2nd Floor, Afriland Towers, 97/101 Broad St, Lagos.
Frequently Asked Questions
FAQs
Purchasing A Plan Online
? Are there any fees added to the total when you pay online?
A N100 convenience fee is charged for each successful transaction.
? I made a payment that was unsuccessful, but I have been debited. What do I do?
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.
? Are my transactions secure?
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.
? What payment methods are available on avonhealthcare.com
We accept payment by debit cards (Verve cards, Naira MasterCard and VISA cards) and by direct bank transfer services.
? How do I make payment online?
Click on “Buy a Plan” This will direct you to a page where you can select your plan category (Individual, Couple, Family, Business, etc.). Here, you can click 'Buy Now' on your preferred plan. This takes you to a page where you can review your purchase and proceed to checkout. After this, you get to enter your customer information and click on 'Place Order' (you will be transferred to a secure payment merchant where you can pay with your debit card.'
? What payment options can I use?
There are various payment options, including online payment (Mastercard/Visa/Interswitch/Verve)
FAQS
General Questions
? What is an exclusion?
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.
? What is a pre-existing condition?
A Pre-existing condition is any condition that is already in existence before purchasing the health plan. All new members are required to disclose this at the time of enrollment.
? Can I select a different health plan for each member of my family?
Yes, you can buy different individual plans for each member of your family. This is different from the option to buy a ‘family plan’ in which case, all family members must be on the same plan.
? What is the 'waiting period'?
Some benefits on your health plan are subject to a waiting period of up to 12-18 months (E.g., maternity, optical, dental). After the waiting period has been completed, these benefits would become automatically active and available permanently.
? Can I upgrade my plan whenever I wish?
You can upgrade your plan once a year at the point of renewal. This is subject to the HMO's review.
? What is the maximum age that can be enrolled?
The maximum age is 60 years old.
? What happens if I misplace my ID card especially when I need to visit the doctor?
We now have e-cards that you can use in place of physical cards. All the hospital needs is your Avon ID so if you lose your physical card, just reach out to our Contact Centre via phone (0700 277 9800), email ([email protected]) or WhatsApp (08175133802) for support.
? Can I call the Contact Centre anytime?
Yes, the Contact Centre (0700 277 9800) is accessible 24 hours, 7 days a week who are happy to respond to any queries you may have. You can also email us at [email protected] or text our WhatsApp helpline via 09126039532.
? Can I use my card to get treatment or drugs for my dependants or relative?
No, this is illegal. The ID card is to be used by you (the owner) only.
? How many people does the family plan cover?
Up to six (6) people. You, your spouse and four legal children under 18 years of age.
? What is the maximum age that can be enrolled?
The maximum age is 60 years old.
FAQS
Membership
? How many people will the family plan cover?
The family plan will provide coverage for you, your spouse and up to four children under 18.
? What happens if I go to the hospital and I am told that the service I require is not covered?
Kindly verify from your plan handbook. You may also contact the Avon HMO 24-hour Contact Centre via phone (0700 277 9800), email ([email protected]) or WhatsApp (08175133802) for support.
? How can I change my hospital?
It’s simple. Just send an email to [email protected], stating the name of the new hospital you want to use. If your preferred hospital is on our network and accessible on your plan, you will be switched and if the hospital isn’t accessible, alternatives will be suggested.
? If I travel out of station (resident city), what happens?
If you are out of town and need medical attention, you can access care at any of the Avon HMO Provider Hospitals nationwide. Simply contact the Avon HMO 24-hour Contact Centre via phone (0700 277 9800), email ([email protected]) or WhatsApp (08175133802) for support.
? Can I pay my premium on a monthly basis?
At the moment, our premium is paid on an annual basis (once a year). We will be sure to announce if anything changes.
? What are the main differences between the 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.
? If I am on an international health plan, how do I arrange treatment?
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 for your care and book necessary appointments.
? Can I call the Contact Centre anytime?
Yes, the Contact Centre (0700 277 9800) is accessible 24 hours, 7 days a week who are happy to respond to any queries you may have. You can also email us at [email protected] or text our WhatsApp helpline via 08175133802.
? Can I register with more than one hospital?
It is recommended that you 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.
? How do you monitor the activities of the hospitals on the scheme?
Our Medical Services team monitors the hospitals in various ways, including routine visits and spot checks. In addition, we have case managers who review admissions and other cases.
? Do you cover children?
Yes, we do. However, there must be an adult on the plan as well.
? Is there a guide for the treatment provided by the hospitals?
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 services team to ensure that standards are maintained and shortfalls corrected immediately.
? After payment for the health plan, what next?
Once you pay for a health plan, your enrollment details will be collected and added to our database. You will also get a welcome email, your Avon ID and useful documents explaining how your plan works, the summary of benefits and other information on how to get the best out of your plan.
? How do you ensure that only hospitals of high standards are on your network?
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.
? What happens if I am dissatisfied with the quality of care from a particular hospital?
We are all for feedback so we encourage you to please make a formal complaint via our Contact Centre via phone (0700 277 9800), email ([email protected]) or WhatsApp (08175133802). This would enable us to investigate the case and adequately address the issue. You would also be allowed to change hospital, should you prefer.
? What ages are eligible to apply?
Adults from the age of 18 and above are eligible to apply for coverage under Avon HMO health plans.
? Can I choose other hospitals apart from those on your network?
Only hospitals on our network can be selected so we recommend that you choose a primary care provider on the list. New hospitals may however be included on our network from time to time.
? In a medical emergency, am I allowed to obtain treatment from healthcare providers within the Avon HMO provider network that I am not registered with?
Yes. The provider would only need to contact us to confirm that you are an active member (since you are not registered with them).
? What happens in a life-threatening emergency situation or I get involved in an accident and none of your provider hospitals is nearby?
In the event of a life-threatening emergency, you may access care from the closest hospital to you. Just ensure our Contact Centre via our Contact Centre via phone (0700 277 9800), email ([email protected]) or WhatsApp (08175133802). within 24/ 48 hours max.
FAQs
Providers
? How soon before we start seeing your members at our hospital?
Once you join our Provider Network, your facility will immediately be made available to our members.
? Who can become a contracted healthcare provider with Avon HMO?
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.
? What are the eligibility criteria for capitation?
Any Provider Hospital with a registered member base of 51 and above is eligible for capitation.
? How do you develop your tariffs?
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.
? What is your fee schedule?
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.
? Who do I contact for more information?
For more information, kindly contact our 24-hour Call Centre at 0700 277 9800 to speak with an Avon HMO representative.
FAQs
Understanding Health Insurance
? How does it work?
When you buy a health plan, you agree to pay a certain amount (known as a premium) to the HMO. In return, your HMO agrees to pay your medical bills whenever you access healthcare services, provided they are covered by your health plan.
? What is an HMO?
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.
? I currently have a health plan through my employer. What happens if I leave?
Your employer will only cover your health plan while you are employed with the company. Once you leave the company, you will be responsible for buying an individual health plan to suit your needs.
? Why should I get a 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 — but also creates an affordable avenue to access high quality medical services.
? What is a moratorium?
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.
? What is health insurance?
Health insurance is a type of insurance coverage that pays for your medical services, either in part or in full.
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