Choosing a health plan can feel confusing, especially when faced with unfamiliar health insurance terms. For many first-time buyers, it can seem like a language only experts understand.
At Avon HMO, we believe that understanding health insurance and healthcare in general should be as simple as breathing, because when it comes to you and your family’s well-being, care is everything.
Whether you’re a young professional in Lagos, a parent raising a family in Abuja, or a Nigerian living abroad, knowing basic health insurance terms empowers you to make confident decisions. By breaking down these common health insurance terms, we’re helping you make informed decisions that give you confidence, peace of mind, and access to quality care when you need it most.
Essential Health Insurance Terms Simplified
1. Out-of-Pocket – This refers to your personal share of the costs for covered healthcare services. This includes co-payments for services where the HMO has a limit they will pay on the benefit you’re trying to access, so you get to pay the difference. It can also include payments you make for services accessed at hospitals outside your HMO’s network during emergencies (the HMO then refunds you), or any costs for services that aren’t covered by your plan at all.
2. Coverage Limit – This is the maximum amount your plan will pay for specific services or treatments within a given period (usually annually). For example, your plan might cover up to ₦500,000 for surgical procedures per year. Once this limit is reached, any additional costs become your out-of-pocket responsibility until the next coverage period begins.
3. Waiting Period – The time you must wait after enrolling in a health plan before certain benefits become available. This prevents people from signing up only when they need immediate, expensive care. Common waiting periods include 30 days for general consultations, 12 months for maternity benefits, and up to 24 months for chronic/pre-existing conditions.
4. Claim – A formal request you submit to your HMO for payment or reimbursement of medical expenses you’ve incurred. It’s essentially asking your insurance company to pay the bill according to your plan benefits. Claims can be filed directly by your healthcare provider or by you as the patient, depending on your plan structure.
5. Exclusions – Medical services, treatments, or conditions that your health plan specifically does not cover. These are clearly listed in your policy document and might include cosmetic procedures, experimental treatments, or certain pre-existing conditions. Knowing your exclusions prevents unexpected out-of-pocket expenses.
6. Pre-Authorisation – Some treatments or procedures need prior approval to be covered. This is called pre-authorisation. It ensures you receive the right care at the right time and that it’s included in your plan benefits.
7. Provider Network – This refers to the extensive list of doctors, hospitals, clinics, and other healthcare providers that have an agreement with your HMO to provide services at negotiated rates. Choosing providers on this network helps you save on costs and ensures you’re receiving trusted, high-quality care.
8. Premium – Your premium is the regular amount you pay to keep your health plan active. Think of it as a subscription to your health coverage; consistent payments ensure you’re protected whenever life happens.
9. Plan Effective Date – This is the official date your health insurance coverage begins. Your benefits are not active until this date. This is typically the first day of the month after your enrolment is completed and your first premium is paid.
10. Principal and Dependants – The Principal is the main subscriber, that’s you, the person who owns the health plan. Dependants are family members covered under your plan, typically including your spouse and unmarried children under 18. It’s like being the captain of your family’s health ship, with everyone aboard safely covered under one comprehensive policy.
Also Read: From Challenges to Change: How Digital Innovation is Rewriting Healthcare in Nigeria
Why These Health Insurance Terms Matter
Understanding these terms empowers you to make informed decisions. When you know what “specialist consultation limits” mean, you can plan your family’s health insurance needs effectively. When you understand your “provider network,” you know exactly where to go when your child has a fever at midnight.
Health insurance isn’t just about treating illness – it’s about prevention, peace of mind, and ensuring your family has access to quality care when they need it most.
What to Look for in a Plan
When selecting a plan, it’s essential to consider your specific needs. Do you want a plan that covers just you, or your entire family? Do you need access to a specific network of hospitals? The right plan should give you access to quality medical services without financial strain.
Our goal at Avon HMO is to make health insurance as simple and accessible as possible. Our plans are designed to remove the financial and emotional burden that comes with unexpected health issues. We want you to feel empowered and confident in your choice, knowing you’ve made the best decision for you and your loved one’s well-being.
Your Next Step: Choose a Plan
Now that you are fluent in the common health insurance terms and can speak the language, it’s time to choose your plan. You can explore Avon’s diverse range of health plans, compare options, and choose your preferred plan instantly. Whether you need basic coverage or comprehensive international protection, there’s a plan designed for your unique needs.
Don’t let unfamiliar terms prevent you from securing your family’s health future. With Avon HMO, you’re not just buying insurance; you’re investing in peace of mind, knowing that when life happens, your health is secured.
Get Started with Avon
Your health is your greatest asset. Protecting it shouldn’t feel complicated. With Avon HMO, you don’t just get health insurance, you get care that covers everything that matters to you and your family. From flexible individual plans to comprehensive family and diaspora coverage, Avon makes health insurance clear, affordable, and built for real Nigerian lives. Visit avonhealthcare.com today to explore plans, get expert guidance, and start your journey to stress-free health insurance.
