Obtaining health insurance is mandatory in Nigeria; here is how to get it

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March 13, 2023
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7 min read
A patient consulting with a doctor

Key Takeaways  

  • According to reports, only 3% of Nigerians have access to health insurance, contradicting the Universal Health Coverage (UHC) policy, which allows everyone access to healthcare regardless of social status.
  • Replacing the National Health Insurance Scheme (NHIS), the government enacted the Nigerian Health Insurance Authority (NHIA) Act in May 2022.
  • The Act requires that everyone in Nigeria, including workers in the informal sector, employers and employees in the public and private sectors with five or more employees, and all other residents, obtain health insurance.

If you work for a company that provides health insurance to its employees, you might assume everyone has access to it, especially if your background is similar to mine.

Since I could tell my left from my right, I've had access to health insurance. I've benefited from the Tertiary Institutions Social Health Insurance Programme (TISHIP) and the National Health Insurance Scheme (NHIS).

And now, I enjoy Corporate Health Insurance, which Techpoint Africa offers its employees. You could say I’m one of the fortunate few because my experience differs from most Nigerians.

Per Statista, 97% of Nigerians were without health insurance as of 2018. Also, Dataphyte estimated that 3% of the population had health insurance under employee health coverage in 2021.

This shows that most Nigerians do not have access to healthcare, which is against the concept of Universal Health Coverage (UHC).

According to the World Health Organization (WHO), UHC means everyone has access to the full range of high-quality health services they require, when and where they need them, and without financial hardship.

It encompasses a range of essential health services, from health promotion to prevention, treatment, rehabilitation, and palliative care.

Consequently, to ensure that everyone in Nigeria has access to healthcare, the government enacted a health insurance act in May 2022.

But before then, in 1962, the Federal Minister of Health attempted implementing health insurance, but the Nigerian Medical Association opposed the move.

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As a public-private partnership, NHIS was formally established in 1999 to offer affordable healthcare to everyone, particularly those working in the informal sector. However, it only became operational in 2005.

The NHIS has faced numerous challenges and criticisms over the years. But on May 19, 2022, President Muhammadu Buhari signed the National Health Insurance Authority (NHIA) Bill into law, making health insurance mandatory for all Nigerians and legal residents.

What does this NHIA Act mean?    

By 2030, the NHIA Act seeks to extend health coverage to all Nigerians, particularly the most vulnerable people unable to afford healthcare.

The Act mandates that everyone in Nigeria, including workers in the informal sector, employers and employees in the public and private sectors with five staff or more, and all other residents, obtain health insurance.

NHIA, which replaces the NHIS Act, is expected to increase funding and accountability in the health sector. It also seeks to improve the quality and efficacy of health insurance services.

The Act establishes a new Third-party Administrators (TPAs) entity that necessitates a new licence, expands TPA roles, and limits Health Maintenance Organisation (HMO) actions.

For context, the NHIS Act of 1999 lacked a definition of TPAs, limiting health administrators to HMOs outside the national scheme and reducing the effectiveness of health service delivery.

However, the NHIA Act defines TPAs as “any organisation with expertise and capability to administer all or a portion of the insurance claims process, including administration of claims, collection of premiums, enrolment and other administrative activities, which is registered by the Authority.”

It also includes HMOs, Mutual Health Associations, and other TPAs of health insurance.

Sidenote: We'd like to know how you access healthcare in Nigeria. If interested, please, fill this form.

How do you get health insurance in Nigeria?   

In Nigeria, where 133 million people live in poverty, health insurance is crucial to ensuring that individuals and families can access healthcare services without experiencing financial hardship.

Health insurance is a scheme that protects your health and gives you access to quality healthcare services for free. While you commit to paying monthly or yearly premiums, it covers your medical costs for the contract.

It frequently includes specific care coverage, which means you won't have to pay for any medical care that falls within the scope of your insurance.

Health insurance lowers out-of-pocket costs for healthcare services, increases access to high-quality medical care and advances the goal of universal health coverage.

Here are some health insurance options available to Nigerians and legal residents.

National Health Insurance Authority (NHIA)  

The National Health Insurance Authority (NHIA) is a government-sponsored health insurance programme available to all Nigerian citizens and legal residents.

It covers primary care, emergency services, pregnant women, and children under 18. It is available to both private and public sector workers. Check out this link for more information.

To enrol, you must do the following:

Step 1: Visit the local NHIA office or a licensed HMO to enrol in the NHIA. You can find a list of the available HMOs with their contact information on the NHIA website.

Step 2: Complete the NHIA registration form and attach all required documentation, including a legitimate ID, a passport photo, and evidence of employment or business registration.

Step 3: Pick a healthcare facility or hospital from any NHIA-accredited hospital or healthcare facility.

Step 4: Pay the required premium for your selected plan and coverage length.

Step 5: Get your NHIA ID card and start enjoying healthcare.

Private Health Insurance

Private insurance companies offer insurance policies that pay medical bills. Typically purchased by individuals or businesses, they provide several coverage options, from the most basic to the most comprehensive.

