Health Maintenance Organisations in Nigeria – HMOs

Health Maintenance Organisations in Nigeria – Nigerian HMOs…

A Health Maintenance Organization (HMO) is a private or public incorporated company registered by the Scheme solely to manage the provision of health care services through Health Care Facilities accredited by the Scheme.

HMOs are designed to deliver quality health care to a designated population in a cost effective manner, through health care providers paid either a fixed budget or discounted fees. They use a value-driven system of managed care to provide affordable health services

The financial burden of risks of over-using health services are borne by the HMO, its service providers or a combination. There are therefore various explicit and implicit rules which govern the risk-sharing.  The member must receive health care from HMO – approved provider.

HMOs have exclusive provider networks. They may also use primary care providers (PCP) as gatekeepers. Gatekeepers are responsible for arranging a patient’s referral to a specialist or admission to a hospital.

While most HMOs use gatekeepers, some HMOs have open access plans. These plans allow the patient to choose any PCP or specialist in the network without a referral.

Many HMOs also use reimbursement systems to encourage providers to be more cost conscious. HMOs may contract directly with physicians in the community, or may contract with networks of physicians. This arrangement is called a network or IPA model HMO

HMOs may have their own physicians on salary or in an exclusive contractual arrangement. This is called a group- or staff-model HMO.

READ ALSO: National Health Insurance Scheme (NHIS) in Nigeria

Characteristics of Health Maintenance Organisations in Nigeria

  1. They assume contractual responsibility for assuring the delivery of a stated range of health care services including at least in-patient hospitalization and ambulatory care services.
  2. They serve a voluntarily enrolled population. Health care is delivered through a proper referral system.
  3. The premium is fixed, regardless of utilization.
  4. There may be a fixed co-payment (direct or indirect) for use of certain services.
  5. The HMO assumes some of the financial risk or gain.

Registration Of HMO

The Council shall approve and register for the Scheme private and public Health Maintenance Organizations  Act 35 of 1999 Section 19 (1)

The registration of an organization of the scheme shall be in such form and manner as may be determined from time to time, by the Council, using guidelines, which shall include provisions requiring the organization to:-

(a)          Be financially viable before and after registration;

(b)          Make complete disclosure of the ownership structure and composition of the organization

(c)           Have an account with one or more banks approved by the council

(d)          Be insured with an insurance company acceptable to the Council

(e)           Give an undertaking that the organization shall manage and invest the funds accruing to it from contributions received in pursuant to this decree in accordance with guidelines to be issued, from time               to time, by the Council

Sets of people  Eligible for HMO

1  Any group of persons or organization of proven and impeccable character may be eligible to form a company either  private or public and apply for registration as an HMO under this Scheme.

2  No HMO shall  appoint or have in its employment a Director, Chief Executive, Manager or Secretary if he/she:

(a)  Is or becomes of unsound mind , or as a result of ill health, is incapable of carrying out his duties

(b) Is convicted of any offence or crime involving dishonesty or fraud Is not a fit and proper person for the position

(c) 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 practising his profession in Nigeria by the order of any competent authority made in respect of him personally.

Read also: Top 40 Health Insurance Companies in Nigeria

Below are the Conditions for Accreditation

Any company applying for accreditation under the Scheme shall meet the following requirements:

1)      Register with the Corporate Affairs Commission.

2)      Original Certificate of Incorporation, Articles and Memorandum of Association would be sighted and verified

3)      Provide Statement of Affairs of the Company or Audited Accounts for the past 3 years (where applicable)

4)      Provide evidence of Fidelity Guarantee/Indemnity Insurance Cover with an NHIS-accredited insurance company to the value of the paid up share capital

5)  Complete the prescribed application forms providing the following information:

  1. Ownership structure and composition of the organization
  2. Names, addresses and detailed CV of the principal officers

6)   A minimum paid-up share capital requirement of HMOs shall be as follows:

  1. A National HMO shall be required to have a fully paid up share capital of N400 million naira and subject to review by the NHIS
  2. A Zonal HMO shall be required to have a fully paid up share capital of N200 Million and subject to review by the NHIS
  3. A State HMO shall be required to have a minimum paid up share capital of N100 Million and subject to review by the NHIS

It is Note worthy that a maximum of 30% of the paid up share capital can be held in form of fixed asset for a fresh applicant.

