Why you should have health insurance and what to look out for
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Why you should have health insurance and what to look out for

Have you ever considered an HMO plan for you and your family? In Nigeria, the awareness for health insurance is still at infancy. 

A lot of people are uninformed; they don’t know why subscribing to health insurance is vital. This is so because they can just walk into any community pharmacy and clinic and get treated or buy drug off the counter. 

Who are the Health Maintenance Organization (HMO)?

Health Maintenance organizations (HMO) are charged with the responsibility of managing the provision of health services through other healthcare providers: hospitals, clinics, pharmacies etc.

The Health Maintenance Organization (HMO) provides health insurance coverage for a periodic fee. This fee can be monthly or yearly, allowing more people to have access to quality healthcare.

It consists of a group of health insurance providers that provide medical care through medical professionals.

Generally, HMO’s function as an intermediary between the hospitals (providers) and the individual (patient). 

They limit coverage of members to medical care providers through a network of healthcare providers who are under contract with the HMO. 

With approximately 60 HMO’s operating in Nigeria, the health and managed care market can be described as ‘emerging’.

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How HMO works 

HMO’s provide primary and auxiliary healthcare services to its subscribers. They acquire networks of healthcare providers by entering into contracts with hospitals, clinical facilities, primary care physicians and specialists. 

The healthcare providers that enter into these contracts are paid an agreed-upon fee to offer a range of healthcare services to an HMO subscriber. 

This agreed fee enables HMO’s to offer lower premiums than other forms of health insurance plan while keeping the high quality of healthcare from its network.

Before you choose an HMO

As humans, we are responsible for our health, but many people do not have the means to access proper healthcare; it is expensive. 

This is where the HMO’s come in. 

HMO’s have made these healthcare services more available and accessible to more people at a more cost-effective fee. 

Subscribing to a health insurance plan with an HMO is vital. It ensures that you can afford proper medical care without breaking the bank.

When faced with the option to subscribe for an HMO plan, before you sign up, consider the following:

1.   The cost of premium: while premium may be cheaper under the HMO plans, it is better to shop for available options and compare their prices.

2. Out-of-pocket expenses: these are costs that are outside the scope of the HMO plan that the subscriber pays from his pocket.

3.   Specialized medical care: consider the requirements you may have for specialized medical care and the cost implication for implementing them.

4.   Primary care providers: Make sure you go through their network of healthcare providers to have a perception of their services. Also, look out for health providers in their system that are within your locality in case of emergency.

5.   Responsiveness: because of the nature of their service, health emergencies can occur at any time. Be sure to confirm that your Health Maintenance Organisation offers 24-hours customer care service to its subscribers. That way, you might have the necessary support during an emergency.

Image credit: Martha Dominguez de Gouveia on Unsplash

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