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Reliance HMO

Frequently-asked questions

We’re always here for you to answer questions and provide support. Here are a few things to know about your health plan.

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Access to careBenefitsGeneral inquiriesReimbursement claimsProvider operations
  • How do I access a care facility?
    You can find a list of eligible providers on the Reliance Care mobile app in the ‘Health Care’ tab under ‘Find a Provider’. Present your Reliance HMO ID number or ID card at the facility for verification so you can be seen.
  • When can I start accessing care after onboarding / registration?
    Immediately after receiving an ID number or ID card.
  • Do I need authorisation to see the doctor every time I go to the hospital?
    No, you don’t require pre-authorisation (PA) except in the case of special consultations or secondary care. The hospital will contact Reliance HMO to get a PA code if needed.
  • In an emergency, how do I access care?
    Go to the nearest hospital on the Reliance HMO hospital list to receive the highest level of care. If there aren’t any hospitals on Reliance HMO’s network nearby, please go to the nearest hospital for emergency treatment. As soon as you start feeling better, reach out to Reliance HMO (within 24 hours at the latest). If you’ve been unconscious, please inform Reliance HMO once consciousness is regained.
  • Can I access medical service in a hospital that’s not registered in the Reliance hospital network?
    Only through a referral from a hospital on our network that does not carry out the required treatment. Except in the case of a lifethreatening emergency, please refer to the nearest registered hospital to receive the care you need.
  • How do I access secondary care? (i.e. Optician, Dentist etc…)
    Please set up an appointment through Reliance Care Center, sending a WhatsApp message, or visiting the app. You can also contact the provider directly to make the appointment. All provider details and contact information are available on the app.
  • If I’m on a long-term prescription, how do I get my medication?
    Your prescription should be issued through a hospital in Reliance HMO’s network. Drugs will be provided to you by the hospital in a convenient manner. If this is not possible, send the recently-signed prescription to hellonigeria@getreliancehealth.com and we’ll deliver your medications to the address provided. If you prefer, you can arrange a pickup from one of our partner pharmacies.
  • How can I access the benefits covered in my plan?
    Once your registration is complete, please download the Reliance Care app. It is designed to give you easy access to all the details of your plan. Access your full list of benefits on the Reliance Care app. Just go to the “Health Care” tab and choose “View Benefit List”.
  • What does “reaching my limit” mean?
    At Reliance HMO, the benefits are designed such that certain benefits have monetary limits, as agreed with your organisation. Once the monetary limit is reached for this type of benefit, you can no longer access this benefit under your plan until the plan is renewed for another year.
  • Can I be denied care at a service provider within the Reliance HMO network?
    In certain scenarios, this situation might occur if:
    • the provider is not included in your plan
    • the care or benefit is not covered by your plan
    • the benefit limit has been fully utilised
    • the benefit/care is not covered by the HMO
    • there’s no medical indication for required care
  • What are the exclusions in my healthcare plan?
    In general, you will not be able to access care relating to:
    • cosmetic procedures
    • hair treatments and balding
    • personal comfort items like toothpaste
    • alcohol and substance abuse
    • fertility treatment apart from tests allowed on the plan
    • sex transformation
    • congenital disease
    • organ transplants
    • dental implants and braces
    • injuries from hazardous activities, professional or amateur sports, war, armed conflicts and criminal acts
    • recognised epidemics
    • advanced surgeries including brain, spine, cardiac and joint replacement surgeries
    In addition, we will be unable to honour requests that are unorthodox, as in alternative medicine, not prescribed by a medical doctor, are not medically necessary, and do not have clear benefits. For a more detailed list of exclusions, you can contact RCC or your organization’s HR department.
  • How do I register my dependents? (e.g. newborn, child, spouse)?
    We have family plans designed to fit the needs of your family and provides them with the healthcare they deserve. If you wish to register, you can contact your HR officer.
  • At what point do I need to reach out to Reliance Care Center?
    Billing and payments: For queries regarding billing statements, payment methods, or to resolve billing-related concerns.

    Complaints: To file a complaint, report issues related to service quality, or address any dissatisfaction with the provided services.

