Steps on How To Apply For HMO in Nigeria (2024)

Health insurance plans are becoming increasingly important in Nigeria to help manage rising healthcare costs.

A Health Maintenance Organization (HMO) is a useful and affordable type of health insurance coverage that many Nigerians are signing up for. Getting an HMO plan involves understanding your options, choosing the right plan, going through an application process, and providing the necessary documents.

This article outlines in easy steps how you can apply for and get coverage from an HMO in Nigeria currently.

STEPS ON HOW TO APPLY FOR HMO IN NIGERIA (2024)

If you’re looking to get an HMO plan in Nigeria as of this year, follow these key steps:

UNDERSTAND HOW HMOS WORK

The first step is to understand what an HMO is and how it works.

An HMO is a prepaid health plan that provides healthcare services to its enrolled members through a network of selected hospitals and physicians. When you enroll in an HMO, you pay a monthly premium.

In return, your medical expenses like doctor visits, tests, surgeries etc. Are covered, usually after paying a small co-pay.

DECIDE WHAT KIND OF HMO PLAN YOU NEED

HMOs offer different plans based on coverage levels, premiums and cost-sharing amounts. The main types are:

• Basic HMO: Lowest premiums but highest out-of-pocket costs
• Value HMO: Moderate premiums and copays
• Enhanced HMO: Highest premiums but lower copays and deductibles

Determine factors like your expected healthcare needs, budget, preexisting conditions etc. And choose a plan that is optimum for your situation. Family plans are also available if you intend to cover spouse, children etc.

CHECK HMO PROVIDER NETWORKS

An important criterion for choosing an HMO is checking their network of hospitals and physicians.

Each HMO has empaneled doctors and hospitals that members can avail cashless services from. Go through the provider list before applying for an HMO and ensure that your preferred healthcare providers are part of the network.

Also check which facilities are closest to your location.

SHORTLIST HMOS TO APPLY

The next step to take is to shortlist 2-3 HMOs you intend to apply to.  This should be based on the plan types, premiums and provider networks. Some of the top HMOs operating nationally and regionally are:

• Hygeia HMO
• Avon HMO
• Healthcare International HMO
• Leadway Health
• Total Health Trust
• Hallmark

There are very many of them. What you have to do is to check reviews, talk to existing members, compare premium charts and benefits before finalizing the HMOs to apply for.

DETERMINE ELIGIBILITY

HMOs stipulate certain eligibility criteria for members such as:

• Age limit: Typically covers from age 18 years to 59/64 years
• Geographic location: Some HMOs only operate in certain states and cities
• Preexisting conditions: May exclude some existing illnesses from coverage

Review the eligibility norms before applying to ensure you meet the criteria. This is also the stage when you fill out health questionnaires to report medical histories accurately.

SUBMIT HMO ENROLLMENT FORM

Once you’ve zeroed in on an HMO provider, obtain the application form. Most HMOs now allow online submissions or downloads. The enrollment form requires you to provide personal information like:

• Names, age, contact details
• Residential address
• Bank account details
• Health and lifestyle data
• Choosing type of cover – individual/family

You have to double check form entries and submit per the instructions provided. Application processing can take 3 to 5 working days.

UNDERGO MEDICAL EVALUATIONS

As part of the underwriting process, HMOs will require you to undergo standard medical tests for assessing risks. These usually consist of:

• Medical history
• Vitals like blood pressure, weight etc.
• Blood tests
• Cardiac evaluations if needed

You have to cooperate with your HMO to complete evaluations smoothly. Provide accurate health declarations at this stage to avoid issues later.

RECEIVE ELIGIBILITY CONFIRMATION

Once your medical reports are submitted, the HMO will confirm if you meet the health criteria for enrollment. Check if they require further details about preexisting illnesses, previous procedures etc. That may exclude some ailments from future coverage. If approved, you will receive written confirmation on your application.

COMPLETE DOCUMENTATION FORMALITIES

On approval, complete all documentation formalities as needed:

• Provide Know Your Customer (KYC) documents like ID proof, address proof etc.
• Set up auto debit for premium payments if applicable
• Specify nominees and contingency contacts
• Activate online account to access details

Ensure all members in family plans also complete documentation protocols. Keep payment options ready for renewal premiums.

COLLECT MEMBER PACKAGE

You will now be provided a member handbook consisting of:

• Member ID Card: Having your HMO ID card is crucial whenever you visit an empaneled provider. Ensure names are correctly printed and the policy tenure is accurate.
• Benefits Schedule: This document lists your health plan inclusions like ambulance limits, tests covered, surgeries included along with applicable copays. Study this thoroughly.
• Provider Directory: A handy listing of all approved hospitals, clinics, doctors and how to contact them. Save these numbers, install apps to find nearest facilities easily.
• Claim Procedures: Step-by-step process for making reimbursements if you visit non-network providers in emergencies.

Keep your member package ready and handy for the coverage tenure.

ADD FAMILY DEPENDENTS

The good thing about health management organization provider in Nigeria is that they offer you an option to add family dependents.

To add family members like spouse, children, parents etc. To the same plan, intimate the HMO to start the process. Fill separate enrollment forms, undergo medical tests if applicable and submit member documents. Pay premiums for each dependent added. Receive ID cards for new members before availing services.

START USING THE HMO SERVICES

You can now start utilizing HMO services as and when needed within the policy covered timeframe. There are many things to enjoy here. You can:

• Visit panel doctors directly without referrals
• Present your membership card on reaching an empaneled facility
• Receive cashless treatment up to the limit covered

Our advice for you is to pay any applicable copays and follow up care protocols. You should also maintain health records for future requirements.

CONCLUSION

We have covered the key steps involved in applying for an HMO plan in Nigeria. Follow them carefully based on the provider you select to ensure smooth onboarding and approval.

It’s very important to choose the right plan and network combined with diligent application protocols. This will help you avail continuous healthcare coverage through your HMO.

Lastly, you have to maintain premium payments and proper documentation to continue enjoying cashless healthcare benefits.