Universal health coverage in Nigeria -How does health Insurance work for individuals and small businesses in Nigeria? It is crucial to get your employees insured against any health challenges that may come their way while working for you, just as it’s vital to get yourself and your families insured against unforeseen circumstances.
This is because when your employees are healthy and can access quality health care when they need it, they will be happy and more dedicated to their duties.
In Nigeria, the law states that if you have up to ten employees, you are required to enroll them into Employee Health Insurance small business plan to protect them against work-related hazards.
What is Health Insurance?
Health insurance is the type of insurance that covers an individual, family, or organization from the cost of health-related problems.
Universal Health Coverage in Nigeria
Apart from reducing the cost of medical problems that may arise due to accidents or illnesses, it also covers the cost of health tips that would prevent them from getting sick.
Health complications are usually on the rise, especially for workers on the site. This is because they are constantly exposed to pollutions and some stressful activities.
These life-threatening circumstances could make you lose your best staff if you did not put a proper measure on the ground that will protect them.
So it’s advisable to get insurance coverage to protect your employees against any potential hazard or illness that may come.
Reasons why you need Health Insurance for small businesses and yourself and your family
1. Increase in productivity
When your employees are healthy and can access quality health care when they need it, they will put more effort into their duty, increasing productivity.
2. Reduce expenses.
Treating an individual under health insurance coverage is cheaper than treating another individual with the same medical problem but without insurance coverage.
3. Pre and post hospitalization
In Nigeria, health insurance has gone beyond taking care of the cost of treatment alone. Some health insurance plans cover tips and guides that would prevent your employees from falling victim to some preventable health problems.
Get health insurance coverage to help your employees be more productive.
4. Protection against medical emergencies
Anyone can be a victim of unexpected illnesses. Health challenges may come, and they may come when you do not have enough money at hand.
So to be on the safer side, grab insurance coverage that would protect your employees against any medical problem that may arise when you are not financially strong.
Types of Universal health coverage in Nigeria
Each insurance company has its own specialized designed plans. But there are standard policies covered under health insurance.
So no matter the name insurance company may decide to call their plan, it will all fall under these plans listed below.
Indemnity health insurance is the most popular health insurance in the market. This plan covers any medical expenses in the event of hospitalization, diagnoses, or screening expenses.
2. Fixed benefit plan
This plan offers a fixed monetary compensation to the policyholder in the event of a pre-defined medical challenge that may arise due to accident, diagnosis, or any critical illness.
Sometimes, this plan will cover the expenses and compensate you for your losses caused by the medical condition. Sub-plan under the fixed health insurance policy are:
- Critical illness plan
- Surgical benefit plan
- Accident Insurance plan
So with these being said, you should constantly study your employees, your financial plan, and the type of health challenge that your staff is prone to because those are the factors that will determine the health insurance plan you will sign up for.
How does Universal Health Coverage in Nigeria work?
Universal health coverage in Nigeria works in such a way that you pay a small amount of money upfront called a premium to an insurance company. Your slight premium will allow you to share the same risk with a thousand or a million others who are also subscribers to that insurance company.
Now, the possibility that all the subscribers will fall sick simultaneously is zero; not possible. So, since most of the subscribers are healthy most of the time, the little money you paid to the insurance company as your premium is used to care for the relatively low numbers of subscribers who may fall sick. This is how health insurance works.
Ways to Access Universal health coverage in Nigeria
As an individual or corporate organization, there are several ways you can access health insurance in Nigeria. Let’s talk about some accepted methods to access health insurance in Nigeria.
1. Preferred Provider Organization (PPO)
This is the type of insurance plan where you choose to use a group of preferred specialists or Doctors. They are usually your first point of call when you or your staff have any health challenge.
Because you choose them as your preferred choice of health providers, they will charge you less than other patients who may randomly need their service.
2. Health Maintenance Organization (HMO)
They are a group of health insurance providers who enter into a contract agreement with doctors, hospitals, or health specialist centers to direct patients to the hospital. The hospital will, in turn, give them a commission based on the number of patients they referred to them. Their services are usually cheap, compared to when you visit the hospital on your own.
3. Point Of Service (POS)
This type of health insurance plan combines the services of the preferred provider organization (PPO) and the health maintenance organization (HMO). Sometimes it requires an employee to choose his preferred doctor.
