What Is An HMO? How Is It Different From Other Health Care Plans?

A Health Maintenance Organisation (HMO) is a type of health plan that gives you access to certain doctors and hospitals that have contracted with the HMO, often called a provider network or just network. An HMO is different from other health care plans in a number of ways:

• An HMO is designed to control costs through preventative health care services that help you avoid serious and costly health problems.
• An HMO typically has lower monthly premium and lower copayment levels than other types of plans.
• HMO networks are not limited to doctors and hospitals. HMO networks include clinics, pharmacies, labs, and imaging centres.
• When you join an HMO, you selected or were assigned a primary care physician (PCP) to coordinate all your health care services.
• Also, HMOs generally only cover health care services provided by a network of health professionals and hospitals that together provide a full range of health care services. When choosing your new plan, make sure the doctors and hospitals you want to use are all in the HMO’s network.

How Can I Learn More About My Benefits?

You can log in to NNPC HMO for Members 24/7 to access your benefits information or Call the Call Centre number on the back of your Member ID card.

Are My Medical Records Kept Private?

Yes. We are committed to protecting your medical records, and have strict rules to make sure our staff and anyone who needs to see your records keep all your member information confidential. Your medical records or claims details may have to be reviewed. If so, precautions are taken to keep your information safe. In many cases your identity, such as name and address, will not be included in the information provided during the review.

Has My Coverage Started? Can I Use My Health Plan?

Your first premium payment activates your coverage, so you can start using your health plan within 1–week of enrolment and your welcome kit is handed over to you.

I Need To Get A Prescription Filled But Don’t Have My Id Card Yet. What Can I Do?

Even if you haven’t received your ID card, you should have received a new member welcome letter within days of your enrolment being completed. Your member identification and group number listed on your welcome letter can be used by the pharmacy to verify your benefits. You will need to pay your first premium payment before you can use your prescription benefits.

I Applied On The Nnpc Hmo Website, But Haven’t Heard If My Application Has Been Received And Accepted. Did My Coverage Start On The Effective Date I Requested?

We receive new applications from the site every day. If you applied through the site, it will take a few days for processing online before they are sent to us. It then takes us about 5–10 business days to process your enrolment in the NNPC HMO system.

If you just applied recently, we encourage you to wait to see if you receive your membership information soon. If you applied weeks ago and have not received anything from us, it is possible your application has been held up for some reason.

If you applied online and you have not received information from us, call our Contact Centre at 09046085500,  and we will look up the status of your application. We will help you as quickly as possible.

When Will I Get My Member ID Cards, And How Many Will I Get?

You should get your member ID cards soon after your application and enrolment process is approved. Individual and family members will receive no more than 2 membership ID cards. Please note that all member ID cards will have only the subscriber name on it, but can be used by all of the dependents enrolled under the policy. HMO Individual and family plans will get a card for each member enrolled.
You will need your member identification number and group number to log in to NNPC HMO for Members. These numbers can be found on the new member welcome letter you will receive within days of enrolling.

When Will I Get Benefit Coverage Information And The Contract On The Plan I Selected?

Within days of your application being accepted, you will receive a welcome letter from NNPC HMO Member Services that includes your member identification number and group number. This information can be used by providers and pharmacies to verify your coverage until you get your member ID card. Your ID card will be sent separately soon after.

Your policy information is available through your NNPC HMO for Members account once your plan is in effect.

I’ve gotten a Call from Someone Asking Me Questions about My New Coverage. Is This Person With Nnpc Hmo, And Why Are They Asking These Questions?

• Since you have new coverage with us, we want to make sure you understand your benefits and that we have the information we need to help you with your health care needs. We are calling to:
• Explain how your plan works
• Answer questions you may have
• Tell you about some of the services we offer to help manage your care and your coverage.
• We also check to make sure the information we have is correct, such as the names of everyone on your plan, your address and other details.

The call often only takes about 15 to 20 minutes. If you have any concern that the person calling you is not with NNPC HMO, ask the caller for a number you can use to call us back.

I Missed The Yearly Enrolment Deadline. Can I Still Buy Health Insurance?

In most cases, you can only sign up for a health insurance plan during the yearly enrolment period. If you missed enrolment, you may be able to enrol during the special enrolment period. To be eligible, you must have had a qualifying “life event” within the past 60 days or experienced other complications that did not allow you to complete your enrolment.

What Are My Options To Pay My Premium?

NNPC HMO offers many convenient ways for you to pay your monthly premium for your individual health care coverage plan. You may choose what works best for you.

Can I Get Cover If Am Pregnant?

Yes, only if your plan includes maternity cover and if you get pregnant after buying into our health insurance.

What Is The Advantage Of This Program To Me?

Beneficiaries do not need cash to access treatment when required. Also, the problem of converting assets to cash especially in catastrophic illnesses, can be avoided.

COMPLAINT RESOLUTION

We value your patronage and are here to help you. There are a variety of ways you can express your concerns about your experience with NNPC HMO or its Providers. We encourage you to get in touch with us by regular mail, email or telephone. Our escalation process is below.

1. Step 1: Contact Call Centre
   • This is your first touch point. You can contact our Call Centre team by telephone or regular mail as follows:
     Tel: 09046085500, 017100225, (234) 080-2220-0180 (234) 080-9777-7689 (234) 080-5886-6690 (234) 080-3695-0614
     Mail: nnpchmoltd@nnpcgroup.com
     Address: 1st Floor, NNPC Pension Building,
     Plot 1534, Ibi Close, Off Gwandu Street, Garki 11, Abuja.

Our agents have the tools, support and training to quickly understand and resolve complaints or concerns.
Please note the name of the person you speak to for future reference, in case you wish to follow up on the discussion.

If you are writing to us, please make sure you include:

• The nature of your complaint and relevant details
• The identity of anyone with whom you have already discussed your concerns.
• Your contact information so we may reach you.

Alternatively, you can request for the complaint form and follow the steps therein.
We will conduct an investigation of your complaint and contact you promptly to gather more information. We will do our best to resolve the issue to your satisfaction.

1. Step 2: Contact the Management Office
   • If your complaint is not resolved to your satisfaction within step 1, you may ask to have your concern escalated to the Manager level and/or above. Within 90 days of receiving your complaint, we will provide to you either our proposed resolution of your complaint or a letter estimating when we will be able to provide a proposed resolution of your complaint.