September 8, 2022
Private Health Insurance Scheme (PHIS) is designed for corporate organizations, small-medium enterprises (SMEs) and private individuals.
The Health Plan is sold at an actuarially determined amount called the premium.
PROHEALTH HMO has three (3) main plans under the Private Health Insurance Scheme (PHIS) as listed below:
PREMIUM
The premium on each of the PROHEALTH plans is actuarially determined considering the medical benefits for the health plan. The premium is payable in advance to PROHEALTH HMO for a policy period of one year, renewable upon the payment of a new premium.
WAITING PERIOD
Waiting period for new enrolment is 10working days and access to healthcare benefits commences after 10 working days for new enrolment. This is to enable conclusion of all enrolment processes.
ENROLMENT POLICY
Enrolment could be for group, family and individual policy. The family or individual is the unit of registration.
GROUP POLICY ENROLMENT
Where an organisation subscribe to the Health Insurance Policy on behalf of its employees, the group would be registered with the organisation’s legal name and its employees registered under the group.
A group policy is a pool with a minimum of ten (10) principals registered under the scheme. The principals can be on family or individual plan.
FAMILY POLICY ENROLMENT
The standard regulatory requirement for a family cover is the principal, the spouse, and a maximum of four (4) biological children under the age of 18years. Under a family plan, there is an expected variation in the household sizes but by principle, a family enrolment is expected to pay the full rate for a family plan regardless of the size at the time of subscribing to the scheme. There is room for addition of dependant as the family size increases.
Grandchildren, siblings, parents and grandparents are NOT eligible dependants under a family plan.
A child or other dependant(s) not covered under the family plan can be enrolled as an individual under the scheme.
ProHealth could adopt a flexible underwriting rule for family composition in a large group to meet client’s unique composition.
Any child above 18 years not covered under a family plan can be registered on individual plan.
INDIVIDUAL POLICY ENROLMENT
An individual can subscribe to our individual plan.
Additional child above the covered four dependants in a family plan can be registered on individual plan. However, the child must be three (3) months of age or older to be eligible for a child-only plan for individual.
MEDICAL SERVICE AGREEMENT
A Medical Service Agreement outlining the terms and condition of the Health Insurance Policy would be executed between ProHealth HMO and the client for every policy.
Community Based Social Health Insurance is a non-profit health insurance programme for a cohesive group of households / individuals or homogenous occupation based groups, formed on the basis of the ethics of mutual aid and the collective pooling of health risks, in which members take part in its management.
This is a social health security system designed by National Health Insurance Agency (NHIA) to manage the health care needs of student in Tertiary Institutions.
The Premium is from funds pooled through the contribution of students.
The scheme is committed to ensuring access to qualitative healthcare service for students, promotes healthy student lifestyle and conducive learning environment.
The scheme is run through a Joint Committee for the Management of the scheme, comprising of representatives of the School Management, students’ representatives, the HMO and NHIS.
The School Management appoints the HMO to manage the scheme through the use of the school clinic as the Primary Health Care Provider and a chosen Secondary Health Care Provider.
The benefits of the scheme include optimum care and health for the students at all times and pooled funds for the school clinic.
Referrer: Where an ailment is beyond the medical scope of the clinic, the student will be referred to a secondary healthcare provider.
TISHIP applies to students of Tertiary Institutions: Universities, Polytechnics, colleges of education, schools of nursing and midwifery, monotechnics and other specialized colleges.
This is the mandatory National Health Insurance Scheme for civil servants in the employments of Federal and State Governments. There is a standard health benefit package for all beneficiaries on the NHIS social health insurance scheme.
This is a health insurance for the health coverage of primary and secondary school student when they are under the care and custody of their school
MICROFINANCE HEALTH INSURANCE SCHEME
The scheme is design for the low income earners and self-employed entrepreneurs. The scheme is to cater for financially viable self-employed Nigerians who are desirous of the opportunity to benefit from quality, affordable and cost reducing healthcare services.
The scheme provides the enablement for contribution by interested persons irrespective of their socio economic background.
The contribution is remitted to a designated account to guarantee coverage for subsequent period of the policy
The scheme is for the elderly in the society
The benefits are targeted at meeting health care need peculiar to old age
The scheme is best suitable for people who have retired from active service
ProHealth HMO has a wide range of Health Care Provider (HCP) nationwide. The choice of service providers in our network has greatly enhanced our administration of the scheme and prompt delivery of services.
Enrolee has the right to select his primary HCP from our network of HCPs in line with his subscribed Health Plan.
In a group policy, with significant pool, the Client may introduce a primary HCP to ProHealth for the purpose of including it on our network of HCPs, provided not be less than twenty (20) enrolees indicate interest to use the HCP and the HCP has accepted to abideby the rules and regulations of the scheme and it meets the minimum standards of service delivery of ProHealth and NHIS.
ProHealth HMO has in place a multi-disciplined Quality Assurance department that has robust system of quality management for ensuring that HCPs on our network meet the standard requirements of NHIS in respect to personnel, facility and maintaining quality assurance in the delivery of health care services under the scheme by regulations and medical guidelines. We continually hold our HCPs to an unquestionable standard of delivery of health care services through quality audits, case management, annual provider accreditation and recertification.
ProHealth HMO runs a well-equipped and functional 24hours call centre guaranteeing unhindered interface between HCPs and ProHealth and to ensure calls from Providers are promptly attended to.
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