What is Health Maintenance Organisation (HMO)?

• A managed care organization that integrates financing and delivery of a comprehensive set of health care services to an enrolled population

 What are the services provided by Marina Medical Services Limited (MMSL) HMO?

•    MMSL  HMO provides affordable Health Plans (Schemes) for individuals and corporate organisations throughout Nigeria.

 Is it compulsory for corporate organisations to subscribe to the Health Insurance Scheme?

•    Yes it is compulsory if the organisation recruits more than 10 persons. This is the stipulation of the National Health Insurance Scheme (NHIS) Act (Act 35 of 1999)

 What are the types of Health plans offered by MMSL - HMO?

•    Basic Plan

•    Basic Plus Plan

•   Premium Plan

•   Ultimate Plan

•    Customized plan (Client specific)

What are the Categories of MMSL enrolled members?

•    Private Individuals (Families)

•    Corporate Organisations e.g. Companies

•    Institutions e.g. Schools

 Who constitutes a Family Plan?

•    The family schemes covers Principal applicant (Staff) , Spouse and up to four biological children

•    Additional spouses and children or dependants would attract additional discounted premium.

•   You cannot substitute relatives or wards for biological children because of Medico-legal implications.

How do I become a private member (Policy Holder) of the MMSL HMO Scheme?

•    You would complete an individual application form

•   Select the type of Health plan that meets your need

•    You would complete a medical questionnaire for your current health condition

•    The premium could increase should there be a pre-existing medical condition e.g. Hypertension.

•    Payment of premium (subscription)  to MMSL for the selected Health to cover 12month period

•    Attach your passport photograph and dependants where applicable

What is a Corporate (Group) Scheme? And how do I become a member

•    A group scheme refers to corporate membership

•    The organisation would select the type of health plans for its staff.

•    Each staff would complete a membership form and select one primary care provider.

•   Payment for subscriptions for the selected Health plan would be made in favour of MMSL(HMO)  to cover 12month period

•    Attach your passport photograph and dependants where applicable

What Value added services distinguishes MMSL HMO plans from Other Health schemes in Nigeria

•    All our plans have emergency medical response services

•    Telemedicine: Access to 24-hour call centre services in emergency and non-emergency medical situations

•   Specialist Clinic and Hospital owned by MMSL holding company.

•    Affordable health scheme with flexible options for customized scheme

•    24 Hour Client Services Operations

•    24 hour first aid / medical advisory services to subscribers

•    24 Hour help line

What are MMSL Benefits package

•    Outpatient care

•    In patient care

•    Specialist services

•    Emergency care services

•   Health Education  / Newsletter on MMSL website

•    Services covered by the selected plan.

Is Maternity care covered under every plan?

•    Yes. (depending on selected plan)

•    Private subscribers have a waiting-period of 10 months before they can benefit.

What categories of Health care providers does MMSL contract with?

•    Primary care providers (Same as GP or family doctor)

•   Secondary care providers (Medical Specialist institutions, Laboratories, Pharmacists etc)

•    Tertiary Hospitals (e.g. Teaching hospitals)

Primary Care Provider

•    Health care professional capable of providing a wide variety of basic health services. Primary care providers include practitioners of family, general, or internal medicine etc ( e.g. MMSL Clinic)

Secondary Care Provider

•    They provide specialist care. The primary care provider usually refers the patients to these groups of professionals. They include surgeons, physiotherapists, paediatricians etc

What are Exclusions?

•    The exclusions (treatment not covered) include but not limited to organ transplants, cosmetic surgery, alternative therapy, cancer treatment, HIV/ AID anti-retroviral treatment, Complex Surgeries (e.g. Brain surgery) , Supply of artificial body parts, herbal therapy etc

Are there Age limits to joining the scheme?

•    Yes. You must be between 0-60 years for the corporate schemes

•    The Private scheme covers any age group.

What if I am above 60 years?

•   Your premium will depend on your age and health status.