4. Exclusive Provider Organization (EPO)
This health insurance plan works more like the HMOs. The only difference between them and HMOs is that while HMOs can provide comprehensive health care, EPOs will only provide health care based on conditions. For Example, EPOs do not offer health care in emergency cases.
This type of health insurance plan can be regarded as a “fee per service plan.” This implies that the amount of money you have will determine the quality of health care you will get.
6. Health Savings Account (HSA)
Health savings account is a contribution made by some individuals specifically for health protection purposes.
A health savings account is usually tax-favored. Suppose your company is a contributor to a health savings account. In that case, whenever you or your employee have any health challenge, HSA Agent can use part of your contributions to solving your immediate health challenge.
7. Health Reimbursement Arrangements (HRA)
This is the type of health insurance plan where you as an employer will assist a member of your staff who does not have any insurance coverage.
This type of plan sometimes does not require the staff to contribute any fee. You, as the employer, are the policyholder.
Health care in Nigeria can be costly, especially during economic inflation. Many things are expensive in the market. The health care sector is not left behind.
So you should guide the future of your employees today by getting health insurance coverage.
There are some affordable and reliable HMOs in Nigeria that you can sign up for today, and you don’t have to worry about tomorrow again.
What you should consider before Getting Health Insurance
Before you buy health insurance, there are some tips you should consider first so that you will not be on the loose end.
Let’s discuss those tips briefly so that you will be aware of what to expect ahead of your plan to buy that health insurance policy that will protect you and your beneficiaries against any potential health challenge that may come up.
1. Limit or sub-limit policy coverage
When you want to opt for health insurance coverage, you should be sure of the policy coverage limit. Know the limit to which the policy will cover you or your beneficiary. Know what and what is covered under the policy.
Does the policy have specific disease coverage? What is the expenditure limit of that policy? You need to ask these questions before committing yourself to any health insurance contract.
Fair enough, here in Nigeria, if you buy a policy with no limit of coverage, your claims are usually easy to process, though such policies are generally expensive.
2. Shared or Co-payment policy
When opting for insurance coverage, you should consider looking at the payment structure of that insurance policy.
How do I pay? What are the conditions of the payment? Some policy works so that you spend part of the insurance fee, and your employees pay the balance fee.
You can sign up for a co-payment or shared payment insurance coverage if you want another health insurance policy to supplement your existing policy.
3. Consider the premium price
People probably go for a lower sum insured because they want to save on premium or maybe because they were not well informed. Here the best advice I will give you is to choose the adequate sum insured.
Choose your plan according to your pocket. Don’t choose the plan that might lead you to a financial crisis in the future.
So before you buy Employee Health Insurance small business, make an informed choice, consider all your priorities and expenses.
Choose the policy by considering your age and your beneficiary’s age because age is one factor that determines your premium price.
4. Fill the Policy agreement form yourself
Each staff should fill the policy agreement form by themselves. Filling the policy agreement yourself would require you to provide your personal information and share information about your health problem.
No one knows yourself better than you do. Some of the proposal forms require you to provide your medical history and pre-existing diseases.
So to provide the right piece of information, one should always fill the policy agreement form themselves.
For your good and the good of your potential insurance company, you should not hide or override any information about yourself. Wrong information can result from delaying or sometimes no payment at all when you need your claim.
5. Hospital network of the insurance company
Before you buy health insurance coverage, you should first consider the insurance company’s essential operation of the selected hospital.
Research more on the list of hospitals on your policy agreement, get to know their responsiveness in case of emergency, their customer relation, and their mode of treatment. If the hospital is not up to your standard, walk away.
6. What do you want?
This is the question you should ask yourself first before signing that policy agreement. So, understand your needs. Do the policy covers what you want for your employees? Will it meet my employees’ health conditions? If you don’t sign the paper.
Remember, you are talking about life here, so no one should sugarcoat you with sweet tongues or force you into any contract that will not meet your needs.
7. Consider additional coverage.
Number 6. says you should understand your need. Still, suppose you like the insurance company’s services, and it happened that there are just a few of the things you needed which are not included in the policy agreement. In that case, you can always ask the company for additional coverage. But remember that extra coverage may increase your premium price.
8. Understand the policy wording.
You must read and understand clearly the policy wordings to know what you are entitled to. If you do not understand the policy clearly, you can always employ your lawyer’s service to interpret the policy wordings for you.
