How to Use Your HMO at the Hospital in Nigeria

Having an HMO plan is only useful if you know how to use it when you need care. Many people pay for health insurance but still pay at the hospital because they’re not sure of the process. Here’s a simple guide to using your HMO at the hospital in Nigeria, from your first visit to specialist referrals, emergencies and what to do if something goes wrong.

Before you go

• Know your member ID. Keep your enrollee ID number or card handy, or saved in your HMO’s app.
• Know your primary hospital. This is the hospital or clinic you chose when you registered. Check its address and opening hours.
• Consider telemedicine first. For minor problems, a phone or chat consultation with a doctor may be faster. Reliance HMO members can speak to a doctor in the Reliance Care app.

How to use your HMO at the hospital: step by step

1. Go to your primary hospital. For non-emergency care, start at the hospital you registered with.

2. Tell reception you’re an HMO patient. Give the name of your HMO and your member ID. The hospital will check that your plan is active.

3. See the doctor. Consultations covered by your plan should not require payment.

4. Tests and medicines. Covered tests and prescribed medicines are provided under your plan. For some services, the hospital must first get approval from the HMO.

5. Approval (pre-authorisation) for bigger services. Admissions, scans, surgery and specialist care usually need a pre-authorisation (PA) code from your HMO before the hospital provides them. The hospital normally requests it for you. Read more about HMO pre-authorisation codes.

Seeing a specialist

If your doctor decides you need a specialist, such as a cardiologist or gynaecologist, they will refer you. The HMO approves the referral and tells you which specialist hospital to visit. Going directly to a specialist without a referral may mean the visit isn’t covered.

What to do in an emergency

In a real emergency, such as chest pain, difficulty breathing, severe bleeding, a serious injury or loss of consciousness, go to the nearest hospital straight away. Contact your HMO as soon as possible afterwards so they can arrange cover or transfer. Emergency care is covered by most plans, even at a hospital that isn’t your primary hospital.

Using your HMO for pregnancy and childbirth

If your plan includes maternity care, register for antenatal care at a covered hospital early in your pregnancy. Check your plan’s waiting period and what’s included. Read does HMO cover pregnancy?

Common problems and how to solve them

• The hospital asks you to pay for something covered: ask them to contact your HMO for approval, or call your HMO yourself before paying.
• A service isn’t covered: check your plan’s benefits and exclusions. You may need to pay for services outside your plan.
• Long waits for approval: contact your HMO’s customer care. Reliance HMO members can use the app or call 0700-RELIANCE.
• You’re unhappy with your hospital: you can usually change your primary hospital through your HMO.

Tips to get the most from your HMO

• Use your plan for check-ups and screening, not just when you’re ill
• Keep your contact details up to date so the HMO can reach you
• Know your plan’s limits and renew on time so your cover doesn’t lapse
• Add family members if they’re not yet covered

Frequently asked questions

Can I use my HMO at any hospital?
For routine care, use hospitals on your plan, starting with your primary hospital. In an emergency, go to the nearest hospital.

Do I need to pay anything at the hospital?
Covered services should not require payment. You may need to pay for services your plan doesn’t cover.

Can I use my HMO in another state?
With a national HMO, yes. Check the hospital list for the state you’re visiting.

New to health insurance? Read what an HMO is and how it works and how to register for an HMO.

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