Another key feature of DHML is that all who enroll will be assigned a Primary Care Provider (PCP). A Primary Care Provider is a health care professional or medical establishment who patients see first for their health care needs. Primary Care Providers will be supported by military and civilian medical specialists to whom patients will be referred if they need specialty care.

How the Scheme Works

1. Each employer wishing to participate in the scheme registers with the NHIS and is assigned with a registration number.

2. The employer selects an accredited HMO and supplies all the necessary personal details. The NHIS issue an ID card to the enrollee and their eligible dependant

3. The PCP takes care of all the primary health care issues of the enrollee based on the NHIS benefit. The PCP will refer the employee to a secondary or tertiary provider accredited by the NHIS for specialized cases, with the approval from the HMO, using the established referral guidelines as listed below in the referral section.

4. The HMO will pay the PCP a global capitation of the N550 per member per month, which has been pre agreed.

5. When the claim is presented, the HMO reimburses the specialist on the pre agreed fee-for- service tariff as prescribed by the NHIS. The appropriate referral must be made before payment is made.

6. Claims shall be submitted monthly by the 14th day of the month following the month in which the claims are incurred. The HMO will reimburse all clean claims within 14 days of receipt of the claim.

7. Standardized pharmacy prescription sheets shall be 3-4 ply for the distribution to the doctor, pharmacy and HMO for notification of claims.