National Health Insurance Scheme (NHIS) in Nigeria

The National Health Insurance Scheme with the acronym NHIS, is the umbrella body as far as Health Insurance in Nigeria is concerned. Health Management Organsations (HMOs) and Insurance companies with good health care plans have been set up to help attain the objectives of NHIS.

Stay with us here, as we will show you all you need to know about Health insurance in Nigeria. Frequently Asked Questions such as: How to register for NHIS? How much is the cost of health Insurance? How many Accredited HMOs do we have? Full list of Insurance Companies in Nigeria? What are the various Health Care Plans in Nigeria?

The National Health Insurance Scheme (NHIS)

The Scheme incorporated under the National Health Insurance Scheme (NHIS) Act, Cap N42, Laws of the Federation of Nigeria, 2004, is intended to provide easy gateway to healthcare for all Nigerians at an affordable cost through several prepayment systems. NHIS is absolutely committed to securing universal coverage and access to competent and affordable healthcare, in order to develop and enhance the health status of Nigerians, particularly for those participating in the several programmes/products of the Scheme.

How National Health Insurance Scheme (NHIS) Works

The National Health Insurance Scheme (NHIS) functions under a prepayment system called capitation. Every month, all registered members will receive a bill for money that they owe, nevertheless if whether that person made use of the NHIS’s services or not. The amount that each member pays is determined by their ability to pay, and someone paying considerably less can receive the same level of care with someone who is even paying ten times more.

The main purpose of this system is to annihilate any socioeconomic barriers, which may be an obstacle to attaining access to a health service. Previously, someone earning a lower income could not access the country’s top clinics. But with the NHIS, they should be able to.

What are the benefits of NHIS?

Some of the benefits of enrolling to the NHIS include:

  • Hospital care in a standard ward for a stay limited to cumulative of 21 days per year.
  • Maternity care for up to four (4) live births for every insured contributor
  • Consultation with specialists such as physicians, paediatrics, gynecologists, surgeons, physiotherapists, etc.
  • Preventive care immunization as it applies in the National Immunization Programme.
  • Health education, family planning (counselling), emergency first aid, antenatal and post natal care.
  • Out-patient care, including necessary consumables (Drugs, Injections, drips), and so on.

Health Management Organisations (HMOs) in Nigeria

There are so many health care providers with good health care plans in Nigeria. Health Management Organisations also have a huge presence in Nigeria. Research has it that around 7 million Nigerians are enrolled with a HMO.

Meaning of HMO

A Health Maintenance Organization (HMO) is a private or public organized company endorsed by the National Health Insurance Scheme mainly for the purpose of operating the provision of health care services with Health Care Facilities accredited and endorsed by the Scheme.

This grants healthcare for citizens at a much lower cost than most private insurances do. Of course, the concession is that there are several constraint on the hospitals and physicians that they can see. Lastly, the black market (Pharmacy) also sells medicine, supplies, and vaccines.

18 Main Functions of HMOs

These organizations that provide healthcare services have many functions which include:

  1. Collection of contributions from voluntary contributors.
  2. Collection of contributions from registered employers and employees registered under the private health insurance.
  3. Ensure that the processing of claims (Secondary services) are carried out effectively.
  4. Ensure the appropriate payment of capitation to Primary health care facilities and fee-for-service to Secondary and Tertiary health care facilities.
  5. Rendering to the Scheme monthly returns on capitation and fee-for service payment within 30 days of the following month.
  6. Collection and submission of encounter data forms from Health Care Facilities (HCFs) to NHIS.
  7. Contracting with only Health Care Facilities accredited by the Scheme for the purpose of rendering health care services.
  8. Ensuring that contributions are kept in the Scheme’s accredited banks.
  9. Establishing and ensuring a quality assurance system for the provision of quality health care by Health Care Facilities.
  10. Quality Assurance monitoring of HCFs by HMOs shall be quarterly and the reports sent to NHIS within one month.
  11. Ensure timely approval of referrals and undertake necessary follow up to complete referrals.
  12. Carry out continuous sensitization of enrollees.
  13. Marketing in accordance with National Health Insurance Scheme NHIS Guidelines.
  14. Marketing of health plans to employers/enrollees of different public and private sectors.
  15. Collect appropriate contributions and make necessary payments to the appropriate pools in a timely manner.
  16. Rendering accounts to the NHIS as stipulated in NHIS operational guidelines.
  17. Comply with other provisions as spelt out in the Operational Guidelines.
  18. Carrying out such objectives as are contained in the NHIS operational Guidelines.

Problems with HMOs in Nigeria

Regrettably, the quality of this medicine is exceedingly questionable. This has caused many deaths. For example, between 2008 and 2009, around 84 children died of adulterated teething medication.

All visitors and expatriates are able to access the healthcare facilities at a very higher rate than locals who are registered in NHIS or HMOs. However, the quality of care and infrastructure is considerably lower than that of North America and Western Europe. In 2000, the World Health Organization listed Nigeria as 187 out of 191 countries on the attainment of their country’s healthcare system. Travelers and expatriates are firmly advised to pay for an international health insurance scheme before entering the country.

