Frequently Asked Questions

Please read through our FAQ  section for service-related questions and answers. If you cannot find the answered to your specific questions, use the form below to send your inquiry or questions to our Customer Care Unit.

What is the IHMS Health Plan?

The IHMS Health Plan is a healthcare program developed by International Health Management Services Limited (IHMS).

The Health Plan is based on the Managed Care Concept – The most advanced and effective method of financing and delivering medical services. Under the IHMS Health Plan, you or your employer or sponsor pay relatively small sums of money into a pool. This money is used to make arrangements with the most appropriate and qualified professionals to provide medical services in case you, your dependants or employees fall ill.

In addition you also enjoy preventive and health promotion services that will not only keep you fit, strong and happy but will reduce unnecessary visits to the hospital.

What is the difference between the HMO system and the retainership or pay-out-of-your-pocket system?

The major difference is in the way medical services are paid for, and delivered to you.

How do I Know which health plan to choose?

If you belong to a company or group, it is likely that your employer or group will choose the health plan for you. If you are  buying as a family or an individual, you can choose any plan depending on your need and pocket. Our client and member services officer are equally available to help you make an appropriate choice.

How many members of my family are covered by my health plan?

If you joined as a company or group, the company policy  determines this but the family plan  usually covers you, your spouse and four biological children under 18 years of age. However, extra dependants can be covered by payment of additional contribution.

Are there different types of health insurance plans at IHMS?

Yes. Our plans are designed to fit both your financial and clinical situations, they also take into consideration your need for different levels of privacy if you need hospitalization. Nevertheless, all our client enjoy the same quality of medical treatment when they visit a provider.

Will I get a list of service providers who are available on your network ?

Yes

What should I know about IHMS ?

IHMS provides you with limitless access to care that covers your basic medical needs at a very reasonable cost for yourself, spouse and maximum of four (biological) children.

If I have more than four children or more than one wife, does it mean that others would have to be left out ?

For every extra child / dependant thereafter you or your employer has to pay an extra premium for their medical insurance.

The extra premium as from the 5th child / dependant is same as the premium rate / annum per person.

What are the criteria for the inclusion of a hospital as a provider in your network ?

Some of the criteria include:

  • Number and quality of qualified medical personnel
  • Hygiene especially in the theatre
  • Regular availability of drugs and other medications
  • Presence of specialists
  • Quality and timeliness care delivery

What is the scope of service that I can expect from my chosen hospital / provider ?

This depends on the plan type your employer has purchased for you. Your member manual and ID card provides you with a description of the services you are covered for.

Does the HMO have all the types of medical specialists on its provider network ?

IHMS has all relevant specialists in its network. Despite that, when there is a need to make referrals to specialist outside the network, IHMS will take care of the bill.

How does IHMS ensure Quality in its network ?

At the point of entry into the scheme the hospitals are subjected to rigorous checks to ensure that they meet the required standard. Subsequently, quality audits are carried out on quarterly basis to monitor their compliance with our set standards.

How do I access the services of IHMS ?

You access our service by completing the registration process as follows:

  • Complete the registration form
  • Return the completed form with payment
  • IHMS ID (Healthcare Access) card would be ready within a maximum of 15 working days

Do I need an ID card for each of my dependants ?

Yes.  You get one ID card for each of them at no extra cost.

How long does it take after registration for the plan to become operational ?

The plan becomes operational fifteen (15) working days after the receipt of premium and the submission of completed enrollee forms. Claims within this period by staff MAY not be paid by IHMS.

Do I need an ID card for each of my dependants ?

Yes.  You get one ID card for each of them at no extra cost.

Do I need to choose a general practitioner through whom all my medical needs will be met ?

Yes. He/she is your link to the medical world of IHMS.

How long does it take after registration for the plan to become operational ?

The plan becomes operational fifteen (15) working days after the receipt of premium and the submission of completed enrollee forms. Claims within this period by staff MAY not be paid by IHMS.

If all I need is an advice or medical tip, do I have to go to the hospital ?

You can call our helpline (07041446622 or 08121010100) where one of our medical personnel would listen to your concern and give you appropriate advice. Also you can reach your GP on his line for such advice.

• Do I need prior authorization before I can enjoy medical services ?

Sometimes you will need to get a prior authorization. This means getting approval from our 24 HOURS call centre/medical department before you get services. Some services that may need prior authorization are:

  • Referrals
  • Elective Procedures e.g. Surgery, Advanced and complex diagnostic investigations
  • Certain medications and diagnostic services
  • Some categories of hospitalization

Your doctor would call or send mail to inform us of the services that needs authorization. For emergency services, authorization is given immediately while an elective procedure MAY take maximum three (3) business days to revert on status of authorization to allow review and second opinion service(s).

Do I have to first contact my GP before I can access emergency and after-hours care ?

No (definition of emergency condition is important). The mission of IHMS is to ensure that you get well as soon as is medically possible. Therefore all that the Doctor on duty has to do is to notify us after setting all apparatus in motion ensuring your immediate care needs have been addressed.

Will my chosen GP be in the hospital all the time ?

It depends on his duty. However he/she would be reachable on phone at all times.

Also there would always be a medical doctor on duty to attend to you.

If I am on treatment with a provider outside your network can I switch into the network ?

You can switch in as much as the waiting period is observed and your doctor gives adequate medical report to your new GP so that he can properly takeover your treatment. Also you may wish to complete your treatment before switching to our network but you would need to pay for such services out-of-pocket.

Can my GP approve a sick leave for me ?

Yes, If necessary.

Can my current physician outside your network be part of your network ?

Yes. If he / she meets the criteria for accreditation on our network.

Can my new born baby access care immediately after birth ?

Yes (neonatal policy applies). He/she will have access to care under the mother’s file within the first 28 days (4 weeks) of birth while we expect the parent to register the baby within this period. Your baby may be denied access to care after 4 weeks if registration is not done.

If I am dissatisfied can I change my provider ?

Yes you can. You can channel your grievances to us or through your HR department where you will be given a grievance and change of provider form OR you can contact your client service officer directly.

You can also wait for the open enrollment period every quarter to change your provider. However note that any change takes effect from the first day of the subsequent month if request is tendered on or before 15th day of the month.

Are there other reasons why access to care may be denied ?

Yes. Misunderstanding from the provider end, courier service delay of current enrollee list, excluded services, unauthorized care/referral/out-of-network services/outstation services e.t.c. All you need do is to call any of our call centre numbers or the inquiry line at the back of the Access ID card at the point of service for prompt issue resolution.

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