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Nigerian National Health Insurance Policy


The National Health Insurance Scheme in Nigeria came into being on 10th May, 1999 when the Federal Military Government established the National Health Insurance Scheme Decree No. 35 of 1999 Laws of the Federation of Nigeria. This was geared towards providing health insurance for the citizens and their dependents and have them benefit from prescribed good quality and cost effective health services as set out in the decree.

The goals of the National Health Insurance Scheme according to the decree are as follows:

  • To ensure that every Nigerian citizen has access to good quality health care services
  • To protect families from the financial hardship of huge medical bills;
  • To limit or reduce the rise in the cost of health care services;
  • To ensure equitable distribution of health care costs among different income groups;
  • To maintain high standard of health care delivery services within the Scheme;
  • To ensure efficiency in the delivery of health care services;
  • To improve and harness private sector participation in the provision of health care services;
  • To ensure adequate distribution of health facilities within the Federation;
  • To ensure equitable patronage of all levels of health care;
  • To ensure the availability of funds to the health sector for improved services.

 

 The Scheme has the right and is responsible for registering every health maintenance organization and health care provider under the scheme. The Scheme is also an entity which can sue or be sued with its name. The benefits of the NHIS policy are that the contributions paid cover healthcare benefits for the employee, a spouse and four (4) biological children below the age of 18 years. More dependants or a child above the age of 18 would be covered on the payment of additional contributions from the principal beneficiary. However children above 18 years who are in tertiary institution will be covered under Tertiary Insurance Scheme.

Any health care provider registered under the scheme should render the following services based on the capital payment or approved fees in respect of each insured person registered with it:

Out-patient curative care including prescribed drugs and diagnostic tests, maternity care up to four (4) live births under the age of 18 for every insured person, preventive care which includes immunization, family planning, ante natal and post natal care, consultation of some defined range of medical specialists (such as physicians, pediatricians, obstetricians, gynaecologists, general surgeons, orthopaedic surgeons, Ear Nose and Throat (ENT) surgeons, dental surgeons, radiologists, psychiatrists, ophthalmologists, physiotherapists, etc), hospital care in a public or private hospital in a standard ward during a limited period of cumulative 15 days per year in cases of physical or mental disorder afterwards the employee or employer pays for the subsequent days after the 15 days are exhausted, eye examination and care (excluding tests and provision of spectacles) and ranges of prosthesis (limited to artificial limbs produced in Nigeria) and preventive dental care and pain relief (including consultation, dental health education, amalgam filling, and simple extraction).

The above mentioned services are covered in the national health insurance scheme through authorized health care providers in Nigeria.

How Successful Has This Scheme Been Since Its Inception?

Not quite successful unless your level of success starts from a lowly 2.9% of the population. Till date, the scheme has only been able to reach about 5 million Nigerians according to record. What happened to the remaining 165 million citizens in the country? The National Health Insurance Policy or Scheme at the moment targets the formal and self employed sector which has not really been covered. Recently, the scheme has planned to cover more of the citizens in the rural areas by launching the Rural Community-based Social Health Insurance Scheme.

Most Nigerians have been reluctant in registering into the NHIS for reasons I cannot fathom. The registration should be made compulsory so as to reach out to as many citizens as possible. This will reduce the rate of deaths that occur due to reasons of the patients or accident victims not having money available with them at the time of occurrence of accidents or time of occurrence of an illness. Once you have your NHIS card, it will be easier to access medical care within the country without the need to go with cash to the hospital. There have been some cases of Nigerians being refused treatment in hospitals because they could not make an initial down payment at the time of their arrival at the hospitals.

I have seen pregnant women not being able to get antenatal care because they did not have the money for ante natal care bills, but this could have been avoided if the women had registered under the scheme.

How Is This NHIS Funded?

The National Health Insurance Scheme (NHIS) is funded primarily by contributions from members based on their respective income. For the Formal Sector, Social Health Insurance Program contributions are premiums that make up 15% of an individual’s basic salary, where the insured person’s employer contribute 10% while the employee pays 5% for coverage of themselves, their spouse, and up to 4 children under the age of 18. An employer may negotiate with an HMO for coverage of additional supplementary benefits and pay the extra contributions required. Participants in the Informal Sector Program are expected to make a monthly contribution based on the benefits package of their choice as well as other factors. The poor, elderly, veterans, and disabled are exempted from paying membership premiums.

There should be more public enlightenment on how the NHIS works and its benefits. This will go a long way in getting a larger number of citizens insured.



3 comments

  1. i need a medical insurance for studying in india

    Comment by Osadebe Elijah on July 19, 2016 at 12:56 am

  2. Doesn’t NHIS cover for children above 18years? What if the children are all above 18years only the spouse u mean are entitled? What is the reason 4dat

    Comment by julius blessing on October 10, 2016 at 3:13 pm

  3. Please, can a student purchase national health insurance policy?

    Comment by Emmanuel chill on October 7, 2017 at 4:24 am

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