Health Management Organizations (HMO) – How it Works

Health Management Organizations (HMO)  How it Works  – offers comprehensive health insurance to individuals, families, and small entrepreneurs. 

Health Management Organizations (HMO) in Nigeria. These organizations are responsible for managing the provision of standard health care services through a network of hospitals under the plan. They serve as a middleman between the hospital and clients that need healthcare services.  HMO plans to make things more convenient.

How HMO works in Nigeria

The Health Management Organization (HMO) offers its services to companies seeking to provide healthcare services for their employees and their families. The arrangement works in the following way

1. The HMO company has a list of Healthcare service providers that serve its clients (companies).
2. The HMO offers its services to companies seeking to provide healthcare for its employees. The services are offered under different product plans.
3. An agreement is made depending on the type(s) of HMO plan the company’s employees opt for including the premium attached to it.
4. The employee selects a hospital from the list of healthcare service providers of HMOs
5. When an employee eligible under the HMO scheme falls ill, the hospital takes responsibility of attending to the patient if that was the choice of the healthcare provider as well as other considerations.
6. The hospitals are often paid upfront regardless of whether the patient uses it or not.
7. The company agrees to pay the premium, which will cover the employees of the company based on their choice of products. Their choice of products is subject to the conditions of that plan for a stipulated time which is usually a year.

What does the HMO premium cover?

HMO plans cover almost everything regarding healthcare services ranging from medical checkups to major or minor surgery. However, there are restrictions based on the type of plan you choose. Many HMO organizations would group their services into different categories, and the customer would have to select which plans they prefer.

The HMO plan has many benefits and covers all but is not limited to the following services:

• Ambulance Service
• Dental care
• Optical care
• General Outpatient and in-house specialist consultation
• Admissions
• Physiotherapy
• Scans
• X-rays, Laboratory & Diagnostic Test
• Antenatal and childbirth
• Accident and Emergencies
• Minor Surgeries and procedures
• Prescribes Medicines and Drugs

However, not all the plans offer the services stated above. The services depend on the choice of plan for a given period of time.

Why is HMO a better option?

There are different reasons why you should choose an HMO plan instead of traditional instead of health insurance, and they include:

1. There is high coordination between the HMO provider, and the healthcare provider makes it easy for clients to access healthcare services
2. Many HMO plans do not have deductibles
3. It is often the best choice in an emergency situation
4. It is more affordable to maintain and easy to administer

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