Frequently Asked Questions (FAQs)
How do I use my ID card?
Please, present your Clearline HMO ID card or dependant’s at the front desk office to see the doctor.
Which hospital do I use?
You will pick a provider from the list of network of providers as your primary care provider.
Can all the hospitals attend to all manner of sickness?
No not all hospital can, there are primary Providers that attend to primary sickness that do not require a specialist attention. When a specialist attention is needed you will be referred to the specialist within your zone or within the hospital on fee for service.
Suppose my favorite hospital is not on your list?
Such hospitals if not already listed on Clearline HMO provider network shall be inspected and listed, provided the hospital meets the minimum required standard and the management of the hospital is willing to join the scheme and abide by the rules guiding our operations. T his is in the interest of all enrollee.
If I am living apart from my family how would I and my family access health?
There is provision on the registration form for alternate primary provider in the case of participants that live apart from their families. (You and your dependents can each have a different primary care provider).
If I travel out station, where will I attend?
In the cases of out-of–station health needs, you should call our 24hr helplines,
to obtain information on the nearest provider to your present location.
When you are out of station or in an emergency can receive treatment without the need to make any payment in any of our network of provider anywhere in Nigeria. You are to present your Clearline HMO ID card; otherwise you may be denied treatment when out of station.
In an emergency, if my usual hospital is far, what do I do?
In an emergency situation, enrollee and dependent may attend any nearest hospital within our network or any safe hospital; reimbursement shall be made on presentation of medical bill and report to Clearline HMO and verification of such bills. If treatment in such an emergency spans 24 hours, it is advisable for a relation or next of kin to contact Clearline HMO.
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?
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 by the 17th day of the month otherwise; action may be delayed by a month).
Can my brother’s or sister’s child replace the child for treatment?
No, unregistered persons cannot replace as Health insurance is not transferable, so ID card is not transferable. The policy covers only the card holder for the chosen healthcare benefits. This is because the healthcare provider is prepaid only for the card holder and has the pictures of all the beneficiaries in his hospital. Only those dependants registered with your employer or for whom you have paid can have access to the scheme with their respective healthcare card. You can take individual policies for them with prorated premiumsfor your relations to enjoy the scheme.
What happens if I should loss my ID card?
You will write for a replacement after payment of #500:00, through your HR.
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 Clearline HMO help desk immediately
(Except if you ask for extra favors).
Please inform our call center at once – 08076490101, 08076490111, 07098141894 or 08052408604
Hospitals may keep one waiting for hours, what do I do?
Politely complain to the officer-in-charge of the hospital, the HMO officer on duty or call our call center.
If I am referred to another hospital for one service or the other, who pays for my transportation?
If there is need for transfer to another provider, it is the duty of the providers and CiL to provide transportation for inter-hospital transfer if the patient is unable to move, otherwise where referral is done and the patient is fit, he shall bear the cost.
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.
If I have more than one wife and four children /my extended family members, can I cover them?
Any member of the family outside the allowable number of dependants can be registered as “extra dependant” by paying from your pocket on a prorated basis. This is cheaper than out of pocket expenditure.
If I have a new addition to the family, what do I do?
You will need to fill a “new inclusion” form, you can obtain the form from the HR. (new entrant must be received by the 17th day of the month otherwise; action may be delayed by a month).
If I leave the services of my current company and I want to continue with the HMO care, what do I do?
Notify Clearline of your intention before expiration of your premium.
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 center, what is the procedure for seeking redress?
You can lodge complaints with the client service person(s) assigned to you organization, call our 24hrs call center numbers to act instantly at point of disaffection, send us an email, or write a letter and send to our office. Nevertheless if you are still not satisfied you can change your provider.
Additions to Family?
Any addition to the family on dependants list should be done by filling an inclusion form with passport photograph. New born babies are covered by mothers I.D card for the first 6 weeks after which Registration must be done.
The HMO ID card issued by Clearline simplifies access to medical service at the hospital. It must always be presented by enrollees before treatment as it protects the Provider against impersonation. It is advisable to choose only one hospital for the family, if they are together or specific hospitals for each member of the family if he/she is in a different location. However any enrollee can use ANY Hospital on our Network of Providers in cases of emergency without necessarily being registered there.
Use of Hospitals Outside Our Regular Network?
Use of ANY hospital in Emergency, to SAVE LIFE is encouraged and allowed. You must inform any of the Call Centers / Help Lines at once (within 48 hrs). Clearline will contact the nearest office anywhere in Nigeria to despatch a Medical Team to assess the situation, authorize continuation of treatment or transport to the most appropriate care center by the fastest and safest means.
Encounter Date Form?
Every enrollee 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.
Enrollees 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.
What does the scheme cover?
Refer to the benefit package at Clearline HMO help-desk or with your HR.