9. Likely increase of the premium.
Due to the unstable economy in Nigeria, medical inflation is on the rise, which may affect the health care sector in the future and, in turn, affect the insurance industry and most likely affect health insurance premium prices.
To this effect, you should understand the limitations that the premium will reach, and it will not increase again.
10. Clear your doubt
Be sure that you have cleared your doubt before you put that pen into the policy paper because your decision today is what will determine the future of your company.
Before you make your final decision to buy health insurance coverage, you should read the policy wordings over and over again and be sure you understand everything the policy is saying about.
Meet an insurance advisor or, better still, visit your potential insurance company and ask as many questions as possible to clarify yourself before you sign the policy agreement.
Health Insurance HMO
Health Insurance HMO– What is Health Insurance HMO? Health Maintenance Organization partners with hospitals to provide health insurance coverage for individuals, families, or corporate organizations. HMOs plays a big role when it comes to Universal health coverage in Nigeria
I can say that the agreement between HMOs and hospitals is a win-win case. HMOs get a percentage for every patient they refer to the hospital they partner with.
The top 4 Health Insurance HMOs in Nigeria and what makes them best
A few years ago, I worked as an Administrative Assistant with one of the best construction companies in Nigeria, Abuja, to be precise.
Initially, we were under National Health Insurance scheme Coverage (NHIS). Still, due to unsatisfactory service with NHIS, our MD gave us the green light to switch to another health insurance organization that would provide the best service for his staff. At this point, we were at a crossroads. We didn’t know what to do.
The Admin and HR guys in our department were all confused about what to do next because, in Nigeria, NHIS is widely recognized as one of the biggest health insurance providers with cheap premiums.
To cut my long story short, the Human Resources Manager instructed that we should research. We gathered about 10 to 15 HMOs in Nigeria and began to sort them out according to the services they provide and the services we need. So finally, we arrived at the four most outstanding HMOs that render the best health care services.
Top 4 Health Insurance HMO in Nigeria
Reliance HMO is number on my list. They have the most flexible and affordable health insurance plans in Nigeria.
The best part is that even as cheap as their health insurance plans are, they still maintain the best and quality health care delivery to their subscribers.
If you read my introductory story, I told you how we were at the crossroads about choosing the HMO for our company, right? Very good, we later decided to go for Reliance HMO, and I must tell you that since then our staff never complained again.
Unlike many HMOs in Nigeria with rigid policies, Reliance tailors theirs to suit different people. Both the poor, the middle class, and the rich, no matter your class in the society, you have a place in reliance HMO
With their various plans, you can pay according to your pocket. It can be yearly, quarterly, or monthly. In addition, you can extend the plan to your loved ones.
Their plans include:
- Personal plan
- Family plan
- Parents plan
- Business plan.
Hygeia is one of the top health maintenance organizations in Nigeria. They help individuals, large and small organizations to access comprehensive quality and affordable health care.
Hygeia HMO has a network of health professionals that render outstanding health care services ranging from primary health care services like general practitioners to secondary health services like specialists in dentists, pediatricians, therapists, etc.
Since its inception in 1986, Hygeia has continued to deliver quality health care services to Nigerians and across the African continent.
If you are a subscriber of Hygeia HMO, it is unlikely you will experience a delay when you visit their network of hospitals because they have developed a system called “No-auths.”
Hygeia’s “No-auths” system is by far the best and the most flexible means of accessing health care compared to other HMOs in Nigeria.
Hygeia’s “No auths” system works in a way that if you are a subscriber of Hygeia and you visit your proffered hospital, and your health challenge falls under primary health care, then you do not need Hygeia authorization to be attended to.
But if your health challenge falls under secondary health care like surgery and other complex health challenges, then it will only take them 10mins to confirm if your premium is strong enough to take care of the medical bills. After confirmation, your treatment commences immediately.
Hygeia HMO Plans
Hygeia has developed some flexible health insurance policies that can contain anyone in society, no matter your class in the community. Hygeia has got you covered with some fantastic and affordable plans.
1. Personal plan
This plan is specially designed to cover the health challenge of a single person. Under this plan, they have:
- Hybasic: Premium for a single person is below N100,000 for one year.
- Hyprime: Under Hyprime personal plan, the premium for a single person is N148,840 for one year.
- Hyprime plus: Premium for a single person is from N150,000 and above for one year.
2. Family plan
This plan is designed for the family: the man, the wife, and the two children only.