What is age limit for children that are dependents?

•    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 fill a questionnaire and an additional premium may be required to be paid based on the health status of the dependant.

Are the dependents covered for Antenatal care and Child birth under the scheme?

•    No, they would need to subscribe to an Individual adult scheme that covers such benefit.

How do I select a Health Care Provider?

•    Before joining the MMSL scheme, a list of over 300 Primary and secondary care provider (Hospitals) would be provided to you to select one provider from.

Is a member restricted only to a primary health care provider?

•    Yes. This is a way of ensuring that your records are properly kept with your selected general practitioner. In an emergency you can visit any hospital nationwide and notify MMSL HMO within 24 hrs to take over the management of your health condition

Do I require any form of identification before obtaining care from the provider?

•    Yes. You would need to carry your member identification with current subscription before obtaining care at the health care provider facility.

•    If you do not have an identification card, the provider would check you passport picture in their file for verification of your eligibility.

How can I obtain Specialist care or Admission Services?

•    You would be referred to a specialist by the primary care provider or MMSL (HMO). Admissions would be provided at designated secondary care provider facilities

What should I do if I am denied treatment in a hospital?

•    You should immediately notify us through our 24 hour help line. We would resolve the issues promptly. In addition, you would also provide us a written report as regards to the treatment denial.

Can I change my provider at any time I desire?

•    Yes. We would require a letter from you requesting to change. All requests that we receive before the 15^th of the month would be effected by the 1^st day of the subsequent months. Requests received later that the 15^th would be effected within 6 weeks due to internal administrative processes

Can I add a Health care provider of my choice to the existing list of MMSL?

•    Yes. If there are 10 or more individuals also willing to select the provider? In peculiar circumstances where the provider is the only one in the locality, such provider would be immediately enlisted once the enlistment criteria is met

What Kind of drugs would be prescribed to me by the Health care provider?

•    Only NAFDAC registered drugs and drugs on our Essential drug list would be prescribed to patients

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 for the plan they have paid for. Where an extra dependant has been paid for by an enrollee, such benefits also accrue to that person.

If I incur high medical bills will my employer surcharge me?

•    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.

Do you have Medical Specialists and paediatricians?

•    Yes. We have medical specialists nationwide and paediatricians on our network of providers

If I buy a plan for my staff and one person resigns, can I replace him with a new staff to continue on his premium?

•    No. This plan is not transferable. If a staff that has been paid for leaves your organization, you may either decide to let him continue with the plan for the remaining part of the year, by leaving his I.D card with him; alternatively on termination of employee appointment, the ID card is collected & the unutilized amount (pro-rata) of the premium paid for the year is deducted from the employee entitlement.

Will I get a refund of my contribution from the HMO because I did not visit any hospital during the year?

•    No, you would not get a refund. 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.

What is an Emergency Medical Condition?

•    An emergency medical condition is a medical condition of sudden onset that must be attended to immediately or within six hours and if not attended to can lead to permanent disability or loss of life

•   Example include , Head injuries, asthmatic & fainting attacks, convulsions, gun shot injuries , ingestion of poisons, etc

How do I access Emergency care services?

•    MMSL have special emergency / help line numbers at the back of the Identification cards. In an emergency subscribers should ensure to get across to MMSL

•   Subscriber can also request for an ambulance service through the 24 hour help line

•    Subscriber can visit any hospital and notify MMSL within 24 hours

•    Subscriber can call the 24 hour help line for first Aid / medical advisory services

How can I obtain further information on MMSL Health Plan?

•    Please Call: 017612320, 7250329,08023061449,08023046522,08036212256.

Can I subscribe to MMSL Health scheme on a 24 hour basis?

•   Yes, through our 24 hours helpline you can subscribe and get your documents completed within 48 hours on receipt of payment.

Can I visit MMSL (HMO) for updates on Health education, preventive care and the company services?

•    Yes. Visit : www.marinamedicalhmo.com