National Health Insurance Scheme in Nigeria (NHIS)

The National Health Insurance Scheme in Nigeria (NHIS) is a program that aims to ensure access to affordable healthcare for all citizens.

The establishment of the organization in 2005 aimed to enhance the country’s healthcare system and alleviate the financial burden of out-of-pocket healthcare expenses for individuals and households.

Under the NHIS, eligible individuals and families can enroll in a health insurance plan and receive coverage for various medical services, including hospitalization, diagnostic testing, and preventive care.

Furthermore, the NHIS receives funding through government subsidies and premiums paid by enrollees.

However, one of the main goals of the NHIS is to increase access to healthcare in rural and underserved areas of the country.

To achieve this, the NHIS has partnered with private and public healthcare providers to establish a network of facilities where enrollees can receive treatment.

Furthermore, despite its noble intentions, the NHIS has faced numerous challenges since its inception.

However, these include issues with funding, corruption, and inadequate coverage for specific medical conditions.

Despite these challenges, the NHIS remains an important component of Nigeria’s healthcare system and efforts are ongoing to improve its effectiveness and reach.

Objectives of National Health Insurance Scheme in Nigeria

• Making sure healthcare services are efficient
• Limiting the rise in the cost of healthcare services
• For appropriate patronage of all levels of healthcare
• To make available funds to the health sector for improved services
• Be sure that every Nigerian has access to good healthcare services
• Maintaining high standards of health care delivery services within the Scheme
• Ensuring equitable distribution of health care costs among different income groups
• Improving and harnessing private sector participation in the provision of healthcare services
• Protecting families from the financial hardship of huge medical bills
• To ensure equitable distribution of health facilities within the Federation

Programs of National Health Insurance Scheme in Nigeria

To ensure that every Nigerian has access to good healthcare services, the Nigeria Health Insurance Scheme has developed various programs to cover different segments of society, and these include:

1. Formal Sector

I. Formal Sector Social Health Insurance Programme

The Formal Sector Social Health Insurance Programme is a social health security system that utilizes funds generated by pooling the contributions of employees and employers to provide healthcare for employees in the Formal Sector.

The Formal Sector consists of the following:

• Public Sector
• Organized Private Sector
• 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. 

Registration

Anyone who falls under this category has nothing much to do because employers will have to register their employees.

However, the system will deduct 5% of your salary at the end of each month for the benefit of you and your family.

II. The National Mobile Health Insurance

This is another Program that is a social health plan/affordable health insurance product that allows mobile network subscribers to enjoy social health insurance coverage underwritten by accredited Health Management Organizations (HMOs) with services provided by NHIS-accredited healthcare providers across the country.

MEMBERSHIP

Nigerians or legal residents above 18 years that have a registered GSM telephone line from any of the Mobile Network Operators (MNOs).

Furthermore, Parents/guardians may enroll Nigerians/legal residents below the age of 18 years as adoptees.

BENEFITS

This unique IT-driven program takes advantage of the high teledensity in the country and allows Nigerians to subscribe to a health insurance package using their mobile phone.

The IT platform allows a subscriber to enroll, select HMO & healthcare providers, and make a premium payment, etc, with unparalleled ease.

Another unique feature of this program is that it offers flexibility in premium payment.

You can pay premiums upfront annually, monthly, weekly, or daily using airtime, Tailored Product Vouchers (TPV), and other electronic payment channels.

REGISTRATION PROCEDURE

Basically, to initiate the enrollment process, dial *616# on any mobile network using your mobile phone.

This action will activate the USSD menu which will take you through the entire process and allow you to input your biodata,

Also, select the Health Management Organization (HMO) & healthcare facility of your choice, as well as the periodic schedule of payment.

The successful completion of enrollment is confirmed by issuing an e-ID, which is then sent through an SMS to the phone used during registration.

Although the unit of enrollment under the NMHIP is individual, an enrollee may register an unlimited number of individuals as adopted defendants.

III. Voluntary Contributors Social Health Insurance Programmes (VCSHIP)

Willing individuals or employers on behalf of employees in organizations with less than ten staff can opt for this health insurance, taking it up and paying for it at their discretion.

Additionally, this program is designed for individuals who are not currently covered by any of the NHIS programs.

This program will provide full or partial coverage for services that the statutory health system excludes or does not fully cover. 

Social Health Insurance premiums are not risk-related, and voluntary contributors can access healthcare only upon providing proof of contribution.

Family members of persons voluntarily insured in Nigeria’s social health insurance scheme are not covered as co-insured.

The Enabling law establishing the Scheme and the Operational Guidelines of NHIS refers to these groups of people as:

The OPS program does not categorize many financially viable Nigerian businessmen and women, who have a staff strength of less than ten, leaving them uncovered.

An active self-employed individual not covered and categorized under CBSHIP but willing to participate in the program.
Retirees who wish to continue under NHIS Formal Sector Programme
Political office holders, Foreigners living in Nigeria (legal residents), etc.

Membership

Membership shall be voluntary and shall cover interested individuals, families, and employers of establishments with less than ten staff.

Actively self-employed persons, political office holders at three tiers of government.

Also retirees not currently covered by any of the NHIS prepaid programs.  Others are foreigners to Nigeria or persons with temporary residency status and Nigerians in Diaspora.