For currently accredited HMOs, a maximum of 40% of the paid up share capital can be held in form of fixed asset. 50% can be held as working capital and 10% in form of cash at hand.

7) HMO shall carry on any business other than the business of health care management as provided by the Decree.

8) The funds management of the HMO should be in accordance with specific guidelines that prevent fraud on solvency problems.

7) HMOs shall be prohibited from directly engaging in any business that is not related to health.

8) HMO’s may not be directly affiliated to banks

9) HMOs shall observe prescribed standards of reporting fund holdings for verification purposes.

Health Maintenance Organisations in Nigeria - Nigerian HMOs

Roles Of Health Maintenance Organizations In Nigeria

Health maintenance organizations play  vital roles in the provision of health care and medical services to the citizens of Nigeria . The Nigerian National health insurance scheme is driven through the Health Maintenance organizations which help to give quality and effective health care services to contributors  under the scheme.

Let’s look at the 21 roles played by the Health Maintenance organizations in Nigeria, some of the major roles are as follows:

  1. To collect contributions of employer and employees from different parts of the country.
  2. To register employer and employees
  3. To register service providers, after making sure that they meet the minimum NHIS standards.
  4. To give health promotion and education
  5. To create an effective quality assurance systems
  6. To ensure qualitative and cost effective healthcare services to contributors through the healthcare providers (HCPs).
  7. To ensure that contributions that are made are kept in the scheme’s accredited banks.
  8. They ensure that processing of claims is done effectively.
  9. They also gather appropriate contributions and make necessary payments to the right pools in a timely way.
  10. They market in-line with the NHIS guidelines.
  11. To ensure that approval of referrals are done within the stipulated time and undertake the necessary follow up to complete the referrals.
  12. To market health plans to employers of several public and private sectors.
  13. To gather and submit the encounter data forms from healthcare facilities to NHIS.
  14. Getting in touch with health care facilities that are only accredited by the scheme with the aim of providing health care services.
  15. To follow all the other provisions as outlined in the operational guidelines
  16. Conducting functions which are stipulated in the NHIS operational guidelines.
  17. To deliver accounts to the National health insurance scheme as required in the operational guidelines.
  18. Delivering monthly returns to the scheme on capitation and fee-for service payment to secondary & tertiary healthcare facilities.
  19. Providing continuous sensitization and education of the enrollees.
  20. To create and ensure that there is a quality assurance system to provide quality healthcare by the health care facilities.
  21. Provide risk management enlightenment for those that enrol and providers.

As a result of the poor health care services in the country, Nigerian health maintenance organization has experienced a slow growth.

But since the country has partnered with international bodies, they have been able to market HMOs.

HMO has penetrated into the regions that lacked medical services and their services has been quite commendable . Nigeria as a whole  has to put more effort intensify its marketing so that many citizens can benefit from the health care programme.

Top 40 Accredited HMOs in Nigeria

  1. HYGEIA HMO LIMITED

11A Idejo Street, Off Ademola Odeku Street Victoria Island, Lagos.

01-4617071 01-4617073

08036710207 Adebajo (Abuja)

  1. TOTAL HEALTH TRUST LIMITED 2, Marconi Road Palmgrove Estate, Lagos 01-4701813 01-7747150
  2. CLEARLINE INTERNATIONAL LIMITED

16, Oyefe Avenue, Off Ikorodu Road,

Savoil B/Stop/Hallmark Assurance Plc.

Obanikoro, Lagos.

01-7741092, 4977542

09-6725605, 2730839

0806006004

  1. HEALTHCARE INTERNATIONAL LIMITED

308A Murtala Mohammed Way, Yaba, Lagos

Abuja Office: 3rd Floor

UACN Commercial Complex

Plot 272/273, Beside Arewa Suites

Central Business District, Abuja.

01-4705701, 01-4705702

09-6709099, 6739099, 09-5238589

6724509, 08033151956

  1. MEDI PLAN HEALTH CARE LIMITED

Plot 286B, Ajose Adeogun Street

Victoria Island, Lagos.

