What is HMO

A Health Maintenance Organization (HMO) is a health insurance provider that connects individuals, families, organisations or groups to a network of healthcare services for a fixed monthly or annual fee(premium).

As intermediaries between healthcare providers and users, HMOs make medical care more affordable and accessible by negotiating rates and ensuring a streamlined service delivery.

Key Benefits of HMOs in Nigeria

Provision of Affordable Healthcare Options: HMOs offer lower health insurance premiums than traditional insurance plans. This affordability extends healthcare access to a wider demographic, including low-income earners, helping reduce financial barriers to quality care. Through negotiated tariffs, the enrolled users enjoy lower costs for healthcare compared to the higher bills they would have been charged if they were to pay out of pocket.

• Inclusion of Preventive Care: 
• HMOs promote preventive healthcare by covering routine checkups, immunizations, and screenings. This proactive approach helps detect and address potential health issues early, reducing the likelihood of more severe and expensive treatments in the future.

Wide Network of Healthcare Providers

HMOs collaborate with a network of healthcare professionals, hospitals, and clinics, ensuring members can access quality services within this network at negotiated, reduced rates.

HealthCare Coordination

HMOs offer coordinated care among healthcare providers for individuals with chronic illnesses or complex medical conditions. This ensures seamless and comprehensive treatment and reduces unnecessary delays and duplications.

Financial Protection Against Emergencies

An HMO covers a significant portion of medical expenses during unexpected illnesses or medical emergencies. This reduces the financial burden on individuals and families, providing peace of mind in challenging times.

Simplified Healthcare Processes

HMOs often handle administrative tasks such as claims processing, reducing the hassle for members and ensuring timely access to medical services.

 

Types of HMOs in Nigeria

HMOs cater to different groups, with plans tailored to meet their specific needs:

Group/Corporate HMOs

These plans are often offered to large corporations or organisations employees as part of their employee benefits package. Most HMOs in Nigeria offer this type of HMO with varied benefits.  If you want an HMO for your organization, you must consider the type of HMO plan that suits your demography. For instance, if your staff constitute more of the aged population, you should be more concerned about getting a health plan that covers chronic sicknesses like diabetes and hypertension. Individual and Family HMOs Designed for individuals, self-employed professionals, and families, these plans provide flexible options for those not covered by group plans. A retail HMO plan is a type of plan offered by most HMOs in Nigeria to individuals who want to insure their health with a paid premium. This type of HMO is gradually gaining popularity as people increasingly discover its benefits. Under this type of HMO, people can secure health coverage for their family for a decent renewable fee. Government HMOs Specifically tailored for Nigerian federal government employees, these plans align with government healthcare policies and schemes. It can be a health insurance established for a particular government service group. For instance, Defence Health Maintenance Limited(DHML) also known as Military HMO is instituted to manage the health needs of all military serving and retired personnel. Such types of HMOs may not cover individuals or other groups which are not captured within their scope of cover. Specialised HMOs Some HMOs focus on specific populations, such as retirees or individuals with particular health needs, offering niche services for targeted groups.

How to Choose the Right HMO

Selecting the right HMO requires careful consideration of your healthcare needs and financial situation. Here’s what to look for:

Network of Providers

Check if the HMO’s network includes trusted doctors, clinics, and hospitals in your preferred locations. Also, consider what the conditions for roaming through different hospitals are for the specific HMO plan you are considering picking. Some HMOs categorise their Hospitals according to networks. In most situations, the networks are usually according to the class of the providers. As a result, your premium plan will determine the hospital network that will be assigned to you. Coverage Options Review the scope of services, such as inpatient care, outpatient visits, maternity care, prescription drugs, coverage for chronic conditions and emergency services. HMOs differ in their benefits and premiums. Depending on your budget, carefully review the coverage options and be sure your budget can cover your specific needs. Cost Considerations Compare premiums, deductibles, and other out-of-pocket expenses across different plans to ensure they fit your budget. Some HMOs are reasonable and can allow the negotiation of premiums. In some cases, if your selected plan does not include your required benefits, ask for customization. This can be possible for most HMOs, especially for groups and organizations. Customer Service and Support Opt for an HMO with a reputation for excellent customer service, responsiveness, and ease of communication in case of emergencies or inquiries. It is very frustrating to use an HMO with nonchalant customer service. Always enquire about the maximum turnaround time. A turnaround time beyond 10 minutes will result in frustration for any enrollees. Additional Benefits Some HMOs may offer value-added services, such as wellness programs, telemedicine options, or discounts on medications, enhancing the overall value of their plans. Conclusion Understanding the role and benefits of HMOs in Nigeria can empower individuals and families to make informed decisions about their healthcare. By choosing the right HMO plan, you can ensure access to quality medical care while keeping healthcare costs manageable.

Contact Us

Get In Touch

We are here to help you 7 days a week and respond within 24 hours. Plus, you can find most answers to your questions right on FAQ page.

Newsletter

Check our blog for informative contents on healthy  living.

General Inquiries​

34/36 Association Avenue, Ilupeju, Lagos. (+234) 906 943 1050 info@doheec.com

Our Services

Want to know more about our services? Check our services page.