2. Informal Sector

The Informal sector consists of

I. Tertiary Institution Social Health Insurance Programmes

The Tertiary Institutions Social Health Insurance Programme (TISHIP) is a social security system in which students’ healthcare is funded.

However, the program is dedicated to ensuring access to quality healthcare services for students of tertiary institutions.

Thereby promoting the health of students and creating a conducive learning environment.

Also, it takes cognizance of the current practices and challenges faced by students in accessing care both during and out of session.

And as well as the potential of the current tertiary health facilities to maximize access to quality health care.

In addition, we categorize tertiary institutions as universities, colleges of education, polytechnics, colleges of agriculture, mono-technics, schools of nursing, midwifery, health technology, and other specialized institutions.

II. Community-Based Social Health Insurance Programmes

A Community-Based Social Health Insurance Programme is a non-profit making program for a cohesive group of households/individuals or occupation-based groups.

It was formed based on the ethics of mutual aid and the collective pooling of health risks, with members actively participating 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.

However, 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 program shall have a clearly defined procedure for registering enrollees.

Also as a form of identification (such as a membership card) to assist in the identification of scheme members. 

III. Public Private Partnership Social Health Insurance Programmes

3. Vulnerable Group

Vulnerable Group Social Health Insurance Programmes are designed to offer healthcare services to individuals.

I mean those who, due to their physical status (including age), are unable to engage in any meaningful economic activity.

They include the following:

1. Physically Challenged Persons Social Health Insurance Programme(PCPSHIP)
   It is a program designed to offer healthcare services to Physically/Mentally Challenged Persons who, due to their physical status, are unable to engage in any meaningful economic activity.
   
2. Prison Inmates Social Health Insurance Programme(PISHIP)
   A program designed to provide health care services to inmates of Nigeria Prisons and offending minors in Borstal Homes, who by their restriction, cannot engage in any activity to earn income.
   
3. The Children Under Five (5) Social Health Insurance Programme (CUFSHIP)
   It is a program specifically designed to provide health coverage for children under the age of five (5) years nationwide, as they are considered vulnerable.
   
4. Pregnant Women
5. Retirees
6. Aged

How to register for National Health Insurance Scheme in Nigeria

Log on to their website HERE locate the registration area and fill in the required fields.

However, please use a computer rather than a phone, as research has shown that using phones can lead to errors.

However, you can fill out your form and that of other people you wish to enroll. After that, submit the form and print it out too.

Furthermore, from the website look for the office nearest to you. They have offices in all States of the federation. They have more than one office in Lagos. Copy out the address and decide on the day to visit.

Do go with the printed form, 4 passports of each person you wish to enroll, and the sum of # 15,000.

They will complete the registration process for you. You will also be shown a list of hospitals near you to choose as your service providers.

Do consider proximity, efficiency, and if it is a multi-specialist hospital. That way, you won’t waste time and money on a referral when the need arises.

Remember, you are to continue with your assigned health provider for one year. In certain circumstances, you may apply for another provider, but the change may not come easy or at all.

Conclusion National Health Insurance Scheme in Nigeria

The National Health Insurance Scheme (NHIS) in Nigeria has the potential to be a valuable resource for providing access to affordable healthcare for all citizens.

However, the program has faced numerous challenges since its inception,

This includs issues with funding, corruption, and inadequate coverage for specific medical conditions.

Despite these challenges, the NHIS remains an important component of Nigeria’s healthcare system and efforts are ongoing to improve its effectiveness and reach.

To improve the NHIS, it may be necessary to address the underlying issues that have hindered its effectiveness, such as corruption and inadequate funding.

In addition, there may be a need to increase the transparency and accountability of the program to ensure that enrollees are getting the coverage they need.

Overall, the NHIS has the potential to play a significant role in improving the healthcare system in Nigeria and increasing access to quality care for all citizens.

By addressing the challenges facing the program and working to improve its effectiveness.

Furthermore, it may be possible to create a healthcare system that truly serves the needs of all Nigerians.

FAQs on National Health Insurance Scheme in Nigeria

1. What is the National Health Insurance Scheme (NHIS), and what does it aim to achieve?
   • The NHIS is a program designed by the Nigerian government to provide accessible and affordable healthcare services to citizens. Its primary goal is to ensure universal health coverage and protect individuals from financial hardship due to healthcare expenses.
     
2. Who is eligible to benefit from the NHIS, and how does one enroll?
   • Eligibility for NHIS coverage includes employees in the formal sector, informal sector workers, children under certain age brackets, retirees, and their dependents. Enrollment can be done through accredited health maintenance organizations (HMOs) or NHIS offices.
     
3. What healthcare services are covered by the NHIS?
   • The NHIS covers a range of healthcare services, including consultations, hospitalization, surgeries, maternity care, preventive care, and treatment of common illnesses. The coverage varies across different NHIS plans.
     
4. What are the key challenges facing the NHIS, and how is the government addressing them?
   • Challenges include limited coverage in rural areas, inadequate funding, quality control issues, and difficulties in achieving widespread enrollment. Efforts are ongoing to address these challenges through increased funding, expanded coverage, and improved service delivery.
     
5. How does the NHIS benefit Nigerians and the healthcare system?
   • The NHIS benefits citizens by providing access to essential healthcare services without financial strain. It also supports the healthcare system by reducing out-of-pocket expenses, improving healthcare infrastructure, and promoting preventive care, ultimately leading to a healthier population.