frequently asked questions to help you out
General Questions
Health insurance is a type of insurance coverage that pays for your medical services, either in part or in full.
HMO is an acronym that stands for health maintenance organization. A HMO provides or arranges managed care for health insurance, self-funded healthcare benefit plans, individuals and other entities and acts as a liaison with healthcare providers (hospitals, doctors, etc.) on a prepaid basis.
Medical treatment and screening can quickly get very expensive. A health plan not only helps you manage the cost of receiving medical care—whether routine or unplanned—but also creates an affordable avenue to access high quality medical services.
- How does it work? When you buy a health plan, you agree to pay a certain rate or premium to your health insurance company. In return, your HMO agrees to pay your medical bills, provided they are covered by your health plan.
When you buy a health plan, you agree to pay a certain rate or premium to your health insurance company. In return, your HMO agrees to pay your medical bills, provided they are covered by your health plan.
Your employer will only cover your health plan while you are employed with the company. Once you leave employment, you will be responsible for buying an individual health plan to suit your needs
Adults over the age of 18 are eligible to apply for coverage under Doves HMO health plans.
The main differences between our health plans are the benefits available within each. Pricing for each health plan will also vary by levels of care available with the purchase.
Yes, but only if your plan includes maternity cover.
No, the premium is payable annually for the number of members enrolled at the beginning of the policy year. Although, exceptions can be made for special customized plans.
The family plan will provide coverage for you, your spouse and up to four children.
Yes we do, in our family and customized plans, we cover children up to the age of 18.
Kindly send an email to callcentre@doveshealthcare.com, stating the name of the new hospital you want to use and enrollee number. You will receive a response confirming the effective date. The operational cut-off date is the 20th day of every month and the effective date is the 1st day of the following month. Hospital changes are allowed quarterly.
Yes. Your selected provider will however be subject to standard assessment, only providers who pass this assessment will be added to our network.
Yes. Doves HMO has entered into formal agreements with every hospital on our network. The Agreements include guidelines for treatment in line with best practices. This is also monitored by our medical team to ensure that standards are maintained and shortfalls corrected immediately.
Kindly verify from your plan handbook. You may also contact Doves HMO 24-hour Call Centre or your case manager for verification/ clarification.
Our medical team monitors the hospitals in various ways, including routine spot checks, claims vetting, authentication codes, clinical audits and case management.
You should please formally inform us using any of the above-mentioned channels. This would enable us investigate the case and adequately address the issue. You would also be allowed to change hospital, should you prefer.
Yes. The provider would only need to contact us to confirm that you are an active member (since you are not registered with them).
In the event of a life-threatening emergency, you may access care from the closest hospital to you, but kindly contact Doves HMO within 24/ 48 hours max.
If you are out-of-station (out of your state of registration) and need medical attention, you can access care at any of Doves HMO Provider Hospitals nationwide. Please contact Doves HMO 24-hour Call Centre for further assistance.
We welcome your feedback on all aspects of your experience with Doves HMO and our network of providers. If you have a complaint, kindly contact our client services department through calls or Whatsapp to 08129377422, 08088908928; email: complaints@doveshealthcare.com to enable us resolve your complaint as efficiently as possible.
You will receive an introductory welcome pack, which will include your Doves ID card/ code and a member handbook that contains all the information about your health plan that you will require for the year.
An exclusion is a condition/ procedure or service that is not covered by your health plan. Any benefit that is not listed on your health plan is an exclusion. Please always seek necessary clarification where required.
A Pre-existing condition is any condition that already existed at the time of purchasing the health plan. All new members are required to disclose this at the time of enrollment and remain liable for non-disclosure or the lack of knowledge should the condition be discovered afterwards.
Some benefits on your health plan are subject to a waiting period of up to 10-12 months. After the waiting period has been completed, these benefits would become automatically active and available permanently.
Yes. Provided you pay the premium for the upgrade.
No, this is illegal. The ID card is to be used by the owner only.
Please notify us promptly and apply for a replacement (charges may apply).
It is unprofessional for you to be treated in such a manner by the provider. Where/when you receive such treatment, please inform us through any of the above listed channels for immediate action.
Yes. Doves HMO covers casual staff based on agreed terms and condition
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