The National Health Insurance Scheme (NHIS) was established in Nigeria in 1999 to provide access to affordable, quality healthcare services for all Nigerians. The scheme is a social health insurance program that provides a range of benefits to subscribers. In this article, we will explore what NHIS covers in Nigeria.
Introduction to NHIS
The NHIS is a government-run program that aims to provide affordable healthcare services to all Nigerians. It is open to all residents of Nigeria who are willing and able to pay the premiums. The scheme is funded through contributions from subscribers, the government, and other stakeholders.
Coverage under NHIS
The NHIS covers a wide range of medical services, including primary, secondary, and tertiary healthcare services. The coverage includes preventive, curative, and rehabilitative services. The services covered by the NHIS are divided into two main categories: the formal sector and the informal sector.
Formal Sectr
The formal sector refers to employees of the government, private sector, and other formal organizations. These employees are required to enroll in the NHIS as part of their employment benefits. The NHIS provides coverage for the following services to subscribers in the formal sector:
1. Outpatient care: This includes consultation with a doctor, laboratory tests, and medication.
2. Inpatient care: This includes hospitalization, surgery, and other medical procedures.
3. Maternity care: This includes antenatal care, delivery, and postnatal care.
4. Emergency care: This includes emergency medical care and ambulance services.
5. Dental care: This includes dental procedures and treatment.
6. Optical care: This includes eye examination and treatment.
Informal Sector
The informal sector refers to individuals who are not employed in the formal sector. The NHIS provides coverage for the following services to subscribers in the informal sector:
1. Outpatient care: This includes consultation with a doctor, laboratory tests, and medication.
2. Inpatient care: This includes hospitalization, surgery, and other medical procedures.
3. Maternity care: This includes antenatal care, delivery, and postnatal care.
4. Emergency care: This includes emergency medical care and ambulance services.
5. Dental care: This includes dental procedures and treatment.
6. Optical care: This includes eye examination and treatment.
7. Health promotion and disease prevention: This includes health education and immunization.
Exclusions under NHIS
While the NHIS covers a wide range of medical services, there are some exclusions that subscribers should be aware of. The following services are not covered by the NHIS:
1. Cosmetic surgery: This includes plastic surgery, liposuction, and breast augmentation.
2. Fertility treatment: This includes in vitro fertilization (IVF) and other fertility treatments.
3. Experimental treatments: This includes treatments that have not been proven to be effective.
4. Non-medical services: This includes services that are not related to healthcare, such as beauty treatments and massage therapy.
NHIS Enrollment
Enrolling in the National Health Insurance Scheme (NHIS) in Nigeria is a straightforward process. The NHIS is open to all residents of Nigeria who are willing and able to pay the premiums. Here is a breakdown of NHIS enrollment:
Step 1: Choose a Health Maintenance Organization (HMO)
The first step to enrolling in the NHIS is to choose a Health Maintenance Organization (HMO). HMOs are companies that provide healthcare services to NHIS subscribers. There are several HMOs in Nigeria, and they offer different packages and benefits. You can find a list of accredited HMOs on the NHIS website.
Step 2: Register with the HMO
Once you have chosen an HMO, the next step is to register with them. You will need to provide your personal information, such as your name, address, and date of birth. You will also need to provide your NHIS number, which will be assigned to you by the HMO. The NHIS number is a unique identifier that will be used to track your healthcare services.
Step 3: Pay the Premium
After registering with the HMO, you will be required to pay the premium. The premium is the amount of money that you will pay to the HMO to access healthcare services. The premium varies depending on the package and benefits that you choose. You can pay the premium annually, bi-annually, or quarterly, depending on your preference.
Step 4: Receive your NHIS card
After paying the premium, you will receive your NHIS card. The card is a proof of your enrollment in the NHIS. It contains your NHIS number, name, and other personal information. You will need to present your NHIS card at the healthcare facility to access healthcare services.
Step 5: Access Healthcare Services
Once you have received your NHIS card, you can start accessing healthcare services. You can visit any healthcare facility that is accredited by your HMO. The healthcare facility will verify your NHIS card and provide you with the necessary healthcare services.
Conclusion
The NHIS provides a range of benefits to subscribers in Nigeria. It covers a wide range of medical services, including primary, secondary, and tertiary healthcare services. The coverage includes preventive, curative, and rehabilitative services. The NHIS is divided into two main categories: the formal sector and the informal sector. While the NHIS covers a wide range of medical services, there are some exclusions that subscribers should be aware of.