- Hybasic family plan: Premium for a family of four (4) is N163,480 for one year. Note: Additional number of family members will increase the premium.
- Hyprime family plan: premium for a family of four (4) is N564,820 for one year. An increase in the number of family members will automatically increase the premium.
3. Senior citizen plan
This plan is designed for parents and older ones of the family.
- Senior mini: premium for one person is N177,920 for one year
- Senior midi: premium for one person is N394,490 for one year
- Senior premium plan: premium for one person is N862,390 for one year
4. Pregnant women
This plan is for maternity purposes. It covers the mother and the child.
- Hymat: Based on negotiations with Hygeia
- Hymat plus: Based on negotiation with Hygeia
5. SMEs Plan
SMEs means small and medium enterprise. This plan covers small and medium-scale business owners from any health-related problem that may arise.
6. Corporate Plan
This plan is designed for big corporate organizations for their employees.
The above plan is available for big companies who want to enroll their employees in health insurance coverage. The plans are available based on the employee’s levels and rank in the Organization.
Hygeia HMO Exclusions
Though Hygeia offers comprehensive health coverage, subscribers also have some excluded health challenges that they do not cover.
The amount of health coverage they offer is depended on the risk and the amount attached to the plan you choose. So your premium plays a more significant role in the number of health services you will get.
Below are some excluded health challenge areas Hygeia does not cover.
- Overseas treatment and transplant surgery
- psychiatric treatment and illness
- Home care and domiciliary services
- Cancer care
- HIV/AIDS Treatment
- Plastic/ cosmetics surgery
- Self-inflicted injuries
- Covid-19 testing and treatment
- Speech disorders
- They will not treat any health conditions or diseases not listed in the policy agreement.
Key Things To Know About Hygeia
- They will not cover Neonatal care service and immunization under the maternal plan immediately after enrollment. Your coverage starts after six months from the date you enrolled.
- They will not Optical care, dental care. They will not also cover some chronic diseases immediately after enrolling. Your coverage will start after three months from the date you registered.
- Any plan you purchase will be active after two weeks from the date of the purchase.
- Family means the man, the wife, and two children. An additional family member will increase the premium you should pay per year.
- You will not access maternity benefits, surgeries benefits, critical illness, and death from the first year of enrollment.
Major Awards by Hygeia HMO
Hygeia HMO was founded in 1986 and has provided comprehensive health maintenance services to individuals, families, and corporate organizations.
Hygeia HMO has won many outstanding awards, which makes them stand out as one of the best health insurance providers, including the award for:
- Nigeria leading world class HMO brand of the year 2018 by Made in Nigeria best brains awards.
- African most innovative leadership in quality health management company of the year by African quality achievement awards.
- Outstanding health management brand of the year 2014 by Marketing edge awards.
- Health maintenance organization of the year 2015 by Nigeria health excellence global awards.
- Commerce and industry awards 2015
Hygeia offers different health insurance plans, which you can select depending on your budget or the kind of service you need. Their plans include:
Redcare health service limited is a limited liability company incorporated in 2009 in Nigeria and licensed by National Health Insurance Scheme (NHIS). Since then, they have focused on delivering quality health care to their subscribers.
Redcare HMO is one of the best in Nigeria, with pocket-friendly options. Their packages will suit your personal needs if you are not buying for an organization or a corporate body.
They have numerous health insurance plans available. All their plans fall under corporate plans or Private plans.
One primary reason many people in Nigeria do not consider getting Health insurance is that they think it’s too expensive.
Today, even as low as N3500. You can get yourself insured and protect yourself from any emergency health challenge that may fall on you. Health Maintenance Organization in Nigeria has provided many flexible options to choose from.
AXA Mansard Health Limited is a Health Maintenance Organization (HMO) under AXA Mansard’s group of companies. The HMO’s core duty is to provide health insurance coverage to its subscribers.
AXA Mansard Health Limited is fully accredited by the National Health Insurance Scheme (NHIS), the body responsible for HMO accreditation in Nigeria. Their head office is located in Lagos, Nigeria, with Enugu, Abuja, and Port-Harcourt regional offices.
How AXA Mansard HMO Plan Work
Unlike most Health Maintenance Organizations in the country that provide health insurance to some selected health problems, AXA Mansard health limited provides unlimited health insurance coverage to its members, focusing on preventive medicine.
