NHIS Operational Guidelines

What is NHIS in Nigeria?

The National Health Insurance Scheme (NHIS) in Nigeria was introduced in 2005 to ensure universal access to good health care services, by protecting families from financial barriers to health care, and ensuring availability of funds to the health sector for improved services.

 

What are the objectives of national health insurance scheme?
To protect families from the financial hardship of huge medical bills. To limit the rise in the cost of health care services. To ensure equitable distribution of health care costs among different income groups. To maintain high standards of health care delivery services within the Scheme. NHIS was set up  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. The amount/funds are pooled, allowing the Health Maintenance Organisations(HMOs) to pay for those needing medical attention.

 

How do I apply for NHIS?

Contact the district office or NHIS agent in your community. Fill a replacement form and pay the processing fee where applicable. You will be issued with a new ID card.

 

How much does Health Insurance cost in Nigeria?

According to reports, registration of dependants (Children and Parents) typically cost around N9,000 per head. For private health care service, individual plans start from N35,000 to N220,000 and family plans range from N125,000 to N650,000

 

Does NHIS cover surgery?

Appliances and prosthesis including optical aids, hearing aids, orthopaedic aids and dentures. Cosmetic surgeries and aesthetic treatment are covered. However, reconstructive surgery, such as is performed on burns patients, is covered.

 

Does NHIS cover fibroid surgery?

Myomectomy (fibroid removal) is the surgical removal of fibroids from the uterus. Women who undergo myomectomy report improvement in fibroid symptoms, including heavy menstrual bleeding and pelvic pressure. Treatment of this condition is covered by NHIS.

 

NHIS Operational Guidelines

 

The Children Under Five Social Health Insurance Programme (CUFSHIP)

According to CUFSHIP, all Nigerian children under five years of age can receive free medical care to cover the major causes of death. If your child is suffering from malaria, diarrhoea, respiratory tract infection, pneumonia, measles, skin infections, domestic accidents or typhoid you are entitled to get medical help for free. Immunization in Nigeria and hospital care expenses are also included under CUFSHIP.

 

NHIS Operational Guidelines: HMO Responsibilities

HMO stands for Health Maintenance Organization. In an HMO health insurance plan, policyholders consult their Primary Care Physican (PCP) first in the event of a medical problem. If the PCP determines that the help of a specialist is needed, he schedules an appointment for the patient. Under NHIS, HMOs must ensure that policyholders understand their benefits. They must also recommend specialist advice when necessary and fully disclose all exclusions or restrictions on coverage that may exist in the contract. HMOs are prohibited from imposing hidden charges. Additionally, HMOs may not prevent PCPs from helping their patients get the coverage that they are entitled to under the plan.

 

NHIS Operational Guidelines: Private sector healthcare obligations

In Nigeria, all business that have 10 employees or more must offer healthcare. The employer must pay for at least 10% of the coverage cost. The employee is only responsible for contributing no more than 5% of the cost. The rest of the cost of healthcare is paid for by the government. If you are paying for more than 5% of your healthcare cost, contact the NHIS and report your employer.

 

NHIS Operational Guidelines: NHIS member rights

Once you enroll in the NHIS, you can choose to change your primary healthcare facility after six months if you are unsatisfied with the service. Once you are fully enrolled and registered, you have a right to receive medical care. You can also add up to 4 dependents to your plan. If you have more than 4 dependents, you can add more if you agree to pay a fee.

 

NHIS Operational Guidelines: Responsibilities of NHIS healthcare facilities

All NHIS healthcare facilities must secure a NHIS accreditation and provide services in accordance with HMO benefit packages. Also, all NHIS facilities must provide data to the NHIS and ensure patient satisfaction. Any complaints from NHIS enrolled patients must be forwarded to the NHIS for review.

 

NHIS Operational Guidelines: Penalties

If a NHIS accredited hospital refuses to treat a NHIS enrolled patient, the facility will be issued a fine of no less than N100,000 along with a warning and a suspension of no less than 3 months. Similarly, if an employee of a NHIS accredited hospital charges any extra fees for health services, all money must be refunded to the enrollee and the hospital will be fined no less than N100,000.  SEE : Full Copy of the National Health Insurance Scheme (NHIS) Operational Guidelines – Revd. Oct 2012

National Health Insurance Scheme (NHIS) Operational Guidelines – Revd. Oct2012 (1)

 

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