THE BENEFITS OF THE NATIONAL HEALTH INSURANCE SCHEME (NHIS) IN NIGERIA.

THE BENEFITS OF THE NATIONAL HEALTH INSURANCE SCHEME (NHIS) IN NIGERIA.

Health Insurance is basically, a social security system that guarantees the provision of needed health services to persons on the payment of token contributions at regular intervals, where the insured pays costs out-of-pocket and is then reimbursed by the insurer, or the insurer makes payments directly to the provider, all depending on the type of health insurance coverage the individual is under. It is worth noting that, under health insurance, the “provider” is a clinic, hospital, doctor, laboratory, health care practitioner, or pharmacy, the “insurer” is the third party organization that provides the framework for the insurance program to hold while the “insured” is the owner of the health insurance policy; the person or dependent (s) with the health insurance coverage. 

Health insurance embodies Health security which over the years has become a point of concern, for individuals, families, local governments, states, countries, nations as well as international bodies like World Health Organization (WHO) running Global Health Security Programs, United Nations (UN) who have seventeen Sustainable Development Goals (SDGs) of which number 3 is “Ensure healthy lives and promote well-being for all at all ages” which boils down to health security. This write-up wishes to sensitize the public on what NATIONAL HEALTH INSURANCE SCHEME (NHIS) is all about and the benefits accrued to being part of the scheme.

 

The National Health Insurance Scheme (NHIS) took off in the year 2005 and is a corporate body established under Act 35 of 1999 Constitution by the Federal Government of Nigeria to improve the health of all Nigerians at an affordable cost through various prepayment systems. The Scheme established under Act 35 of 1999 by the Federal Government of Nigeria, is aimed at providing easy access to healthcare for all Nigerians at an affordable cost through various prepayment systems.

The vision statement of NHIS is “to be a strong, dynamic and responsive National Health Insurance Scheme that is totally committed to securing universal coverage and access to adequate and affordable healthcare; in order to improve the health status of Nigerians, especially for those participating in the various Programs/products of the Scheme.” Her mission statement is “to facilitate fair-financing of healthcare costs through pooling and judicious utilization of financial resources to provide financial risk protections and cost-burden sharing for people, against high cost of healthcare, through various prepayment Programs/products prior to their falling ill. This is in addition to providing regulatory oversight to Health Maintenance Organizations (HMOs) and participating Healthcare Providers.” NHIS Operational Guideline 2005.

The National Health Insurance Scheme (NHIS) has a well-planned Program for every Nigeria to benefit. The various Program are:

1. Formal Sector Social Health Insurance Program which is a health insurance Program for employees in the public sector and organized private sectors (OPS). OPS is a private company that has 10 staff and above. Formal sector covers staff, spouse and four biological children.
2. Voluntary Contributors’ Social Health Insurance Program (VCSHIP) is for individuals who do not work in formal sector or who do not belong to a community of tertiary institutions that is covered under NHIS. Its cost is 15,000 yearly in bank draft in favour of national health insurance scheme. VCSHIP is gradually phasing out giving way for the NMHIP (National Mobile Health Insurance Program) which is inconjunction with the mobile communication industry like MTN.
3. Tertiary Social Health Insurance Program is for students in tertiary institutions.
4. Community Based Social Health Insurance Program is for community’s such as villages, market people, and groups with a member of 1000 people and above.
5. Pupil in Public Primary School Social Health Insurance Program for pupil in

public primary school.

It is worthy to note that there are three levels of care in NHIS:

1. Primary health care providers – they act as first point of contact and gate keepers.
2. Secondary health care providers – contact with them is through referrals via primary provider.
3. Tertiary health care providers – entry is through referrals via primary and/or secondary providers.

 

You may ask, why is it important for every Nigerian to be covered by Health Insurance? First and foremost, the scheme is geared towards reducing out-of-pocket expenditure. A lot of people, at the time they need health care, pay a lot of money at service delivery points which is one of the things health insurance is trying to take care of so that Nigerians can actually equate the risk and payment involved in their healthcare management. The whole idea of the NHIS is to be able to pool the risk together and funds together for it to be used to take care of every Nigerian when they need health care so that people will not need to pay at the point of service. This is the whole essence of health insurance in Nigeria.

The following are the Benefits Nigerians stand to get from the NHIS package;

1. Receive Out-patient care or treatment (that is, treatment that does not require an overnight stay in a hospital or medical facility), including necessary drugs, injection, dripe.
2. Receive prescribed drugs, pharmaceutical cares as well as diagnostic tests.
3. Receive maternity care for up to four (4) live births for every insured contributor/couple in the formal sector Program. Additional care is also available if any stillbirth occurs.
4. All live births requiring covering or incubation will be incubated appropriately during the post-natal period of twelve (12) weeks from the date of delivery.
5. All preterm/prematured babies eligible for covering or incubation shall be covered for twelve (12) weeks from the date of delivery.
6. Preventive care including immunisation as it applies in the National immunisation

Program, Health education, Family planning (counseling), antenatal and post-natal

care, as well as adult immunisation against Human papillomavirus (HPV) and hepatitis.

7. Consultation with specialist such as physicans, pediatrics, obstetricans,

gynecologists, general surgeons, orthopedic surgeon, ENT, dental surgeons, radiologists, psychiatrics, ophthamologists and physiotherapists, etc.

8. Hospital care in a standard ward for a cumulative limited stay of 21days per year.
9. Eye examination and care, the provision of low priced spectacles but excluding contact lenses.
10. All ophthalmological cases that can be handled at the primary level except those requiring tertiary care or on the exclusion list.
11. A range of prostheses (limited to artificial limbs produced in Nigeria).
12. Preventive dental care and pain relief (including consultation, dental Health education, amalgam filling and simple extraction).
13. Root-canal treatment, a treatment is needed when an injury or a large cavity damages the tooth’s root (maximum of two treatments).

 

Considering these benefits accruing to individuals who are part of the National Health Insurance Scheme (NHIS), I hereby call on all Nigerians to identify and subscribe to any of the program package suitable to them. Always remember, your health is your wealth and only a healthy man can achieve his or her set goals.

 

WRITTEN BY SILAS OJOAROME AMEH