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'Up to' limits
Every plan states an annual maximum for each category. A 2025 individual schedule from one large HMO shows inpatient limits from N150,000 on its cheapest tier to N3,000,000 on its top tier, outpatient from N100,000 to N1,500,000, surgery from N200,000 to N600,000, and 7 to 20 ward days a year. Once the limit is reached, the rest is cash. For an older member, the inpatient and surgery limits are the numbers to compare.
Waiting periods
A plan typically becomes usable 7 to 30 days after purchase for ordinary care. Surgery, intensive care, chronic disease management, optical and dental commonly wait 3 to 12 months, and some plans exclude surgery in the first year entirely. Buying a plan the week a relative is admitted does not help with that admission.
The authorisation code
At the hospital, the member shows their HMO card and the hospital asks the HMO for a code before treating. This is where plans historically failed: codes came late or not at all. Since 1 April 2025 the NHIA requires the code within one hour; if it does not arrive, the hospital is meant to treat and inform the NHIA. Emergencies are treated first and coded within 48 hours. Delayed codes were still the most common complaint against HMOs in the NHIA's 2024 report.
Four questions to ask before buying
- Which hospitals near the member are in the network, by name?
- What are the inpatient, surgery and drug limits, in naira, on this tier?
- Which waiting periods apply, and are pre-existing conditions excluded, delayed or capped?
- Does the hospital the member would actually use ask for a cash deposit on admission regardless?
How the Kinship Plan helps
The Kinship Plan provides the Kinship team, who hold the member's history and medicines and reply the same day, Kemi on WhatsApp and a shared family record. Add visits, with a named Kinkeeper, when someone there in person would help. Treatment bills remain separate.
Questions people ask
What does capitation mean?
The HMO pays a hospital a fixed amount per enrolled member for primary care, whether or not the member attends. Referrals and secondary care are paid per item.
Can I complain about an HMO?
Yes, to the NHIA, which publishes complaint numbers and sanctions HMOs and hospitals. In 2024 it sanctioned 47 HMOs.
The Kinship Plan
The base layer and optional nurse visits.
The Kinship PlanRelated
Sources
- An HMO's published individual plan schedule: limits, waiting periods and exclusions (2025)
- An insurance comparison site's guide to waiting periods and pre-existing conditions (June 2026)
- One-hour authorisation rule (Channels TV, April 2025)
- NHIA 2024 complaints report (Guardian Nigeria)
- How HMOs and capitation work (Premium Times, Aug 2026)
- Lagos hospital deposits (lagos.cool, May 2026)
Prices in naira are quoted with their date because they move. Where a figure comes from a commercial provider, the source is described rather than named, and nothing on this page recommends a provider.
This page is information, not advice. Kinship wrote it from the sources listed above and checked it on the date shown. It is not medical, legal, financial or insurance advice, and it does not take account of any one person's circumstances. Decisions about treatment belong with the person and their doctor; decisions about money, insurance or immigration with the person and a qualified adviser. Our platform terms apply.