HMOs in Nigeria explained: 'up to' limits, waiting periods and authorisation codes
A Nigerian HMO plan pays for care at its own network hospitals, up to a limit per category per year, after a waiting period, once the hospital has an authorisation code from the HMO. Read those three things before the price, because they decide whether the plan works on the day.
By Kinship · Updated 19 September 2026 · 5 min read · Information, not advice.
'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 Kinship Well relates to this
Kinship Well provides health benefits in the member's name through the Care Partner's arrangement with a licensed provider; the member receives the provider's full benefit schedule on enrolment, with its limits stated. What Kinship adds around it is a Kinkeeper who knows the schedule, a doctor to talk to before a hospital visit, and someone who can be alongside the member at the hospital.
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 health benefits in Kinship Well
What is inside Kinship Well, who provides it, and when the member sees the full schedule.
The health benefits in Kinship WellRelated
Sources
- Hygeia individual plan schedule (2025)
- Comparing plans: waits and pre-existing conditions (nairaCompare, 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. Nothing on this page recommends a named provider.