came into Nigeria to become affiliates of/ set up HMOs. These include entities such as Liberty Health in 1998 – the parent company of Total Health Trust (THT) HMO and AXA Italia (AXA Mansard).
It stands to reason that these providers would be more structured and be more compelled to follow international best practices because they are accountable to both the National Health Insurance Scheme and their parent companies outside Nigeria.
Oh, and before I forget, if you are the type that embarks on frequent international trips, your cover can be extended or modified to reach the countries you are visiting if your HMO has these regional/ international affiliations.
Just make a note to ask about that if you choose to go with any of them
3. Hospitals They Service
I always tell my clients that when they choose their hospitals in Nigeria, the must always follow individual health professionals, followed by how structured the establishment is.
Not the location, not the glass doors, bling and other window dressing.
Why? Because in the end (unfortunately in this country) it’s actually the experience and expertise of these professionals (certain consultants, nurses, etc.) and the right processes and systems in these establishments that save lives.
So, sometimes you are better off in an older hospital staffed with gifted/seasoned hands in Shomolu than some glitzy one on the Island where you pay an arm and a leg for less than stellar medical care.
I’m now going to draw a leaf from the second criterion above and take that line of thought further.
If you have a very good hospital you trust and are already registered at, consider working your way back and finding out what health insurance companies they service and register with one of them.
If you’ve never had cause to visit a hospital and you are just trying to be a responsible adult by taking an insurance plan, don’t worry.
Ask for the list of hospitals the companies you are considering service, sometimes these lists are so extensive they include centers in different states in Nigeria (which is great).
Do your research on the hospitals which work for you based on location and from online reviews then zero in on one.
You can also call or visit the hospital to enquire about the insurance company to know what their relationship looks like.
The more top-notch hospitals your insurance company has on its list the better for you.
Once you register with the insurer of your choice, if one hospital in their network doesn’t work, you can request a change and wait the statutory one month to switch.
4. Their Health Insurance Coverage Versus Your Needs
Insurance companies have several tiers of packages. Each tier varies with the amount and nature of the services you are entitled to if the need arises as well as the premiums (as mentioned in my first point).
When you are reviewing them look at the break down of these packages and see if these suit your circumstances.
There’s no point signing up for something that does not cover your basic needs.
I once consulted for a company that bought different tiers of coverage for their staff.
A security guard of theirs was ill and visited one of their provider hospitals. He was told he could only have a malaria test done.
He wasn’t covered for any of the other basic microbiology tests that could be done such as a urine screening. The malaria test was negative but they could go no further as he wasn’t covered for anything else. The poor guy came away deflated.
Signing up for health insurance is like getting married. Once you’ve said your vows and signed the marriage register, getting divorced can be a painful and protracted process (getting refunds, etc.).
Do your homework and decide what you can live with the long term before saying I do.
5. Their Responsiveness to Issues and Enquiries
It can be really annoying when you are supposed to be in a relationship with someone and you can’t reach them when you need them the most.
Beyond one of their marketers coming to woo you at your office or home to get you to sign up for a plan, call their customer care line or other contact channels and see what their response is like.
This can be telling of their potential behavior in a crisis situation. I’ve been hung up on before and my calls not answered in an emergency situation as I was calling on behalf of a client, it wasn’t funny.
6. How long have they been in Business
This criterion is to be taken with a pinch of salt. The companies that have stood the test of time in Nigeria are more likely to be stable, credible and have a wider network of hospitals than the newer ones.
However, this may not translate to efficiency, customer service, and use of modern technology to manage your records or communicate with you.
Ask around these when you are shopping for a health insurance provider. The final decision as to which of these you are willing to trade off on lies solely with you.
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