Abuja: Suite 42-44, God’s Own Plaza

Takun Close, Off Nkwerre Street

By Ahmadu Bello Way

Behind Unity House (Rochas Foundation)

01-2611012

01-2614828

08033081650

  1. MULTI SHIELD NIGERIA LIMITED

No. 322, Ikorodu Road, Anthony, Lagos.

Abuja: Metro Plaza

Suite F18, 1st Floor (Opp. Nat. War College)

Central Area, Abuja.

01-7737579

01-7910807

09-4619127

09-4619128

Fax

08032916251 (Amana)

  1. UNITED HEALTHCARE INTERNATIONAL LIMITED

NICON Plaza, 2nd Floor, Abuja.

Dorcas 08034086095

  1. PREMIUM PRIVATE HEALTH TRUST LIMITED

31B, Itafaji Road, Dolphin Estate

Ikoyi, Lagos

Abuja: No. 5B Kabo Street

Garki II Opposite Eddy Vic Hotel, Abuja

01-4614498

08023387494

  1. RONSBERGER NIGERIA LIMITED

Plot 359, Mambolo Street, Zone 2, Wuse

District, Abuja.

09-5234162

09-6709889

08035053179

(Mr. Ben. Chukwu)

  1. INTERNATIONAL HEALTH MANAGEMENT SERVICES LIMITED

2, Joseph Street, Off Broad Street, Lagos

01-4736933

08033145541 (Mrs. Medo)

08054156880 (Miss Elizabeth)

  1. I love EXPATCARE HEALTH INTERNATIONAL LTD.

39A, Sura Mogaji Street, Off Coker Road, Ilupeju, Lagos.

Abuja Office: IGI House 3, Gwani Street, Wuse, Zone 4, Abuja 08055890010, 08055274020 08055890025, 08025240194 080252540194,08034886898

  1. SONGHAI HEALTH TRUST LTD.

Ground Floor, Nigeria Re-Insurance Building Beside Unity Bank,

Plot 78A Herbert Macaulay Way,

Central Area, Abuja.

09-2223636,08033571011

  1. INTEGRATED HEALTHCARE LTD.

19 Jos Street, Area 3, Garki, Abuja.

09-2342199 ,09-2342299

  1. PREMIER MEDICAID LTD. 

Olive House, No. 6/53 Fajuyi Road Adamasingha, Ibadan.

Abuja Office: No. 4 Takum Close  Area 11, Garki, Abuja

01-2410052 ,08037866956

Steve Auta 08063446465

  1. MANAGED HEALTHCARE SERVICES LTD.

16 Obokun Street, Off Coker Road,

Illupeju, P.O.Box 641, Oshodi, Lagos.

Abuja: 1st Floor Tofa House  Central Business District, Abuja.

01-4931629-32 ,08059705441 08033206673

  1. PRINCETON HEALTH GROUP

26, Mogaji-Are Road, Opposite Vital Bakery, Ring Road, P.O. Box 23512, Mapo, Ibadan.

Abuja Office: 42, Adetokunbo Ademola Crescent Opp. First Inland Bank Wuse II, Abuja.

02- 7511737, 08023137463

08060429280 08038440320

08023928579 09-7801184

08034306380 – Olalekan (Abuja)

  1. MAAYOIT HEALTHCARE LTD.

1, Iloffa Road, G.R.A., P O Box 5504,

Ilorin, Kwara State

Abuja Office: No. 5 Mahatma Gandhi Street Off Shehu Shagari Way  Behind Bulet Garden  Area 11 Junction B/Stop Garki, Abuja.

031-229898 08058026841

09-3145815, 08050825957

08023240467

08050825957 Adesuyi P.R.O

  1. WISE HEALTH SERVICES LTD.

Plot 533, Durban, Off Adetokunbo Ademola

Crescent, Wuse II, Abuja.

09-6723065 09-5238935

01-2623114

09-5238925, 09-5236625

(08023355000)

Mr. Ayo Rabiu (08036339696)

  1. WETLANDS HEALTH SERVICES LTD.

5, National Supply Road, Off Trans-Amadi Road,

P O Box 12403, Port Harcourt, Rivers State.

