About Health Plans

1Is this pre authorization required for all services covered by my plan?
No, It is only for some services that we pay the provider on a fee for service basis.
2What is a HMO Premium?
This is the amount paid annually in exchange for access to an agreed set of benefits on the health plan chosen
3What is a group/employer plan?
These are health plans available to you through your place of employment. Please contact your HR for further clarifications.
4How do I enroll on the Hygeia HMO Scheme?
The organization sends a list of staff to be enrolled, as well as choose their selected Hygeia plan type(s) for these staff. Each staff would read through and complete the Hygeia registration form and select one primary care provider. Staff would attach adequately labeled passport photograph for him/her self and dependants where applicable. Names of each member registered are written at the back of each passport photograph.
5What if my circumstance changes or I need to add other member of my family to my health insurance membership?
You can apply via your company’s HR department to add your partner or your children (including newborn children) as dependants on your membership as indicated by the policy agreement. To do this you will need to complete an application to alter your registration form. Please contact your HR for details.
6Can I upgrade my plan whenever it's suitable for me?
You can only upgrade or change your plan at renewal.
7What categories of Health care providers do we at Hygeia HMO contract with?
Primary Care Provider: Health care professional capable of providing a wide variety of basic health services, primary Care providers include practitioners of general, or internal medicine.
Secondary care providers (Medical Specialist institutions, Dental and optical clinics) : They provide specialist care. The primary care provider usually refers the patients to these groups of professionals. They include physiotherapists, pediatricians, ophthalmologists etc. Some providers may provide both primary and secondary care services
8How do I select a Health Care Provider?
Before joining the Hygeia HMO scheme, a list of over 370 Primary care providers (Hospitals) would be provided to you to select one provider from. This choice can be made based on proximity to place of work, or place of residence or any other personal choice where applicable.
9What is pre-authorization?
Pre-authorization means that we make sure all aspects of your treatment are eligible under the terms of the scheme you have.The hospital is to ask for this authorization either by phoning our call center or sending an email. The process of obtaining this authorization should take less than 10 minutes

About Hospital Networks

1Can I change my provider at any time I desire?
Yes. We would require you to fill out our change of hospital forms from you requesting the change. All requests that we receive before the 15th of the month would be effected by the 1st day of the subsequent month.
2Can I continue using my old hospital after my enrolment with Hygeia?
Yes. If the hospital is registered on our network.
3Can I reach Hygeia HMO on holidays and weekends?
Yes. Our call centre numbers can be reached 24 hours a day, 7 days a week.
4Do I require any form of identification before obtaining care from the provider?
Yes. A Hygeia HMO identification card will be issued to you at commencement of your plan. You would need to carry your Hygeia identification card before obtaining care at the health care provider facility. If you do not have an identification card, kindly contact our call centre or your client relationship manager to confirm validity
5If I am a traveler, can I access care anywhere in the country apart from my chosen provider?
Yes. Call the Care Call Centre and they will pre-authorize you for access.
6What are Hygeia HMO’s call center numbers and other contact details?
0700 HYGEIA HMO (0700494342466). You can also send us an email on callcentre@hygeiahmo.com
7What happens if I travel outside the area of my chosen primary care provider and I need access to care?
Go to the nearest Hygeia HMO provider. Present your Hygeia ID card. Treatment would be given at once. In an unlikely event that there is no Hygeia HMO provider, go to the nearest hospital. You would be required to settle the bills incurred and apply for a refund. Ensure Hygeia HMO is informed of delivery of care within 72 hours