1What is the difference between the HMO system, retainership or pay - out - of -pocket system
The HMO system takes sole responsibility of your healthcare needs after you must have paid a certain premium. Pay-out-of pocket is the system of paying for your healthcare at every visit made to the hospital. While retainership is where there is a contractual agreement between you and the provider to treat and send a bill to you on the later date.
2The Wellness Health Plan is a healthcare program developed by Wellness Healthcare Management Services.
The Health Plan is based on the Managed Care Concept - the most advanced and effective method of financing and delivering medical services. Under the Wellness Health Plan, you or your employer pay a certain premium based on the choice of the hospital you will like to access care from as well as the health benefits you will like to have. In addition you also enjoy preventive and health promotion services that will not only keep you fit, strong and happy but will reduce unnecessary visits to the hospital.
3How do I know which health plan to choose?
You belong to a company or group, it is likely that your employer or group will choose the health plan for you. If you are buying as a family or an individual, you can choose any plan depending on your health needs, choice of hospital and financial capability. Our client relationship managers are always available to advise you on the appropriate health plan to be chosen.
4How many members of my family are covered by my health plan?
The family plan comprises of father, mother and four children within the age bracket of 0-21years.
5If I am single, can my relations benefit from my contributions?
Your relations can not benefit from your purchased health plan as an individual. We however advise you purchase a separate health plan for your relations for seamless access to care.
6How do you monitor the activities of the hospitals on the scheme?
We have a medical services team which consists of qualified and experienced medical officers that carried out quality assurance on the hospitals on our network.
7How do you ensure that only hospitals of high standards are on your network?
A rigorous selection process is usually adopted in signing up hospitals on our network. This involves a review of credentials and certification of the intending healthcare as well as the inspection of the facility.
8Can I choose other hospitals apart from those on your network?
We do not allow our enrollees to choose other hospitals not on our network that we do not have any contractual agreement with. However should you be interested in using an hospital not on our network, kindly notify us or request that the provider send us an application letter. We shall carry out an accreditation exercise and if successful, the provider will be included in our network.
9Can I register with more than one provider?
Should you be buying a family plan, you could register to a provider of your choice while your spouse and dependents register with another provider. The health plan is one provider to an individual.
10How often can I visit the hospital?
As much as care is needed
11Can I collect drugs for my relatives who are not on the scheme?
Treatment is only limited to registered members on the scheme, covered benefits are not transferable
12What happens if I am not satisfied with the quality of care from a particular hospital?
Should you be dissatisfied with the services received at your healthcare provider, kindly reach us through all our communication channels, this will be duly looked into and changes will be made where
13What happens if I fall ill while outside my locality and can’t reach my primary care provider, or get involved in an accident and none of your hospitals is nearby?
In cases of emergencies and out-of station, you are advised to access care at the nearest hospital. However a call or notification must be placed to us in 24hours, also the receipt of care accessed and a medical report should be forwarded to us for a refunds.
14What happens if I misplace my ID card especially when I need to visit the doctor?
For card replacement, kindly put a call through to the Call center and the processes of replacement will be explained to you. However should you need to access care without your card, kindly inform us and your care will be authorized at the hospital.
15If I have more than four children, or more than one wife can I register them all?
Addition of extra dependent attracts additional premium.
16As a corporate organization, can we replace or substitute our members as the scheme progresses?
Replacement can be carried out based on the mode of premium payment,this is will be alighted in the policy document that will be duly signed at the commencement of the scheme.
17What happens if I attain my medical limit before the year runs out?
Although the possibility of this happening is very remote, but in such an event, you or your sponsor will be required to pay for the subsequent treatment or renew your plan
18Are your premiums paid monthly or annually?
Premiums can be paid annually or on an agreed installment term.
19If I do not exhaust my maximum benefit limits in a year, will I get a refund?
For corporate organization if your utilization is well below 60% a rebate of 10% will be given as discount at renewal butindividuals, this might not be applicable.