A Health Maintenance Organisation (HMO) is a private or public company registered by the National Health Insurance Scheme (NHIS) in Nigeria to manage the provision of healthcare services through Health Care Facilities accredited by NHIS. HMO’s carry out healthcare services which includes hospital treatments, Optician care and Dental care.
In Nigeria, people buy HMO plans to protect their family or businesses from the experience of paying out of pocket during a health emergency. HMO’s are the most popular form of Health Insurance in Nigeria and some of the popular ones include Reliance HMO, Clearline HMO, Anchor HMO and Hallmark HMO.
12 Things Health Maintenance Organizations Do
- Health Maintenance Organizations Collect Donations From Contributors.
- Health Maintenance Organizations Compile Contributions From Employees.
- Health Maintenance Organizations Assure Effective Procession Of Claims.
- Health Maintenance Organizations Ensure Timely Payment Of Duty.
- Health Maintenance Organizations Clarify Monthly Scheme Returns.
- Health Maintenance Organizations Collect and Submit Data Forms.
- Health Maintenance Organizations Contracts with Health Care Facilities.
- Health Maintenance Organizations Keep Contributions In Accredited Banks.
- Health Maintenance Organizations Establish And Ensure Quality Assurance System.
- Health Maintenance Organizations Ensure Timely Approval Of Referrals.
- Health Maintenance Organizations Carry Out Continuous Sensitization.
- Health Maintenance Organizations Carry Out Marketing Programmes.
Registering A Health Maintenance Organisation in Nigeria
Before any HMO is registered, there is a special accreditation guide that was created by the National Health Insurance Scheme (NHIS). Any group of persons or organization of proven and impeccable character may be eligible to form a company (private or public) and apply for registration as an HMO under the Scheme.
No HMO shall appoint or have in its employment a Director, Chief Executive, Manager or Secretary if he/she:
- Is or becomes of unsound mind , or as a result of ill health, is incapable of carrying out his duties;
- Is convicted of any offence involving dishonesty or fraud;
- Is not a fit and proper person for the position;
- Is guilty of serious misconduct in relation to his duties;
- In the case of a person with professional qualification; has been disqualified or suspended from practicing his profession in Nigeria by the order of any competent authority made in respect of him personally.
Also any company applying for accreditation under the Scheme shall meet the following requirements:
- Register with the Corporate Affairs Commission.
- Original Certificate of Incorporation, Articles and Memorandum of Association would be sighted and verified.
- Provide Statement of Affairs of the Company or Audited Accounts for the past 3 years (where applicable).
- Provide evidence of Fidelity Guarantee/Indemnity Insurance Cover with an NHIS-accredited insurance company to the value of the paid up share capital.
- Complete the prescribed application forms providing the following information:
- Ownership structure and composition of the organization.
- Names, addresses and detailed CV of the principal officers.
The minimum paid-up share capital requirement of HMOs shall be as follows:
- A National HMO shall be required to have a fully paid up share capital of N400 million naira andsubject to review by the NHIS.
- A Zonal HMO shall be required to have a fully paid up share capital of N200 Million and subject to review by the NHIS.
- A State HMO shall be required to have a minimum paid up share capital of N100 Million and subject to review by the NHIS.
- NHIS – HMO Accreditation Guidelines
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