- What is Health Insurance?
Health Insurance can be defined as a system of advance financing of health expenditure through contributions, premiums or taxes paid into a common pool to pay for all or part of health services specified by a policy or plan.
- What is an HMO?
Health Maintenance Organization is a private or public incorporated company registered by the NHIS solely to manage the provision of health care services through Health Care Providers accredited by the Scheme.
- How does the MetroHealth HMO Plan work?
When you have selected your plan type, filled the registration form (selecting a primary care provider from the hospitals in the network) and your ID card has been handed over to you, you simply visit your elected hospital whenever you need to access medical services.
- Who is eligible to register with MetroHealth HMO?
Every Member of staff and eligible family members as determined by your company policy.
- Can I change my plan type?
Yes you can change your plan type at the renewal of your policy which would be annually.
- How many people does the family plan cover?
The family plan covers an individual, a spouse, and four children under the age of 21 years.
- Am I covered for medical emergencies?
Yes, you are covered for emergency stabilization on all plans. A medical emergency is an accidental injury or the sudden and unexpected onset of a condition requiring immediate medical or surgical intervention.
- Can I access care without my Identification card?
Yes, you can access care without your identification card. A letter of introduction to the hospital will be mailed to you and the hospital prior to the delivery of your HMO card. Please contact our customer care centre for assistance.
- Can I access care while out of state or locality?
Yes, you can access care. When you travel out of state or perhaps you are in dire need of medical care and you are not in close geographical proximity to your hospital, you can access care via the other hospitals in the network.
- To whom do I send my complaints or make clarifications from?
You send in your complaints by calling our 24/7 customer care representative on 01 460 6790, 01 6310038, 0800METROHEALTH (080063876432584), or by sending an e-mail to clientservices@metrohealthhmo.com; callcentre@metrohealthhmo.com
- How do I choose my health care provider?
We have a wide network of providers and, we would advise that you choose a health care provider near where you live or work. Our contact centre is available 24 hours daily to help you with your choice of a health provider.
- How often can I change my Primary Care Provider?
You are only allowed to change your Primary Care Provider once a month and the change will be effected from the 1st day of the subsequent month.
- What happens if I go to the hospital and I am told that the service I require is not covered?
At the beginning of the health plan period, you will receive a health plan handbook in hard and electronic form which contains the medical benefits covered. Kindly Contact our call centre to validate the plan benefits.
- If I do not attend hospital over a 12 month period, is there any form of refund or compensation paid to me at the end of one year?
There is none because the HMO plan operates just the same as a regular insurance policy. The premium is not refundable.
- Does every member of my family have to use the same primary care physician?
No, each family member may choose a different primary care physician.
- What happens if I lose my MetroHealth ID Card?
Inform MetroHealth HMO and a replacement ID card will be produced for you at a cost of N500 only.
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