Rural and urban facilities are implausible to be able to perform any treatment beyond fundamental medical services. In the event that a severe injury or illness does occur, evacuation to a another country will be necessary. These expenses are presumed to be as much as $100,000 USD. It is mandatory to purchase a policy that will cover both medical evacuation and transportation costs.

Health Care Plans in Nigeria

According to the declaration by the CEO (Chief Executive Officer) of the NHIS on 19th June, 2014, proposals have been made and programs designed to enhance healthcare technology where about 20 million Nigerians can easily pay for their healthcare services on their mobile phones.

Plans were also established for digital management to attend to primary school children and all pregnant women and children in 2015.

What is Health Care Plan?

A health plan is a set of defined health care advantage, provided to the enrollee at a premium price, payable as agreed by the involved parties. There are fundamentally two basic types of health care plan used in Nigeria which are HMO and Out- of- Pocket (OOP) Plans.

The HMO plan has been elucidated in the beginning while the OOP is the plan where you purchase for the health services from your private pocket in a large sum at once. This plan is very costly and the vital cause of people averting the use of hospitals and resorting to other black market medicines. The HMO health plan should be expanded to all Nigerians, even in the obscure parts of the country for easy contact to quality health care.

READ ALSO: Top 40 Health Insurance Companies in Nigeria

Top Health Insurance Companies in Nigeria

These are the top accredited Health Insurance Companies in Nigeria:

NB: Feel free to access the HMOs of your choice via the links given.

  1. Hygeia HMO Limited

Hygeia prides itself on customer service, its simply one of the best in terms of customer service. According to their official website, Hygeia seeks to provide a “wow” customer service experience every single time.

  1. Total Health Trust Limited

THT was the first ever HMO to register with Nigeria’s NHIS. It’s also the biggest and largest health insurance company in the Nigerian market with over 270,000 members.

  1. Clearline International Limited

Clearline has 13 centers and over 2000 health care providers nationwide. Clearline’s Director, Dr. Segun Ogundimu performed as Lagos’s Commissioner of Health and knows all the ins and outs of Nigeria’s health care system.

  1. Healthcare International Limited

Healthcare International focuses on international travelers. Because they have several branches in many different countries, its members enjoy superb health coverage both at home in Nigeria and abroad.

  1. Mediplan Healthcare Limited

Mediplan supplies health insurance for Nigeria’s Federal Ministry of Works, Federal Ministry of Labour and Productivity in addition to the Federal Ministry of Agriculture & Rural Development. This Insurance company focuses in providing superb health care to Nigerian citizens in rural areas.

  1. Multi Shield Nigeria Limited

Multi Shield offers some of the best precaution care services in Nigeria. It was one of the first 8 health care providers to enroll with NHIS the very first time in 2005. In 2014, Multi Shield concluded the NHIS re-accreditation procedure early again, making it one of the first Nigerian health care providers to abide by NHIS’s new accreditation criteria.

  1. United Healthcare International Limited

UHIL prides itself on transparency. There are absolutely no loopholes or hidden clauses in their contracts. UHIL’s insurance agents do their very best to make sure that members understands everything about their plans before they sign the papers.

  1. Premium Health Limited

With over 250,000 members, Premium Health Limited is one of the largest health insurance companies in Nigeria. According to their advertising material, Premium Health provides individual health care solutions with a personalized touch.

  1. Integrated Healthcare Limited

IHL provides a 24 hour call center service and an IT driven procedure to health care. Their advantage package is one of the most comprehensive packages provided in the world, according to IHL’s official website.

  1. Managed Healthcare Services Limited

MHSL’s main values are promptness, professionalism, empathy, quality and integrity. Any questions about their plans can be answered immediately via chat by sending them a message through their virtual consultant system.

  1. Princeton Health Group

Princeton Health Group has been around since 1999, it is one of the oldest HMOs in Nigeria. It’s affiliated with Princeton Health Incorporated, an American health insurance company whose head office is situated in New Jersey, USA.

  1. Maayoit Healthcare Limited

At Maayoit, their focus is on innovation and customer service. Maayoit Healthcare Limited prides itself on its determined staff, feedback-based customer care service system and their cutting-edge computer technology.

  1. Defence Health Management Limited

Defence Health Management Limited is collectively owned by the Ministry of Defence and Nigerian Armed Forces. DHML was created to help with the health care needs of the Nigerian military because of some medical needs that are not being covered by the regular military health care plan.

  1. Healthcare Security Limited

Healthcare Security Limited was first accredited by NHIS in 2005 and was also one of the first health insurance companies to get re-accredited in 2014. Their website provides an easy-to-understand chart that shows a quick look at all of their various health care plans.

Other accredited HMOs include:

  1. International Health Services Limited
  2. Zenith Medicare Limited
  3. Zuma Health Trust
  4. Prepaid Medicare Services Limited
  5. Accessible Managedcare Limited
  6. MetroHealth HMO Limited
  7. Police Health maintenance Limited
  8. Strategic Health Planners Company Limited
  9. Sterling Health Care Managed Services Limited

There are about seventy-seven (77) accredited HMOs currently operating in Nigeria.

