Perhaps you went to your health plan instructor to choose a suitable health plan and you heard “HMO” (which you have not heard before or not very sure about it). You have also been wondering what HMO is all about.
Not to worry, in this post, you will learn all you may need to know about HMO. We have organized this article in such a manner it will give you the necessary information: we answered what HMO is, how HMOs work, and some HMOs in Nigeria
WHAT IS HMO?
HMO is the abbreviation of Health Maintenance Organization. It is one of the most popular types of health insurance provider that is available in the health insurance market. Others would include Preferred Provider Organization (PPO), Exclusive Provider Organizations, Point-of-service plans, and so many others.
Health Maintenance Organization (HMO) is a health insurance plan, designed to keep you covered under a network of doctors, hospitals or health care centers. In other words, when you are under the HMO health insurance plan, you are allowed to receive medical treatment or attention from medical practitioners or hospitals in the network of the insurance plan.
It is designed in such a fashion that you will make a particular payment for a specified period of time (usually one year), to cover the services rendered.
HOW DOES HMO WORK?
Some companies which seek to provide health care services usually employ the services of the Health Maintenance Organizations. A family or group of individuals and even a person can enroll for the HMO health insurance plan. This is how it works:
When you join the HMO plan, you will be assigned a Primary care Physician (PCP). The PCP is usually a family practitioner, a pediatrician or an internist. The PCP will take coordinate all that concerns your health. As such, maintaining a close relationship with him/her is very necessary. If you are not comfortable with the PCP assigned you, you can always opt for a switch or change.
In the coordination of all your health matters, your primary care physician will determine when you need to see a specialist (when the case is above him) and you must receive the care from the referral he has stated.
HMOs usually have a list of health care providers including doctors, hospitals, pharmacies, labs, x-ray facilities and so on.
If you get care from those within the network of the HMO, the HMO will not bear the burden of the cost incurred in the course of the special treatment. So you must keep to the agreement of the insurance plan.
You can go out of the HMO network only under some conditions:
- In a case of true emergencies
- When the HMO does not have in their network the provider for the specialty service you require.
- If you become a member of an HMO when you are in the middle of complex specialty treatment and the specialist taking care of you is not part of the HMO network you joined. It is supposed that you finish your treatment before the agreement begins to count upon you.
WHO IS HMO FOR?
Since you may not be sure yet if HMO health insurance plan is for you, I believe these points stated below should guide you through an informed decision:
- If you are seeking a health insurance plan with lower premiums, then an HMO plan is an option to consider.
- You could also look up to HMO when you need a plan without deductibles and you do not mind having an out-of-pocket limit (the maximum amount of money you will pay before the HMO begins to take care of the rest of your health care bills).
- HMO plan is also an option when you need a plan that will cover services like check-ups and immunizations.
WHAT DOES THE HMO PREMIUM COVER?
An HMO Premium is the amount of money you will pay for the health insurance provided. It is usually paid to cover a period of one year or more or less depending on the policies of your choice HMO.
The HMO Premium can cover the following health care services:
- X-rays, Laboratory and Diagnostic tests
- Accidents and emergencies
- Ambulance services
- Prescription of medicine and drugs
- Primary surgeries and procedures
- General specialist consultations
These services listed above are the basic health care services members of the HMO can receive. Therefore, high HMO packages come with more services like:
- Dental care
- Optical care
- Maternity care (ante-natal, delivery, and postnatal care).
- MRI Scans and so on.
BEST HMOs IN NIGERIA
There are many Health Maintenance Organizations in Nigeria, with which you can go into a health insurance agreement with on the HMO plan.
This is a leading HMO in Nigeria that has been in operation since 1986. They are one of the best in the industry, having accumulated experience of their years of operation.
TOTAL HEALTH TRUST HMO
THT came into existence in 1997 when three dogged doctors came together to form the company. The company has worked with over 500 corporate bodies and more than 300,000 members. In 2016, Total Health Trust HMO won the Nigeria Health Care Award.
INTEGRATED HEALTHCARE LIMITED
Integrated Healthcare Limited is an HMO provider that has such packages as the corporate plan, Family plan, Formal Sector plan, Individual plan and Tertiary Institutions Social Health Insurance Programme.
Avon is a subsidiary of the investment company, Heirs Holding Company. It started operation in 2013 and over the years, the company has shown great strength as a Health Maintenance Organization. Their plans cover families, SMEs, companies and large groups.
CLEARLINE INTERNATIONAL LIMITED
Clearline International Limited as HMO is affiliated with up to 2000 partner hospitals across Nigeria. Their plans cover families, individuals and tertiary institution health insurance plan. This HMO company was established in 1994, but it started operating squarely in 1997.
If you have come up to till this point from the beginning, I am certain you have got the answer to the question: “What is an HMO?” HMOs cover you under health insurance with a network of practitioners, hospitals, pharmacy and so on.
You can go on learn about the services of the HMO companies in Nigeria listed above, following their individual websites.
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