Frequently Asked Questions

Health insurance is a type of insurance coverage that pays for your medical services, either in part or in full.

When you buy a health plan, you agree to pay a certain rate or premium to your health insurance company. In return, your HMO agrees to pay your medical bills, provided they are covered by your health plan.

Medical treatment and screening can quickly get very expensive. A health plan not only helps you manage the cost of receiving medical care—whether routine or unplanned, local or international—but also creates an affordable avenue to access high quality medical services.

HMO is an acronym that stands for health maintenance organisation. An HMO provides or arranges managed care for health insurance, self-funded healthcare benefit plans, individuals and other entities, and acts as a liaison with healthcare providers (hospitals, doctors, etc.) on a prepaid basis.

Your employer will only cover your health plan while you are employed with the company. Once you leave employment, you will be responsible for buying an individual health plan to suit your needs.

A moratorium refers to a delay in medical coverage if you have had a pre-existing condition. It excludes all pre-existing conditions for a certain period, usually one to two years, but may then include them after that.

• Click on “BUY A HEALTH PLAN NOW”
• Fill in Details and click “Next”
• Enter the quantity in the box beside the chosen/desired plan and click “Next”
• Read the Exclusions and the tick the box “I have read and understand the terms and conditions*
• Choose your payment method and click on “Buy Your Plan”
•  If you have chosen “Pay Online via U-Bills (Mastercard/Visa/Interswitch/Verve)” you will be redirected to the UBills payment portal where, after confirmation of payment amount, you will be transferred to a secure payment merchant.
• Select your payment option and click on “Make Payment”

Your data will be handled confidentially and encrypted with SSL (Secure-Socket-Layer) secure server software. The encrypted information of your order, your name, address, credit card or bank details cannot be read by any third party.

We accept payment by debit cards (Verve cards, Naira MasterCard and VISA cards) and by direct bank transfer services.

A N100 convenience fee is charged for each successful transaction

Your bank should reverse the transaction within 24 hours. If the funds are yet to be reversed into your account or card you may email [email protected] or call 0700-277-9800.

Adults over the age of 18 are eligible to apply for coverage under Avon HMO health plans.

The main differences between our health plans are the benefits available within each. Pricing for each health plan will also vary by levels of care available with the purchase.

Yes, but only if your plan includes maternity cover.

No, the premium is payable annually for the number of members enrolled at the beginning of the policy year.

The family plan will provide coverage for you, your spouse and up to four children.

Yes, up to four children are covered within our family health plans.

No. Kindly select one hospital from our national network of hospitals. This hospital serves as your primary care provider for proper coordination and management of your care. You can change your hospital on request.

Kindly send an email to [email protected], stating the name of the new hospital you want to use. You would receive a response confirming the effective date. The operational cut-of date is the 20th day of every month and the effective date is the 1st day of the following month.

No. We kindly ask that you select a primary care provider on our network. New hospitals may however be included on our network from time to time.

Avon HMO adopts a rigorous selection process in on-boarding hospitals to our network. This includes a review of the credentials/certifications of the hospital/ staff, and further inspection of the facilities on an ongoing basis. We also welcome feedback from our members.

Yes. Avon HMO has entered into formal agreements with every hospital on our network. The Agreements include guidelines for treatment in line with best practices. This is also monitored by our medical team to ensure that standards are maintained and shortfalls corrected immediately.

Kindly verify from your plan handbook. You may also contact the Avon HMO 24-hour Call Centre for verification/ clarification.

Our medical team monitors the hospitals in various ways, including routine and spot checks. In addition, we have case managers who review admissions and other cases.

You should please formally inform us using any of the above-mentioned channels. This would enable us investigate the case and adequately address the issue. You would also be allowed to change hospital, should you prefer.

Yes. The provider would only need to contact us to confirm that you are an active member (since you are not registered with them).

In the event of a life-threatening emergency, you may access care from the closest hospital to you, but kindly contact Avon HMO within 24/ 48 hours max.

If you are out-of-station (out of your state of registration) and need medical attention, you can access care at any of the Avon HMO Provider Hospitals nationwide. Please contact the Avon HMO 24-hour Call Centre for further assistance.

Before you seek medical advice and/or treatment overseas, please contact us first. This will allow us to verify the benefits covered by your plan, confirm that your proposed treatment is eligible for payment, and in many cases, contact your provider hospital to arrange direct settlement.

We welcome your feedback on all aspects of your experience with Avon HMO and our network of providers. If you have a complaint, kindly inform us via our 24-hour Call Centre by dialling 0700 277 9800 or contact your Avon HMO client manager to enable us resolve your complaint as efficiently as possible.

Your claims can be processed in two ways:

Direct Settlement

• You contact us to advise what treatment you intend to receive.
• We confirm that treatment is eligible and that we can pre-authorise (guarantee) payment for it.
• We send pre-authorisation to you and your chosen medical provider.
• You complete and sign the pre-authorisation form.
• Your medical provider attaches the invoice(s) for your treatment and returns the pre-authorisation documents to us.
• We process the claim and pay your medical provider directly.
• We send you a ‘payment statement’ advising when and how it was paid, and who received the payment.
• You settle any shortfall with your medical provider.

Pay and Claim

• You contact us to advise what treatment you intend to receive.
• We confirm your cover and benefit limits.
• You receive treatment and pay your medical provider (usually at time of treatment).
• You and your medical provider fully complete a claim form and return the claim form to us.
• We process the claim and pay you. We send you a ‘payment statement’ advising when and how it was paid, and who received the payment.

Yes, the Call Centre is accessible 24 hours a day, 7 days a week.

You will receive an introductory welcome pack, which will include your Avon ID card and a member handbook that contains all the information about your health plan that you will require for the year.

Healthcare providers, i.e. hospitals, clinics, etc., that pass our rigorous selection process may become eligible to join the Avon HMO provider network. This involves submission of an application by the prospective provider, followed by a review of your credentials and/or certifications and regular inspection of your facilities.

Once you join our Provider Network, your facility will immediately be made available to our members.

Tariffs are a set of prices and rules that help our providers give our members the best value for their plans. Our tariffs were developed in agreement with our providers to ensure they are adequately reimbursed for the delivery of high quality and cost-effective care.

Any Provider Hospital with a registered member base of 51 and above is eligible for capitation.

Avon HMO ensures payments are paid to relevant provider hospitals before the first day of the month and that claims are processed and paid within 30-45 days of receipt.

For more information, kindly contact our 24-hour Call Centre at 0700 277 9800 to speak with an Avon HMO representative.

An exclusion is a condition/ procedure or service that is not covered by your health plan. Any benefit that is not listed on your health plan is an exclusion. Please always seek necessary clarification where required.

A Pre-existing condition is any condition that already existed at the time of purchasing the health plan. All new members are required to disclose this at the time of enrollment and remain liable for non-disclosure or the lack of knowledge should the condition be discovered afterwards.

Some benefits on your health plan are subject to a waiting period of up to 12-18 months. After the waiting period has been completed, these benefits would become automatically active and available permanently.

No. Your health plan is fixed for a period of 12 months and can only be upgraded at renewal, subject to review by the HMO.

Up to six (6) people. The principal, spouse and four legal children under 18 years of age.

The maximum age is 60 years old.

Yes, you can buy different individual plans for each member of your family. Please note that this is different from the option to buy a ‘family plan’ in which case, all family members must be on the same plan.

No, this is illegal. The ID card is to be used by the owner only.

Please notify us promptly and apply for a replacement (charges apply).

Yes, the Call Centre is accessible 24 hours, 7 days a week we are happy to respond to any queries you may have. You can also email us at [email protected]