See the Full information on the Top 40 Health Management Organizations (HMOs) in Nigeria.

What are the Health Insurance programs in Nigeria?

Here are some common health insurance programmes in Nigeria.

  • Formal Sector Social Health Insurance Programme: This is a program specifically for employees in the public and private sector (a company with at least 10 staffs and above). Formal sector totally covers the staff, spouse and their four biological children.
  • National Mobile Health Insurance Program (NMHIP): This is a program steadily chasing out the previous Voluntary Contributors Social Health Program. Popularly known as VCSHIP.
  • Tertiary Social Health Insurance Programme: This is for students in tertiary institutions.
  • Community Based Social Insurance: This is for people in villages, markets, etc.

How does one enroll for Health Insurance Programme in Nigeria?

To register for the Formal Sector Health Insurance Programme, you just need to make enquiries of the Health Management Organization (HMO) the firm uses and go enroll to get the enrollee card.

To register for the National Mobile Health Insurance Programme (NMHIP), you have to contact NHIS in any of their various branches which can be found online. Although you also have to visit them in person during the registration process, and after, to get your card.

Issues with HMO Staff:

Of course in Nigeria, HMOs staffs are not well skilled and they always tend to see people who have chosen to insure their health lower to those who didn’t want to. Since they pay lower and enjoy insurance advantages. Hence, they tend to concentrate on them in a personal manner compared to others.

How much does Health Insurance Cost in Nigeria?

The cost for subscribing for the National Health Insurance Scheme varies from programme to programme. The government organization typically covers the large amount for the registration of Formal Sector Health Insurance Programme and individual input relies on the Health Service Provider.

Registration of your dependants (Children and Parents) typically cost around N9,000 per head. But the Health Care International has the goal of providing health care services anywhere and at any time to all participants. Depending on the NHIS, the private ones have individual plans starting from N35,000 to N220,000 and family plans ranging from N125,000 to N650,000.

VCSHIP costs a registration fee of N15,000 and N10,000 per head while NMHIP costs N12,000 and N9,000 per head.

All fees would be renewed annually.

What Critics Say is the Problem with the National Health Insurance Scheme

The NHIS has been laboriously criticized for many reasons. One of the determinants is that due to lack of organization and the reality that the NHIS is not compulsory, many states and regional governments are not participating in the scheme. The NHIS cannot really be national and healthcare cannot be reachable to all citizens if some local governments or states are not a part of the NHIS.

Since 2006, the federal government has exchange views on amending the Act in order to make it mandatory for all regions to join. The basic problem lies with the way the government is organized. Nigeria has a three-tier system of government, so what is approved at the federal level may not automatically be accepted by the states. Because Nigeria has 38 different governments, 1 federal, 36 state, and 1 Federal Capital Territory (FCT).

Another primary problem with the NHIS is the monetary cost. In Nigeria, more than 70 percent of people live on less than US$1 a day. People are often not ready to spend a whole day or a large portion of their earnings on going to hospitals that are mainly situated in urban areas. Furthermore, people just do not trust the system yet. People are not compelled to join a system that they believe is inadequately funded, and where the quality of service is intensely poor.

Major Problems With Health Care Sector in Nigeria

Nigeria’s healthcare sector also faces lots of problem that several geographically large countries face.

Decentralization

Most disease-burdened areas are in the rural parts of the country. However, less than 10 percent of healthcare facilities are situated in these areas. The complete lack of other infrastructure such as water, electricity, and schools is the main reason why healthcare personnel do not want to move to these rural areas. To infuriate this problem, Nigeria is also suffering from a “brain drain”. This is a problem that countries face when the learned, skilled members of their society migrate to other countries in looking for a better quality of life.

Poor Pay to Practitioners

Even doctors practicing in the best hospitals in Nigeria only make about $700 USD a month, about 280,000 Naira. In 1995, a census revealed that there were around 21,000 Nigerian doctors who were practicing in the United States alone. This is almost equal to the number of doctors who actually practice in Nigerian healthcare facilities.

All of these problems have led Nigerians to search for other means of medical care. Some alternatives have been to turn towards traditional medicine, HMOs, and the black market. Many poor and rural Nigerians still depend on traditional medicine and juju. Although there are various traditional medical producers who do play a specific role in their communities, there are also several false healers.

Conclusion

The federal and state governments should look to investing more in the health sector, they should also give out loans to partnering HMOs so that their Health Services can be definitive.

Also they should take time out to educate the staffs on the real line behind deciding to choose for health insurance and deciding not to as most people who went for it are even more educated and most times richer than those that didn’t.

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2 Comments

  1. David Asuquo

    January 28, 2018 at 6:50 am

    can N H I S be transfer from the hospital he has been register to another. if the person been transfer within the state.

    • Pharm. Goodnews

      January 29, 2018 at 9:10 am

      Yeah, sure. It is a national scheme.

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