10 Things To Consider Before Choosing HMO Provider in Nigeria
Looking for the right health insurance in Nigeria? Not sure how to choose an HMO provider from the many options? What key things should you evaluate so that you pick the best HMO plan for your medical needs and budget?
Selecting a Health Maintenance Organization (HMO) in Nigeria to partner with for your health insurance coverage is an important decision.
The HMO provides access to quality healthcare through its network of accredited hospitals, clinics, doctors, labs and pharmacies. It pays for the medical costs of covered services outlined in your chosen plan.
This article will highlight to you the top ten things to consider before choosing a health management organization provider in Nigeria.
10 THINGS TO CONSIDER BEFORE CHOOSING HMO PROVIDER IN NIGERIA
Choosing a Health Maintenance Organization (HMO) provider in Nigeria can be confusing, with many options to pick from. As you shop around, keep these 10 key things in mind before signing up with an HMO provider:
CHECK REGISTRATION AND REPUTATION
Before you choose a HMO provider in Nigeria, first check they are registered with the government regulatory bodies like the National Health Insurance Scheme (NHIS) and the Healthcare Federation of Nigeria (HFN).
Don’t choose an HMO that is not accredited and properly licensed in the country. Also make sure they have a good reputation in the market.
Read online reviews, talk to people who have used them and see what feedback they give about their services.
The more proven trust and good reviews an HMO has over the years, the more reliable they are.
NETWORK OF HEALTHCARE PROVIDERS
Another thing is to make sure that the HMO has a big network of registered and quality healthcare providers like clinics, hospitals, pharmacies, labs, dentists and specialists.
Check if they have providers close to where you live or work so that you don’t have to travel far in emergencies. It also helps that they have a range of providers to choose from when you need medical care and referrals.
A good HMO should have partnerships with many reputable and experienced healthcare providers, professionals and facilities so that customers face less hassle.
RANGE OF COVERED MEDICAL SERVICES
One of the key things to check is what all medical and healthcare services are covered under the plan you choose. Make sure routine checkups, major illnesses requiring hospitalization, medications, scans, chronic disease management and pre-natal/delivery (if applicable) are included.
Also see if pre-existing diseases are covered or not. Some other things you may want to be covered – dental, vision, mental health, ambulance, home care etc. Know the coverage before you select an HMO plan otherwise you might end up paying a lot of out of pocket expenses later on.
QUICK ACCESS TO HEALTHCARE SERVICES
Find out if the HMO has a simple and quick process for getting referrals and approvals to see specialists, go for scans or tests and access healthcare services that you are entitled for. Delays in getting care, tests and specialist opinions when you genuinely need them can negatively impact your health.
So the HMO should have an efficient system and reasonable turnaround times for preauthorizations and paperwork so that you face minimal waiting period for receiving treatment and medical care.
USAGE OF TECHNOLOGY
It helps if the HMO has integrated technology into their services such as mobile apps, online member portals, teleconsultations, digital payments and billing etc. This provides you more control, access and convenience.
For example, you can set appointments online, chat with a doctor virtually, order medicines home delivery via app, keep track of claim status etc. This saves you effort and makes it a smooth experience.
PRESCRIPTION MEDICATION COVERAGE
If you take maintenance medicines for chronic health conditions, evaluate if those prescription drugs are covered in the HMO pharmacy formulary before you enroll.
Also check what level of subsidy is provided on branded vs generic drugs. See if you have affordable co-pays on medicines you take regularly. Not having your essential, life-saving medicines covered can cause you lot of anxiety and cost burden.
VALUE ADDED WELLNESS INITIATIVES
Some good HMOs include preventive health and wellness features in their offering such as health risk assessments, regular screenings, health education programs, gym tie ups, weight management plans and more. This helps you take charge of your health through monitoring tests and aids.
Also see if they give incentives and insurance discounts for adopting healthy lifestyle choices like fitness activities, not smoking etc.
RESPONSIVENESS OF CUSTOMER SERVICE
Once you enroll, you will likely need to contact the HMO frequently regarding authorizations, claims, billing, adding dependents etc.
Check their customer service channels like call center, emails, live chat options and see if they are responsive enough.
Long delays and poor grievance resolution reflects badly on service quality. Quick turnarounds and helpful representatives indicate they value customers.
FLEXIBILITY TO CHANGE PLANS
Your insurance needs keep changing over time. See how flexible they are in terms of letting you upgrade, downgrade or switch between plans based on life stage.
Things like marriage, childbirth, job loss etc should allow you seamless options to modify existing health cover. Lock in periods and lack of flexibility can prevent you from adjusting to needs.
COSTS
Finally, compare premiums across similar plans that meet your requirements to find one that is affordable. Along with premiums, check the deductibles, co-pays and total out of pocket costs you need to bear for over a year.
Make sure you are aware of all direct and indirect expenses. Balance optimal coverage with costs you can budget for over the policy term without defaulting on payments.
CONCLUSION
Choosing an HMO provider requires you to assess several parameters around services, access, costs, technology and customer care. Evaluate options closely before deciding.
Having the right HMO that caters well to your medical requirements gives you great relief about handling healthcare costs for self and dependents. So take time and make a careful, informed choice.
With these 10 key considerations before selecting your HMO, you can find the ideal health insurance company to cover you and your family during illness and medical emergencies in a cashless manner.
Our advice for you is to pick one that provides adequate healthcare access through a quality network of providers, convenient technology platforms and responsive customer service – along with affordable premiums that suit your pocket.
I hope this gives you clarity and confidence to decide on your health plan. Stay healthy and covered!