Abuja Office: Banex Plaza

Plot 750 Aminu Kano Crescent

Zone A7, Wuse II  P O Box 6914, Abuja

084-750952

08023373103  08050981840

(Miss Sifawu Prisca Jimoh) Abuja

08035233502 08050981840

  1. ZENITH MEDICARE LTD.

Plot 131B Adetokunbo Ademola Crescent Wuse II, Abuja.

09-8705763

08069261950

Fax: 09-4131660

  1. DEFENCE HEALTH MAINTENANCE LTD.

No. 2 Kamina Close, Off Ndele Street, Wuse Zone 3, Abuja.

09-2348096

  1. UNITED COMPREHENSIVE HEALTH MANAGERS LTD.

Suite 40, 24 Old Aba Road, Rumuogba

P O Box 6150, Trans Amadi, Port Harcourt, Rivers State.

08033419470, 08055021760

08023145171 Akajiaku (Abuja)

  1. HEALTHCARE SECURITY LTD.

3, Kanta Road (Near NNDC), P. O. Box 8318 Kaduna.

Abuja: Bannex Plaza

BPS 6, 750 Aminu Kano Crescent  Wuse II, Abuja

08052745337 08033148050

08037107658 062-212872 Augustine Igomu

08055121516, 08025701970

  1. STRATEGIC HEALTH PLANNERS CO. LTD.

BK International House

SPC Junction, Murtala Mohammed Highway P O Box 3047, Calabar, Cross River State.

08050233249 08037091628

08037871484 Mr. Ezete – Abuja

08055353370

  1. ROYAL HEALTH MAINTENANCE SERVICES

24 , Wetheral Road, Owerri, Imo State.

08037956689 FAX 083-231053

27 AREWA HEALTH MAINTENANCE SERVICES

Plot 645, Alex Ekwueme Street, Jabi, Abuja.

09-2908529

09-5231162, 08027128412

  1. ZUMA HEALTH TRUST

1235, No. 6 Sapele Street, Opp. NSMP Quarters, Garki, Abuja.

09-5236159

Dr. C.D. Ali 08033147249

  1. MARKFEMA NIGERIA LTD.

4A Gurara Street

Ibrahim Abacha Estate Zone 4, Abuja

09-5238945 FAX 6725510

08033109117 Dr. Femi Onimole

08054472099

  1. PREPAID MEDICARE SERVICES LTD.

No. 1 Bengui Street

Off Adetokunbo Ademola Crescent

Wuse II, Abuja

08057430303 Dr. Oluyide

08058959065 Dr. Olagbegi

  1. CIGNET HEALTH LIMITED

15, Admiralty Way Lekki Phase I, Lagos State.

01-2706697 5555603, 5555567

01-2706697 Hon. Jeff

  1. FORTECARE LIMITED

303 Nnebisi Road

Asaba. Delta State

056-280855, 282157, 282164

08033185341 Dr Onyia I. Odaniba

08033085205 Valentine – Abuja

  1. GTI HEALTHCARE LIMITED

39A Saka Tinubu Street

Victoria Island, Lagos.

01-4610266, 2625682, 2625684-5

08034963464 Mr. Martin

Chukwu

  1. STERLING HEALTH MANAGED CARE SERVICES LIMITED

Valley View Plaza

99 Opebi Road, Ikeja, Lagos.

01-2790698

08023020934

  1. HEALTH PARTNERS LIMITED

12, Sobo Arobiodu Street

G.R.A., Ikeja, Lagos,

Lagos State

01-2716982-4

  1. PRECIOUS HEALTHCARE LIMITED

No. 8, Lungi Street, Off Cairo

Wuse II, Abuja

234-9-4139411

  1. KADUNA GMD HEALTHCARE LIMITED

13 Isa Kaita Road

Kaduna, Kaduna State

062-213122

Fax 213120

38 DIAMOND SHIELD HEALTH SERVICES LIMITED

73A, Mainland Way Dolphin Estate, Ikoyi Lagos.

01-4620601

08033092081

  1. OCEANIC HEALTH MANAGEMENT LIMITED

20, Ozumba Mbadiwe Avenue,

Victoria Island, Lagos

01-4615145/46, 01-7614947

  1. UNIC HEALTH MANAGED CARE SERVICES LIMITED

Plot 144, Oba Akran Avenue

Ikeja, Lagos. 01-2709728

Read also: Top 40 Health Insurance Companies in Nigeria

 

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