They provide special health insurance to individuals willing to prevent any impending health-related problems.
The HMO works in a way that you, as a subscriber, are required to pay a specified amount of money as a premium every year or every month as stated in your policy agreement.
Your premium contributions are combined with other subscribers’ contributions to serve as insurance coverage to all scheme subscribers.
Because all the subscribers of the scheme cannot fall sick simultaneously, you will get quality health care at a meager cost from the combined premium of all the subscribers.
AXA Mansard HMO is also available for group health insurance coverage for corporate organizations who want to buy health insurance coverage for their staff.
Here, a certain percentage of the staff’s salary is deducted every month as a premium. Usually, 1.75% to 5% of the staff’s salary is removed, while the Organization will pay the remaining money to complete the entire premium.
Benefits Of AXA Mansard HMO
- Nationwide emergency coverage
- Very flexible and easy to access
- Unlimited health services
- Unlimited coverage
- Low cost of health care
- High-quality health care
How to get AXA Mansard HMO plan?
- Visit one of their physical offices located in Lagos, Abuja, Port Harcourt, or Enugu. But if that will be too stressful;
- Contact them via their email address email@example.com
- You can just dial *987# on your mobile phone and follow the commands to buy new products or renew your existing plan.
- Apply via their website or better still
- You can connect online via the 24/7 online chat from their website.
Health care services offered by AXA Mansard HMO
Below are services provided by AXA Mansard HMO
- Nationwide ambulance services for emergency cases
- In-patient admissions
- Accident and emergency cases
- drug prescriptions
- laboratory tests
- Dental care
- Psychiatric or mental health care
- Maternal care and the list goes on and on….
myAXA Mobile App
The AXA Mansard mobile app is called myAXA. The App is available on play store, both android users and iOS users. With the help of the app, you can buy a new product, renew your existing plan or monitor the changes and the progress of your current project.
It would be best to understand that the health care treatment you receive under health insurance coverage is cheaper than the treatment you receive on a regular hospital visit. AXA Mansard Health Limited is one of the top HMOs in Nigeria that can give you the best health insurance coverage.
What you should consider before you choose Health Insurance HMO for your employees
Health Insurance HMO. The only difference between HMOs and Insurance companies is that HMOs specialize only in providing health insurance coverage while insurance companies offer general insurance coverage.
HMOs’ mode of operation is more like an insurance company. Most people prefer their service to insurance companies because they narrowed their services to providing only health insurance coverage, unlike insurance companies that combine all the insurance services at a go.
How Does Health Insurance HMO work?
As stated above, the HMOs plays a vital role when it comes to Universal health coverage in Nigeria. Their mode of operation is closely related to insurance companies. They provide primary and auxiliary health services to their subscribers.
What they do is that they reach an agreement with hospitals, specialists, doctors, or any health care institutions that can provide excellent health care services up to their standard.
The agreement between Hospitals and HMOs is usually a case of “help me, I help you” The HMOs will refer patients to the hospital. The hospital will pay the HMOs an agreed percentage based on the number of patients who came to the hospital. So basically, it’s usually a case of win-win for both parties.
Sometimes the Health care institution that enters a contract agreement with HMOs will give them an agreed sum of money which will enable the HMOs to offer low premiums than another form of health insurance coverage and at the same time maintain high-quality health care delivery.
Things to consider before you choose an HMO
- When you are at a crossroads, confused about the HMO to sign up for, the first thing to consider is the quality of health care to be rendered. Google or research more on their selected health care give. If their chosen hospital is not up to your standard, you should turn their offer down.
- Another major thing to consider before you sign up for HMOs service is the premium rate. You should know your pocket before you subscribe to HMOs service.
- Area of specialization. You may not need the kind of services that the hospital has chosen offers in such a situation. It would help if you considered looking elsewhere.
- You should also consider the hospital’s record on responsiveness in case of emergency. What time frame are they expected to arrive in the event of an emergency.
- High rating from experts. You should consider the level and standard of the hospital as well.
- Have it in mind that a quality health insurance plan helps you stay well and get better after treatment.
- Check the exceptions of the policy. The exceptions, I mean the does and don’ts attached to the policy.
- Check if they have a quick claim and settlement or treatment process. Not the one that when health challenges come, they will start referring you from one section of the hospital to the other.
I hope this article about Universal health coverage in Nigeria is helpful.