What is HMO? All You Need to Know About Health Maintenance Organization

Maintenance of a healthy lifestyle is very necessary in our lives although quiet expensive especially when you are diagnosed of a disease that affect the most vital organs of your body.

There is a great need to find a means or backup plan that will provide for you the necessary financial requirements to maintaining your health status hence the need for a health insurance policy but finding a suitable healthcare provider with unique features is also important.

Health insurance is one of the largest and most important type of insurance, it is commonly offered by many companies across different countries. It can simply be described as a form of insurance that financially covers its beneficiaries (the insured) from hospital bills or expenses they make for a better health.

Once you have acquired a health insurance premium plan, any health challenge you experience will be financially sponsored by the insurance company you partner with. Ever since its establishment in 1973 by president Richard Nixon, HMO has retained its principle function of network provision of healthcare services to patients who buy its insurance plans (at community standard rates).

There are several types of health insurance plans such as the Preferred provider organization (PPO) plans, Health maintenance organization (HMO) plan, Health savings account (HSA)-qualified plan, Indemnity plans etc that serves the choices of the insured whether he\she needs a private or public health coverage.

A health maintenance organization (HMO) can be defined as a network or an association that renders all kinds of health insurance coverages for a particular period of time, it could be monthly or annual fee depending on the health insurance premium purchased by the insured. 

Working Principles of an HMO

The providers employ well trained health scientists that work together as a body to ensure that the health of an insured individual is guaranteed in good hands. The organization employs a network of doctors and other auxiliary medical health service providers that work as a given contract in a specific hospital for the organization. Premium charges from healthcare providers are cheaper hence the organization bears the financial responsibilities each medical personnel unlike in the traditional Health insurance scheme where patients have to pay directly for a policy.

Premium rates for HMO beneficiaries are less expensive because the healthcare provider receives insured patients at the hospital. Like the normal or usual way of premium acquisition, HMO plans maybe out of pocket plans (i.e. The individual is charged daily for medical services like the daily Cash plan), special medical care like seeing a doctor in person or having your own personal healthcare provider for routine healthcare, or maybe more advanced health challenges that may require surgery or organ transplant. Whichever way, bear it in mind that premium rates increases in accordance with the type of HMO plan you are interested in, or how wide the plan’s coverage is.

Merits of HMO Plans

  • Obviously, HMO plans are cheap
  • They have lower deductibles than the usual plans
  • Out of pocket plans are also cheaper
  • Demerits of HMO plans
  • HMO plans have restrictions on their usage
  • You have to pay for special plans to see a doctor

Any healthcare service received outside the organization’s network referral requires extra charges paid by you the insured.

Duty Of An HMO Primary Care Physician (PCP)

The insured patient has the privilege to choose a primary care physician (PCP) within the company network plan. The duty of a primary care physician is to orient or examine the insured individuals before they can be referred to a Doctor, the individual is not allowed to consult a medical doctor without passing via the PCP who bridges the gap between the two parties. The PCP works by contract so if eventually he/she leaves their duty, the insured individual will be given a chance to choose another PCP.

Required Skills of a HMO Officer

  • A minimum of 5 times experience post NYSC in applicable and affiliated position; Attendance of affiliated Courses/ shops/ forums may be needed. 
  • A minimum of First Degree (HND/B. Sc) or its original in Health or Science affiliated field.
  • Excellent client relationship chops is needed. 
  • Good communication/ donation chops (both oral and spoken) 
  • He/she must be suitable to take responsibility and demonstrate high position of integrity in dealing with all stakeholders, and also have the Knowledge of statistical/ epidemiological tools similar as SPSS, Graph Pad Prison, MS Excel, and MS Power point. 
  • Once HMO experience may give better chances of acceptance. 
  • The Knowledge of the operations of the National Health Insurance Scheme (NHIS)

Types of HMO in Nigeria. 

There are four types or models of HMO in Nigeria, they include:

Staff HMO: They are medical personnel employed by the HMO itself, staffs are each worker receives his/her pay from the company. Only insured patients are examined by the physicians.

Group HMO: It consists of multiple physicians who specialize in different fields of human health sciences. The amount of money to be paid by patients is determined by these physicians.

Network Model HMO: It works with both physicians with the organization and also hire workers outside it whom patients are referred to in times of more complex medical operations.

Individual Practice Association Model: This works with physicians out the network by giving them contract for a particular period of time. New workers are contracted if the contract duration of the older physicians elapses and the routine goes on.

List of Best HMO in Nigeria.

Below is a current list of HMOs in Nigeria, they include:

  • Hygia HMO
  • Reliance HMO
  • Health point HMO
  • Redcare Health Service Limited
  • Hallmark
  • Greenbay
  • Metrohealth
  • Total Health Trust Limited

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