Medical Insurance – How it works in Nigeria

Medical insurance is one a very important, yet vague part of the industry, especially in a country like Nigeria. Essentially, the average citizen isn’t really bothered about insuring himself, but rather focuses on valuable properties. However, life remains our greatest asset, and consequentially the medical aspect of insurance. In recent times, making health insurance compulsory by the federal government has done a lot to spread its reach across the nation. As a citizen, it is important that you know how medical insurance works in Nigeria.

What is medical insurance?

Medical insurance is simply protection or insuring against certain medical expenses. Also, the coverage is most times limited depending on the details of the plan. However, the average one mostly cover for specialized medical treatments and while some cover medical procedures. Medical insurance is mostly handled by a health maintenance organization (HMO) who settles the bill directly with the hospital or reimburses the insured if they pay out of their pockets.

How does a medical insurance work?

It has a straightforward working procedure, let’s say requirements for getting health insurance. It involves an individual purchasing an insurance plan, which gives certain specified medical coverage or more, depending on the policy. It usually provides coverage against specific diseases, hospitalization treatment, accident and other treatment expenses. However, this could be more or less depending on the policy coverage. Also, usually comes with a pre-decided assured sum.

They form a plan or policy based on the following details; insured’s age, gender, sum insured, geographic location, and expected duration of the plan. Also, HMO processes medical insurance mainly two forms; cashless treatment and reimbursement. Furthermore, you can purchase an individual plan or more of a family basis edition.

What are the benefits of medical insurance?

It comes with different benefits, which include the following:

  • It provides coverage against pre specified medical expenses
  • Coverage against critical illnesses
  • Cashless claim benefit that eases you off out-of-pocket payment
  • It gives additional protection beyond the basic group plan purchased by most employer

What does it cover?

Generally, medical insurance mostly covers the following:  

  • Other exceptions and peculiar treatments as stated by the policy
  • Cosmetic procedures
  • Fertility treatment
  • Certain expensive medical procedures

It usually does not cover the following but could, depending on your policy:

  • Regular hospital visits
  • Drug prescription
  • Wellness and care

What is the difference between medical insurance and health insurance?

The major difference between the two is that medical insurance provides you with coverage over certain ailments and accidents for a certain amount of time. On the other hand, health insurance goes for more comprehensive coverage against hospital expenses. Also, medical insurance does not cover critical illnesses and offers no flexibility in terms of coverage. Furthermore, health insurance provides these and allows you the flexibility to even reduce policy duration and premium after a while.


Medical insurance is the less known part of the insurance industry in Nigeria. It provides coverage for certain pre-defined treatments and is more specific than a general health insurance. Also, purchasing a medical insurance is your best bet against battling with bills that could arise from emergency specialized treatments.  

Categories: Health Insurance