    Enquiries: If you have questions regarding your insurance policy, coverage details, or specific benefits offered by your plan or your benefit limit status.
  • How can I get prescribed medication for a diagnosis that is covered under my plan delivered to me?
    For your convenience, medication can be delivered to you or can be picked up at the pharmacy.

    This is determined by Reliance HMO pharmacy team and is dependent on various factors like medication type, medication availability and your location. You can follow the below steps for medication delivery:

    1. The provider sends in a request for medication supply for the plan member OR the plan member sends in a valid prescription note from the hospital. The request or prescription note must carry a matching diagnosis. The facility must attach a prescription note for controlled medications.
    2. Reliance HMO reviews the prescription and determines coverage. If the plan member is not covered for any or all the medications, they will be informed.
    3. If Reliance HMO processes the prescription, the plan member’s address is verified to enable Reliance HMO pharmacy team to fulfil the prescription at the appropriate location, either via pickup or delivery. The RCO will also inform the plan member that fulfilment can be via any of those options.
    4. Reliance HMO officer then advises the plan member on the SLAs:
      • For prescriptions created before 12pm, delivery will occur on the same day, considering the plan member’s responsiveness and completion of necessary checks.
      • Prescriptions created after 12pm will be delivered the next day, considering the same conditions.
    5. In case of medication delay, you can always reach out to reliance care center for follow-up
  • What should I do if I need to make an out-of-pocket payment at the hospital?
    As plan member, you shouldn’t have to make any out of pocket-ofpocket payments at the hospital. If you’re ever put in this situation, please reach out to Reliance Care Center for approval prior to payment.

    If there’s an emergency, please proceed with payment and contact Reliance Care Center when it’s convenient.

    Please do not make any out-of-pocket payments without getting approval from Reliance HMO via the communication methods mentioned at the beginning of this document, except in lifethreatening emergencies (please reach out to Reliance HMO as soon as this payment is made).

    Please send any reimbursement requests to us at the following address: hellonigeria@getreliancehealth.com. It should include scanned copies of the below documents, in addition to the reason for payment:

    • Payment receipts
    • Medical report showing details of all care accessed
  • Why is my claim denied?
    A claim is typically denied either because the coverage limits have been exhausted or because the service being requested is not covered by the current plan. If you ever had to pay out-of-pocket for any service, please contact Reliance Care Center prior to doing so. This is help keep you informed about the process, know in advance if this service is covered and will avoid denying the claim.
  • Can I choose more than one hospital?
    You can go to any hospital of choice under the Reliance HMO network, and within your plan. You can find the list of hospitals on Reliance Care App. Just go to the “Health Care” tab and choose “Find a Provider”.
  • Can I choose other hospitals apart from those on your network?
    Reliance HMO network has a wide selection of hospitals and other health care providers. You can check Reliance Care application for the list of providers on our network.

    If you’re unsure about which provider can attend to your health issues, you’ll find all the contact information for the providers on the Reliance Care app, as well as their locations. Alternatively, you can reach out to Reliance Care Center by calling, WhatsApp messaging, and on application support.
  • How often can I visit the hospital?
    You may visit the hospital when you need medical care.
  • What happens if I am dissatisfied with the quality of care from a particular hospital?
    Please reach out to Reliance Care Center by calling, WhatsApp messaging, and on application support. You’ll also receive a link on your registered email for a post-visit survey that you can use to rate and provide feedback on the provider you visited.
  • How can I change my hospital?
    Reliance HMO grants you access to any hospital on our network that is within your plan. The list of providers available in your plan can be found on the Reliance Care app.
  • What happens if I go to the hospital and I am told that the service I require is not covered?
    Reliance HMO aims to provide you with healthcare services that are accessible, affordable, and delightful. To be able to maintain our promise to our customers, and keep providing you with the healthcare services you need at the quality you deserve, we won’t be able to cover all the services.

    We understand that this can be an inconvenient situation, and this is why we highly recommend that you stay informed about the benefits that are covered under your plan.

    This can be done through reaching out to your HR team, the Reliance Care Center, or by downloading the Reliance Care app. On the app, just go to the “Health Care” tab and choose “View Benefit List”.
  • Can I use my HMO ID to get treatment or drugs for my dependents (spouse or children) or others?
    The HMO ID is to be used by the owner only. Where registered as a family, every family member has a unique HMO ID.

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