29/03/2022
Let's get to know what HMO is and how they operate.
Health Maintenance Organizations also known as HMO are healthcare insurance providers that must be duly licensed by the Federal Government of Nigeria and duly accredited under the National Health Insurance Scheme before providing healthcare access.
These organizations are mandated to deliver quality healthcare services through their network service providers(healthcare facilities).
HMOs, serve as the intermediary between the enrollee(a client with a health plan) and the healthcare facility.
There are many Health Maintenance Organization that offers different health plans to individuals, corporates, family, and SMEs to cater to their healthcare needs.
HMOs operates in the following way:
The HMO propose their services of providing healthcare to individuals, corporates, family, and SMEs.
The HMO educates the clients about the different types of health plans, benefits, and the healthcare providers(hospital).
After both parties reach a consensus for the type of health plan for all employees or individuals, a payment has to be made which is called a premium.
Making a payment to the HMO signs the deal, it could be monthly, quarterly, or yearly depending on the agreement.
For companies, the employee has to submit the names of all dependants which includes spouse and four kids below the age of 18 for registration.
Individuals and families have to submit the names of all dependants.
For companies, the employee has to submit the names of all dependants which includes spouse and four kids below the age of 18 for registration.
Individuals and families have to submit the names of all dependants.
An individual or employee has the right to choose any healthcare facility within the HMO network providers.
After the registration process, the HMO sends the individual's name to their preferred hospital which is the primary healthcare provider, and for companies, a list of all the employees and their dependents with their health plan is sent to the healthcare facility for easy identification
An identity card is issued to each enrollee to have access to the healthcare facility
Any time you seek medical attention, you are free to go to your hospital.
After receiving treatment, the hospital makes bills and forwards them to the HMO every month.
