Is the scheme compulsory for enrollees?
The scheme is compulsory not optional for corporate enrollees.
How do I enroll myself and my family?
Each enrollee must complete the enrollee Questionnaire form and attach
one recent Passport Photograph of each person to be enrolled.
Can new hospitals not yet listed by the HMO be
introduced into the Scheme?
Such hospitals if not already listed on expatcarehealth list of providers shall be inspected and listed provided the hopital meets the minimum required standard and the management of the hopital are willing to join the scheme and abide by the rules guiding our operations. This is in the interest of all enrollee.
The organization / individual may introduce all providers (doctors) that
they were previously retaining for possible inclusion in the provider
Who chooses the providers?
Each and every enrollee has the right to choose any of the hospitals he
finds on the list whether or not the organization / individual was previously
using such a hospital.
What is the limit of cover per enrollee?
Each enrollee and his dependants (maximum of spouse and four children)
are entitled to unlimited medical facilities. Where an extra dependant
has been paid for by an enrollee, such benefits also accrue to that person.
How do I receive treatment when out of station
or in an emergency?
The enrollee when out of station or in an emergency can receive treatment without the need to make any payment in any hospital listed by Expatcarehealth International Limited anywhere in Nigeria only on production of his/her Expatcarehealth International Limited identity card, otherwise he may be denied treatment when out of station.
In an emergency situation, enrollee and dependent may be
treated in any hospital whether listed or not and reimbursement shall be
made on presentation of bill to ExpatCare Health and verification of such
bills. If treatment in such an emergency spans 24 hours, it is advisable
for a relation or next of kin to contact ExpatCare Health. This is in the
best interest of the enrollee
Does the plan cover maternity care?
The scheme covers the female enrollee and wife of male enrollee for antenatal
care, child delivery up to four live births and gynecological treatment.
However, an enrollee that already has a wife and 4 children cannot enjoy
antenatal and delivery care unless additional premium is paid.
What happens if I need specialist care not available at
my primary care provider?
For specialist care, the patient if need be may be referred to another
specialist hospital if such facility is not available in the chosen hospital.
Who is responsible for inter hospital transfer
When there is need to transfer a patient to specialist hospitals, it is
the duty of the providers and ExpatCare Health to provide transportation
for inter-hospital transfer if the patient is incapable, otherwise where
referral is done and the patient is fit, he shall bear the cost.
If I incur high medical bills will my employer
No enrollee has any deduction made or bills piled up against his name
for visiting the hospital irrespective of the number of visits. The mechanism
of the scheme is that there is no financial limit within one contract
year to encourage several genuine visits to the hospital until you are
certified alright health wise.
If I do not have up to the premium of four children
can I substitute?
No you are not allowed to substitute relations for children. You should
simply pay a prorated premium as in above.
Can I change my provider within the year?
Any enrollee reserves the right to change hospital any time, if he/she
is not satisfied with the service provided, or when he/she changes
Change can only become effective on the first day of each
month when the new hospital chosen would have been adequately mobilized.
Any request for a change or new entrant must be received by the 20th day
of the month otherwise, action may be delayed by a month
What is capitation payment?
Capitation is the periodic upfront payment made to the provider on each
registered enrollee with its hospital whether such enrollee goes for treatment or not.
Does the amount of capitation paid monthly represent the
limit of care I can receive?
No the monthly capitation which is paid to the provider whether the enrollee
visits the hospital or not is for primary care only and does not represent
the cost of care receivable. Not all persons paid for go for treatment
every month, therefore, those who do not go for treatment bear the cost
of those who go.
Does capitation cover expensive drugs?
No capitation does not cover expensive drugs even when used for primary
care conditions; laboratory investigations, admissions, specialist treatment,
surgeries etc. are not covered by capitation.
Is substitution of patient or enrollee allowed?
No health insurance is based on each individual life, hence substitution
is not allowed. It is expected to be an annual contract.
How many types of health care plans are there
and what are the differences?
The plan types or brands for corporate bodies are:
Bronze: Entitles the holder to General ward admission
Silver: Entitles the holder to Semi private ward admission
Gold: Entitles the holder to Private ward admission
Platinum: Entitles the holder to the use of Band C hospitals and private ward admission
Platinum Plus: Entitles the holder to overseas medical treatment
Can the provider refuse me treatment because of past frequent
No enrollee or dependants can be refused access to medical care because they frequent the hospital, except where an enrollee goes with a dependent that is not duly registered on the scheme or he is asking for treatment of a condition that falls under the exclusion list
Will the HMO make a refund of my contribution
because I did not visit any hospital during the year?
Because the scheme works on the principle of pooling of risks, the excess
money to treat individuals does not necessarily come from the premium
contributed on a particular enrollee, it comes from other contributors
to the scheme, which even spans beyond population of any particular group.
How do I join the scheme?
The only requirement for the enrollee to enjoy the scheme is for him to
complete the enrollee Questionnaire, give names and dependants so that
relevant identification materials can be produced and forwarded to hospital
of choice. It takes not less than (2) weeks to complete this process therefore
all beneficiaries must comply promptly.
What happens if I have more than four dependants?
When dependants are more than four or you want to include additional dependants
and domestic servants who reside with you, simply inform the Human Resources
Department representative who will tell you how much to pay. The additional
premium is premium paid on you divided by four, multiplied by the number
of people you want to add e.g. to add both nephew and one domestic servant
for a junior enrollee =N=48,000.00 ÷ 4×3 = =N=24,000.00 additional
The age limit for a dependent shall be eighteen (18) or
maximum twenty four (24) if still in tertiary institution. Where the
dependant is a parent, the enrollee will be required to feel a
questionnaire and an additional premium may be required to be paid based
on the health status of the dependant