Personal insurance includes Corporate and Voluntary Health Insurance.

  1. Corporate Health Insurance  

This is a type of medical insurance that companies offer to their employees. It covers medical expenses, including consultations, hospitalisations, and surgeries.

Your employer should provide a corporate health insurance plan. Since your company takes care of that, you don't need to enrol. Contact your human resources department for more information.

  1. Voluntary Health Insurance  

Individuals can purchase this type of health insurance for themselves and their families. It covers medical expenses such as consultations, hospitalisations, and surgeries.

You can get voluntary health insurance by contacting a private insurance company with health insurance plans.

Depending on the insurance provider, the eligibility requirements may change, but generally, enrollees must be employed or self-employed and able to pay the premiums.

Employers and employees can follow these steps to get health insurance:

Step 1: Select a private health insurance provider that meets your healthcare needs and budget.

Step 2: Contact the insurance provider or visit their website to request a quote and review the available plans. They will inform you of their offerings and assist you in selecting the one that best satisfies your requirements and financial constraints.

Step 3: Provide the necessary information to complete the application process.

Step 4: Pay the required premium based on the chosen plan and duration of coverage.

Step 5: Wait for the insurance company to process your application and send you your policy documents and ID card.

Step 6: Enjoy healthcare!

Examples of companies that provide corporate and voluntary health insurance include AXA Mansard Health Insurance, Reliance HMO, Hygeia HMO Limited, Avon Healthcare Limited, and Leadway Health Limited.

Community-Based Health Insurance (CBHI)  

CBHI is a revolving loan programme that offers microfinance to a community to pay for healthcare.

Aimed at rural communities and low-income individuals, a community or group of people, such as an artist's cooperative or a farmer's cooperative, manages such health insurance.

Community members voluntarily pool their risks in the hope of receiving payouts to offset vulnerabilities — in this case, a health vulnerability — and the premiums are modest and variable.

Enrolment is also voluntary and determined by the perceived benefits of the system.

Depending on the specific CBHI programme, different criteria apply, but generally, enrollees must be community members and be able to pay the premiums.

Step 1: To sign up for a CBHI, find out if your community has a health insurance programme. If you’re not sure, contact your local government or community leaders.

Step 2: Submit the required documentation and personal information to register for the CBHI programme.

Step 3: Select a healthcare provider from the list of CBHI-accredited healthcare facilities or hospitals.

Step 4: Pay the required premium based on the plan and time frame of coverage.

Step 5: Obtain your CBHI ID card and begin using the services of your preferred healthcare provider.

Examples of CBHI include Edo Health Insurance Scheme (EdoHIS).

State Health Insurance Schemes  

Some states in Nigeria have health insurance schemes. Similar to the CBHI, this may have different eligibility requirements depending on the state and programme.

But, anyone who resides in the state and has the financial means to pay the premiums is eligible to enrol.

Examples of these schemes include Lagos State Health Management Agency (LASHMA), Oyo State Health Insurance Agency (OYSHIA), and Anambra State Health Insurance Agency (ASHIA).

Tertiary Institutions Social Health Insurance Programme (TISHIP)  

This is a health insurance programme for employees and students at public tertiary institutions like universities, polytechnics, and colleges of education.  

It covers essential healthcare services like consultations, lab tests, and medications.

You will be enrolled in the TISHIP programme by default if you are a student or employee of a Nigerian tertiary institution. However, you must submit some personal data to activate your coverage.

 Tips to consider before choosing the right health insurance plan   

Making the right decision when selecting a health insurance plan can be challenging because there are several things to consider. Here are some tips for choosing the right health insurance plan.

  • To help you select a plan that offers the benefits and coverage necessary to meet your healthcare needs, consider your age, medical history, and the medical requirements of your dependents.
  • Health insurance plans frequently include a network of healthcare providers, and it is critical to consider this when choosing a plan. Ensure the selected healthcare providers are those you like or those in your neighbourhood.
  • Before choosing a health insurance plan, it is critical to review the benefits and coverage that each one provides. The plan that best meets your needs will depend on variables, including deductibles, co-payments, and out-of-pocket maximums.
  • Comparing prices of various options is essential before selecting a health insurance plan. Select an affordable one that provides good value for money.
  • Be sure to research the health insurance provider's reputation. Learn more about the company's claims and customer service practices and check out reviews and ratings from other policyholders.
  • Be on the lookout for extra benefits like wellness initiatives, telemedicine, and prescription drug coverage. Saving money and maintaining your health are possible benefits.
  • Finally, before enrolling, read the details of the health insurance plan. Ensure you understand the terms and conditions, restrictions, and exclusions to know what is and isn't covered.

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She's autistic and interested in mental health and how technology can help Africans with mental disorders. Find her on Twitter @latoria_ria.
She's autistic and interested in mental health and how technology can help Africans with mental disorders. Find her on Twitter @latoria_ria.
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She's autistic and interested in mental health and how technology can help Africans with mental disorders. Find her on Twitter @latoria_ria.

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