Frequently Asked Questions Continued

Before sending us a message, kindly read through our FAQs

Things you need to know...
+Can I attend as many hospitals as I like on the list?

No you can’t, because of the mode of payment. You are allowed to visit only one hospital at a time. You reserve the right to change hospital any time, if you are not satisfied with the service provided, or when you change location.Change can only become effective on the first day of each month when the new hospital chosen would have been adequately notified. Any request for a change or new entrant must be received by the 17th day of the month otherwise; action may be delayed by a month.

+What is the procedure for hospital change?

Any request for a change or new entrant for a change or new entrant must be received on or before 10th of the month. Otherwise, action may be delayed by a month.

+When the scheme takes off, can I still keep my present doctor?

You will have to fill a change of hospital form domiciled in the HR department. (Change can only become effective on the first day of each month when the new hospital chosen would have been adequately notified. Any request for a change or new entrant must be received on or before 10th of the month otherwise; action may be delayed by a month).

+There is a hospital I am currently using or intend to use, but is not on the list of hospitals under this scheme. This hospital is close to my house or office, hence convenient for me. If I access care there, can I forward the bill to the HMO?

No, you are not allowed to use a provider not registered on the scheme, except in the event of a medical emergency.

+Can I change from one healthcare provider to another?

Yes, you can change your healthcare provider under the following circumstances:


    -Transfer to another location, city or state
    -Dissatisfaction with quality of care delivered by your chosen provider after due investigation by Mediplan
    -Change of enrollee’s place of residence.

In each of the above mentioned case, a formal letter should be written to that effect giving 30 days’ notice. The change will become effective at the start of a new month following the expiration of the 30 days. However, where the reason for change bears on dissatisfaction with services rendered, there shall be intervention by our medical personnel after which if the need still arises, the change shall be effected

+I have a drug I am using with my current hospital; will my chosen provider on this scheme provide this drug?

Enrollees are not expected to dictate to the provider the drugs to be prescribed or the mode of treatment. Your provider will give to you the drugs that best suit your medical needs in line with the Essential Drug List for the scheme.

+I need to see a dentist for my teeth, what is the procedure?

A visit to the dentist qualifies as specialist care. A dentist is a specialist care provider. Others will include Dermatologists, Ophthalmologists, ENT Surgeons, Cardiologists, Paediatricians, and Orthopaedic Surgeons etc. In such cases you will visit your primary care provider who will subsequently give you a referral form to see a specialist. In this case, your primary care provider will refer you to a dentist.

+What is the procedure for hospital change?

You will have to fill a change of hospital form domiciled in the HR department. (Change can only become effective on the first day of each month when the new hospital chosen would have been adequately notified. Any request for a change or new entrant must be received on or before 10th of the month otherwise; action may be delayed by a month).

+If I do not go to the hospital, do I get a refund?

Refunds shall not be made for benefits not utilized, this is because the premium paid is actually determined and is based on the probability that not all enrolees would be sick at the same time. SHTL pools the resources from all subscribers to render healthcare to those who may become ill. Likewise, you will not be surcharged, if you get ill more often than others.

+Can I request for some set of drugs from my Doctor?

No you can’t request for drugs, your doctor will prescribe drugs based on his clinical findings and judgment.

+If I am not satisfied with the level of care in a centre, what is the procedure for seeking redress?

You can lodge complaints with the client service person(s) assigned to you organization.

+At what point should we pay extra, for services at provider’s end?

Please be informed that you are not to make any payment for a benefit covered under your scheme. Please call SHTL HMO help desk immediately (Except if you ask for extra favours). Please inform our call centre at once – 08079393631, 08079393632

+If I leave the services of my current company and I want to continue with the HMO care, what do I do?

Notify SHTL of your intention before expiration of your premium.

+Is pregnancy covered?

Yes, if you are on a corporate plan you are covered immediately. However, on all other individual plans, a 1 year waiting period applies before you are able to access any maternity care benefits

+Encounter Data Form?

Every enrolee is expected to sign a completed form at the hospital after accessing medical care, for each visit to the Provider. It is very important for quality control

+Referral System?

Enrolees requiring referral to secondary facilities within covered services are referred automatically within the facility; where the facility falls outside the primary provider’s zone, a pre-authorization is obtained from the call centre and the appointment fixed. This is waived in emergencies and paediatrician consults.