National Health Insurance Scheme (NHIS)

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The National Health Insurance Scheme (NHIS) is a body corporate established under Act 35 of 1999 Constitution by the Federal Government of Nigeria to improve the health of all Nigerians at an affordable cost

NHIS is to provide social health insurance in Nigeria where health care services of contributors are paid from the common pool of funds contributed by the participants of the Scheme.

It is a pre-payment plan where participants pay a fixed regular amount. The amount/funds are pooled, allowing the Health Maintenance Organisations(HMOs) to pay for those needing medical attention. It is primarily a risk sharing arrangement which can improve resource mobilization and equity. It is indeed regarded as the most widely used form of health care financing worldwide.

NHIS also regulate private health Insurance operated by HMOs.

Health Insurance is social security system that guarantees the provision of needed health services to persons on the payment of token contributions at regular intervals.

Programmes

In order to ensure that every Nigerian has access to good health care services, the National Health Insurance Scheme has developed various programmes to cover different segments of the society and these are:

Formal Sector

1.Formal Sector Social Health Insurance Programme

2. Mobile Health

3.Group, Individual and Family Social Health Insurance Programme

Informal Sector

1.Tertiary Institution Social Health Insurance Programmes

2.Community Based Social Health Insurance Programmes

3.Public Private Partnership Social Health Insurance Programmes

Vulnerable Group

1.Pregnant Women

2.Children Under five

3.Prison Inmates

4.Retirees

5.Aged

 

The Formal Sector Social Health Insurance Programme

The Formal Sector Social Health Insurance Programme is a social health security system in which the health care of employees in the Formal Sector is paid for from funds created by pooling the contributions of employees and employers.

The Formal Sector consists of the following:

  1. Public Sector
  2. Organized Private Sector
  3. Armed Forces, Police and other Uniformed Services

Membership

Employees of the public sector and organized private sector organizations employing ten (10) or more persons shall participate in the Programme.

Contributions

Contributions are earnings-related. For public (Federal) sector programme, the employer pays 3.5% while the employee pays 1.75% of the employee’s consolidated salary. For the private sector programme and other tiers of Government, the employer pays 10% while the employee pays 5% representing 15% of the employee’s basic salary. However, the employer may decide to pay the entire contribution. The employer may also undertake extra contributions for additional cover to the benefit package.

Payment Mechanism

NHIS pays capitation for primary care and Fee-for-service upon referral through accredited HMOs to accredited Healthcare facilities

Waiting Period

There shall be a processing/waiting period of ninety (90) days before a participant can access health care services.

Scope of Coverage

  1. The contributions paid cover health care benefits for the employee, a spouse and four (4) biological children below the age of 18 years.
  2. More dependants or children above the age of 18 are covered on the payment of additional contributions by the principal beneficiary as determined by NHIS.
  3. Principals are entitled to register four (4) biological children each, however a spouse or a child cannot be registered twice.

TERTIARY INSTITUTION SOCIAL HEALTH INSURANCE PROGRAMME

The Tertiary Institutions Social Health Insurance Programme (TISHIP) is a social security system whereby the health care of students in tertiary institutions is paid for from funds pooled through the contributions of students. It is a programme committed to ensuring access to qualitative healthcare service for students of tertiary institutions thereby promoting the health of students with a view to creating conducive learning environment. It takes cognizance of the current practices and challenges faced by students in accessing care both during and out of session, as well as the potential of the current tertiary health facilities to maximize access to quality health care. Tertiary institutions are categorized as Universities, Colleges of Education, Polytechnics, Colleges of Agriculture, Monotechnics, Schools of Nursing, Midwifery, Health Technology and other Specialized Institutions.

The Purpose

The purpose of TISHIP is to cater for the health care needs of Nigerian students in tertiary institutions who due to their studentship status cannot benefit under other health insurance programmes.

This population constitutes a very large percentage of the country’s population. By virtue of their age and their status as students, most of them cannot benefit from the public sector programme as enrollees or dependants of enrollees. This necessitates a programme designed to meet their needs.

Providing students access to qualitative and affordable healthcare is not only imperative to the achievement of the presidential mandate which is to achieve universal coverage and access to healthcare services for all Nigerians and legal residents but also to the overall development of our nation.

The ultimate goal is to ensure the health and well-being of this critical population 9 with a view to creating a conducive learning environment and contributing to the overall development of the country

COMMUNITY-BASED SOCIAL HEALTH INSURANCE PROGRAMME

Based Social Health Insurance Programme is a non-profit making programme for a cohesive group of households/individuals or occupation-based groups. It was formed on the basis of the ethics of mutual aid and the collective pooling of health risks, in which members take part in its management.

Membership

This shall be voluntary and open to all residents (families) of the participating communities/occupation-based groups (including retirees). The family or individual members shall be the unit of registration. In order to achieve a critical pool of funds to ensure financial viability, as well as to address the problem of adverse selection, communities/occupation-based groups shall have at least 50% of members willing to participate (or a minimum of 1000 members).

Registration Procedure

Registration of enrollees shall be by technical facilitators or BOTs. Each programme shall have a clearly defined procedure for registering enrollees as well as a form of identification (such as membership card) to assist in the identification of scheme members.

Benefit Package

The benefit package shall reflect preventive, promotive and curative components of health care delivery. It shall aim at minimum primary and secondary curative care, taking into cognizance the prevailing local morbidity and mortality profile, including pre- & post-natal care, normal delivery, child welfare services (including immunization), family planning and health education services.

Contribution/Premium

This shall be actuarially determined flat rate fee per household/individual household member or member of an occupation based group and paid in cash monthly or seasonally in advance.

Donations

Project managers may seek for donations/grants by way of formal launching/fund-raising events, or by targeting individuals, governmental and Civil Society Organizations, including private companies, with the aim to boost the financial base of this scheme.

 

Vulnerable Group Social Health Insurance Programmes

Vulnerable Group Social Health Insurance Programmes are designed to provide health care services to persons who due to their physical status (including age) cannot engage in any meaningful economic activity.

They include the following:

 1.  Physically Challenged Persons Social Health Insurance Programme(PCPSHIP):- Physically Challenged Persons Social Health Insurance Programme is a programme designed to provide health care services to Physically/Mentally Challenged Persons who due to their physical status cannot engage in any meaningful economic activity.

Membership Physically/Mentally Challenged Persons will be covered under the programme

Contributions

The Federal, States, Local Governments, Development Partners and Civil Society Organizations will pay contributions in advance into the Vulnerable Group Fund.

2.  Prison Inmates Social Health Insurance Programme(PISHIP):- A programme designed to provide health care services to inmates of Nigeria Prisons and offending minors in Borstal Homes, who by virtue of their restriction, cannot engage in any activity to earn income.

Membership

  1. Convicts
  2. Awaiting trial (remanded in Prison custody).
  3. Offending Minors in Borstal Homes.

Contribution: –The Federal, States and Local Governments, Development Partners and Civil Society Organizations (CSOs) will pay contributions in advance into the Vulnerable Group Fund.

3.  Children Under Five (5) Social Health Insurance Programme (CUFSHIP):- Children under Five Social Health Insurance Programme (CUFSHIP) is a programme designed to cover the health needs of Children under the age of five (5) years across the country, who are considered vulnerable.

Membership:- Children under the age of five (5) years especially those whose parents are participating in Community Based Social Health Insurance Programme (CBSHIP).

Contributions;- The Federal, State, Local Government, Development Partners and Civil Society Organizations will pay contributions in advance into the Vulnerable Group Fund.

4.  Pregnant Women

5. Aged


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