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Health Insurance Company: 4 Factors To Consider When Choosing

The rising prevalence of illnesses, combined with rising medical inflation, has necessitated the purchase of health insurance plans. There are many health insurance companies in Nigeria, with Serene Healthcare being the best HMO in Nigeria. Each plan has its own set of unique selling propositions that distinguish it from the competition. The options may be overwhelming if you are in the market for a health plan in this situation.

First, let’s look at how to find the best health insurance company. The next stage would be to investigate and identify the best policy.

Step 1: Locate the Best Health Insurance Company


Here are some criteria to consider when selecting a health insurance company:

1. The variety of plans available

Examine the many sorts of plans that a company provides, as well as the plan USPs. Some companies provide a variety of products to meet your various coverage needs. Choose a provider that offers a wide range of plans so that you may choose the best coverage for your needs.

2. The hospital network

The hospital network is critical for obtaining cashless claims. The more extensive an insurer’s network is, the better. This would allow you to discover the nearest cashless hospital easily.

3. Ratio of claim settlements

The claim settlement ratio indicates one thing: the percentage of claims settled by the health insurance company in a fiscal year. A greater ratio implies that the health insurance company is persistent in resolving its claims. A factor that works in the insurer’s favour.

4. Loading based on claims

If you have made claims in previous years, some companies will raise your renewal premium. This translates to greater premium costs. As a result, avoid companies who engage in this behaviour.

5. The premium rate

Pricing policy refers to how much of a premium the health insurance company charges over its competitors. You can examine the price policies by comparing identical programmes from various firms.

6. Claim settlement ease

Insurers have simplified and revolutionized their claim processes. The following ideas are gaining popularity:

  • AI-assisted claim processing
  • WhatsApp notification
  • Documentation in digital form
  • Faster approvals
  • App-based claim notification and tracking, for example.

Such services expedite and simplify the claim process. Look for insurers who offer such services to expedite claim settlements.

7. Evaluations

Finally, don’t disregard customer feedback and reviews. On their websites, most HMO companies in Nigeria display client reviews. You can look them up. Alternatively, you can inquire about the insurance of your friends and family. If they have filed a claim, inquire about their claim experience to see whether the firm adheres to the best practices.

Step 2: Selecting the Best Strategy


Once you’ve decided on the correct health insurance company, the next and most critical step is to choose a plan. You have a lot of options with multiple insurers offering various plans. However, picking the appropriate policy is critical.

As a result, here are some considerations to consider:

1. Coverage advantages

The first thing you should consider is the coverage benefits of various plans. While most plans provide basic coverage, look for policies with special features.

Assess your coverage requirements first, and then hunt for plans that meet them. For example, if you intend to have a kid in the near future, seek plans that provide maternity care. Alternatively, if your family is complete, such preparations should be avoided.

Second, look for other elements that may broaden the extent of coverage. Some characteristics to look for are sum insured restoration, a high no-claim incentive, value-added benefits, annual health check-ups, and so on.

Select the plan with the most comprehensive breadth of coverage. This will reduce your out-of-pocket expenses during claims and provide you with greater financial security.

2. Option for customization

Look for plans that allow you to tailor the coverage features to your specific needs. This is feasible thanks to health insurance plan add-ons. The add-ons allow you to choose extra coverage elements based on your needs and allow for customization.

3. Amount of the premium

Of course, the premium is significant. Examine the premium cost in relation to the coverage provided. Compare to get a better idea. Compare the premiums of different insurers’ plans with similar coverage benefits. Check to see if the premium is competitive or overpriced in relation to the coverage.

Choose the plan with the lowest premium rate for the same coverage benefits, even if it means switching to a different health insurance company.

4. Restriction

Sub-limits on various charges such as room rent, ICU room rent, AYUSH coverage, domiciliary treatments, and so on may be included in health plans. These sub-limits restrict coverage and may result in out-of-pocket payments.

As a result, buy a policy with no sub-limits so that you can get the most coverage available.

5. Co-payment provisions

Co-payment clauses in health insurance plans may exist for a variety of reasons. Co-payments imply that in each instance of a claim, you are expected to pay the set portion of the claim out of your own pocket. A co-payment of 10%, for example, means that you will bear 10% of all claims.

Common co-payment provisions apply in the following situations:

  • If the insured is 61 or older at the time the policy is purchased
  • If you purchase the policy in a lower-tier city and seek treatment in a higher-tier city
  • When it comes to certain ailments and/or therapies
  • Look for health insurance policies that do not include a co-payment. Even if the clause is inevitable, such as in senior citizen plans, choose plans with a lower co-payment cost.

6. Waiting times

The waiting period occurs when the health insurance policy does not allow for specific coverage. After the waiting period has expired, coverage is available.

In some cases, health insurance plans mandate waiting periods. 

7. There are discounts available.

To entice customers, health insurance companies provide a variety of incentives. 

You may believe that your effort is finished now that you have found the best provider and the best plan. It is not the case. Another consideration is selecting the appropriate sum covered.

Step 3: How Do I Determine the Appropriate Amount of Coverage?


A substantial sum insured is required to ensure that your health plan adequately covers your medical bills. A modest sum covered negates the entire purpose of investing in health insurance and is strictly prohibited.

Choosing the appropriate sum insured is simpler than you think. You only need to think about the following factors:

  • The number of members covered by the policy.
  • Whether you or any other family member has a pre-existing condition
  • The fundamental cost of hospitalization and medical treatments
  • Medical inflation is on the rise.

Most insurers will assist you in calculating the optimal sum insured depending on your income, expenses, existing coverage, and covered members. You can alternatively estimate the ideal requirement using the following simple formula:

Sum insured = 50% of annual income + total hospitalization costs incurred in the previous three years

Step 4: How to Afford a Health Insurance Plan


Healthcare insurance premiums are reasonably priced. Furthermore, insurers provide the option of paying premiums in installments, allowing you to pay the premium monthly, quarterly, or semi-annually. This makes health insurance more inexpensive.

Furthermore, if affording a large sum covered is difficult, you can choose super top-up health insurance. Super top-up options aim to improve coverage while keeping premiums cheap.

In conclusion

Purchasing healthcare insurance alone is insufficient. You must confirm that you have chosen the appropriate insurance and plan. So, keep the preceding tips in mind while you study to choose the best health insurance plan.

Looking For The Best HMO In Nigeria That Meets The Above Criteria?

If you are earnestly in search of a health insurance company in Nigeria, Serene Health Care is the best possible option for you. Serene Healthcare offers the best HMO services in Nigeria.

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