AI agents for business finance: what they can and can't do
What AI agents can do in bookkeeping, close, collections and compliance today, where a person must stay in charge, and how to judge a product.
The short answer
Check the HMO against the National Health Insurance Authority's list of accredited HMOs on nhia.gov.ng, or ask NHIA directly; accredited HMOs carry an NHIA code number, so ask the HMO for its code and confirm it. Then check that the hospital you want is on the HMO's provider list, because NHIA-scheme treatment takes place at NHIA-accredited facilities.
How health insurance is organised
The National Health Insurance Authority (NHIA), formerly the NHIS, regulates health insurance in Nigeria. Health Maintenance Organisations (HMOs) sit between you or your employer and the hospitals: you pay a premium, the HMO pays accredited hospitals for your care. NHIA's FAQ says treatment under its programmes takes place at NHIA-accredited facilities, and that complaints can go to NHIA offices, to HMOs or to its call centre. States run their own schemes too, under state laws, for residents and state employees.
That gives two things to check: is the HMO accredited, and is the hospital you want accredited and on that HMO's list?
Step 1: confirm the HMO
- Get the HMO's full registered name and its NHIA code. A Nairametrics review of HMOs in March 2024 listed an NHIA code number for each one, which shows the codes exist and are used publicly.
- Go to nhia.gov.ng (type it yourself) and find the list of accredited HMOs. We could not confirm the exact page for this guide; if you cannot find it, contact NHIA through the details on its website.
- Match the name and code. Several HMOs have similar names.
- If you are buying a private plan, confirm the HMO is also registered with the Corporate Affairs Commission; see verifying a Nigerian company.
Step 2: check the hospital list
An accredited HMO is only useful if the hospitals near you are on its list. Ask the HMO for its current provider list for your plan, and check:
- Is your preferred hospital or clinic listed, at the right branch?
- Is it listed for your plan level? Many HMOs have tiers, with larger hospitals only on higher plans.
- Does the list include a facility near your home and one near your work?
- For specialist care, which hospitals take referrals?
Call the hospital too. Ask whether it currently accepts that HMO; hospital and HMO relationships change.
What cover usually looks like
For the formal sector programme, NHIA's FAQ says cover extends to the contributor, a spouse and four biological children under 18, with extra dependants registrable. It also notes there are exclusions and partial exclusions, and gives the example of dialysis limited to six sessions a year. State schemes set their own rules. The Edo State scheme, for instance, sets a 30-day waiting period before cover starts and a 10% co-payment on drugs and laboratory tests, according to its policy page. Read your own plan's benefit list for:
- Waiting periods before you can claim.
- Co-payments you pay at the hospital.
- Excluded or partly excluded treatments.
- How emergencies outside your network are handled.
Example
Example only: Kemi pays an annual HMO premium of ₦90,000 for a family plan. Before paying, she confirms the HMO's NHIA code with NHIA, then calls her children's clinic, which says it stopped accepting that HMO last month. She chooses another accredited HMO whose list includes the clinic. Had she not checked, she would have paid ₦90,000 for cover she could not use at the clinic she relies on.
Questions to ask before you buy a private plan
- What is your NHIA code, and can I confirm it with NHIA?
- Which hospitals near my home and work are on my plan's list today?
- How long is the waiting period before I can claim, and for which services?
- What co-payments will I pay at the hospital?
- Which treatments are excluded or capped?
- How are emergencies handled at a hospital that is not on the list?
If you are covered through work, your employer chose the HMO, but you can still ask your HR team for the NHIA code and the provider list. If the HMO your employer uses does not include a hospital near you, ask whether you can change your primary care provider within the HMO's network, how often you may change it, and how long a change takes to apply. If the answer is no, raise it with HR before renewal, when the employer can compare HMOs. Get the answer in writing, and keep your enrollee ID card with you.
If something goes wrong
If an HMO refuses a valid claim or a hospital refuses an accredited enrollee, raise it with the HMO first, in writing. If that fails, NHIA's FAQ says complaints can be taken to NHIA offices or its call centre. For a state scheme, use the state agency's complaint channel. Keep your enrolment slip, ID card, receipts and any written refusals.
Where Pryme fits
Pharmacies are a Spaces sector in Lagos, Abuja and Port Harcourt; for costs your plan does not cover, Loans on Spaces can be offered for spending with pharmacies in Spaces, with the full agreement shown before you accept (see Loans on Spaces). For city costs, see healthcare costs in Lagos and in Abuja.
Questions people ask
How do I know if my HMO is accredited by NHIA?
Ask the HMO for its NHIA code and check its name and code against NHIA's list of accredited HMOs on nhia.gov.ng, or contact NHIA.
Can I use any hospital with my HMO?
No. Only hospitals on your HMO's provider list for your plan. Under NHIA programmes, treatment is at NHIA-accredited facilities.
Who is covered under NHIA formal sector insurance?
NHIA's FAQ says the contributor, a spouse and four biological children under 18, with extra dependants registrable.
Where do I report an HMO in Nigeria?
Complain to the HMO first in writing; if unresolved, NHIA's FAQ says complaints can go to NHIA offices or its call centre.
Sources
- NHIA: Frequently Asked Questions · accessed Oct 2026
- Top 15 HMOs in Nigeria for individuals based on affordability (Nairametrics, 16 Mar 2024) · accessed Oct 2026
- Edo State Health Insurance Commission: insurance policy · accessed Oct 2026
This article is general information, not financial, legal or tax advice. Products described are provided under the terms on this site and are subject to regulation and eligibility.