HOW DOES A BENEFICIARY WHO FALLS ILL OUTSIDE HIS/HER STATION GET TREATED?
Such a beneficiary can access care from any NHIS accredited provider in location, who would later be reimbursed by the HMO covering the beneficiary’s organization.
IF I AM LIVING APART FROM MY FAMILY HOW WOULD I AND MY FAMILY ACCESS HEALTH?
There is provision on the NHIS registration form for alternate primary provider in the case of participants that live apart from their families.
HOW DO I CHANGE MY PROVIDER IN CASE OF TRANSFER TO ANOTHER TOWN?
Contact your nearest NHIS OFFICE or HMO. A list of providers in your new location will be given to you to choose from.
ARE ILLNESSES LIKE HIV/AIDS COVERED UNDER THE PROGRAMME?
No. Associated opportunistic illnesses/diseases like diarrhoea, tuberculosis etc are included in the benefit package. However, National Action Committee for AIDS (NACA) is handling supply of antiretroviral drugs.
IS THERE A LIMIT TO THE MEDICAL BILLS THAT NHIS WILL PAY?
No limit, as long as the care is within the provision of the benefit package.
IF I AM SINGLE, CAN MY RELATIVE BENEFIT FROM MY CONTRIBUTIONS?
Yes. Your relatives can benefit as extra dependants on payment of extra premium.
ANY SPECIAL ARRANGEMENT FOR CONTRIBUTORS HAVING MORE THAN ONE WIFE AND FOUR CHILDREN?
Yes. Any member of the family outside the allowable six can be registered as extra dependant.
WHAT IS AN HMO?
An HMO means Health Maintenance Organization. It can be considered as a midwife in the implementation of National Health Insurance Scheme (NHIS).
WHAT IS NATIONAL HEALTH INSURANCE SCHEME (NHIS)?
National Health Insurance Scheme is a Corporate Body established under Act 35 of 1999 by the Federal Government of Nigeria to improve the Health of all Nigerians at an affordable cost.
WOULD A BENEFICIARY CONTINUE TO ACCESS SERVICE AFTER RETIREMENT?
NHIS has different programmes targeted at various groups such as rural community, Urban self – employed, and the voluntary contributors in which retirees can participate.
WHAT HAPPENS IF LIFE IS LOST THROUGH THE NEGLIGENCE OF A PROVIDER?
Arbitration Boards will be set up to address cases where parties were aggrieved. In addition, aggrieved party can seek redress in a court of law if he/she suffers injury/loss as a result of the provider’s professional negligence.
IF I AM NOT SATISFIED WITH THE SERVICES OF THE PROVIDER WHO DO I COMPLAIN TO?
You can lodge complaints with nearest NHIS office or report to your health maintenance organization. Nevertheless if you are still not satisfied you can change your provider after six months.
SUPPOSING I PREFER A PROVIDER OUTSIDE NHIS LIST OF PROVIDERS?
The beneficiary is only allowed to patronizes NHIS accredited providers to ensure high standard health care delivery within the system. Nevertheless, accreditation of providers is an on-going exercise
WHAT HAPPENS TO MY CONTRIBUTIONS IF MY FAMILY MEMBERS AND I DO NOT ACCESS CARE OVER A LONG PERIOD OF TIME?
Payment to the primary provider is by capitation and that means that a certain amount is paid to your primary provider montly in advance whether you utilize his service or not. Also, the healthy subsidize the sick; hence the necessary pool of funds is created. It will therefore not be possible to refund any monies or grant rebates to contributors.
CAN MY CHILD ABOVE 18 YEARS BENEFIT FROM MY CONTRIBUTION?
No. However students in tertiary institution can be covered under Tertiary institution and voluntary participants Social Health Insurance Programme. Children above 18 years of age that are not in Tertiary institution can be covered as extra dependants.
WHAT IS THE ADVANTAGE OF THIS PROGRAMME TO ME?
Beneficiaries do not need cash to access treatment when required. Thus the problem of converting assets to cash especially in catastrophic illenesses can be avoided. Furthermore, the benefits package is among the most comprehensive in the world.
HOW MANY MEMBERS OF MY FAMILY ARE COVERED BY MY CONTRIBUTION?
The contributor, spouse and four biological children under the age of 18 years. However, extra dependant (s) can be covered by payment of additional contribution.
WHAT IS FORMAL SECTOR HEALTH INSURANCE PROGRAMME?
It is the social health insurance programme for employees of the Public and organized private sector employing ten (10) or more persons. However, extra dependants can be covered by payment of additional contribution.
WHAT IS SOCIAL HEALTH INSURANCE?
Social Health Insurance is a Social Security System that guarantees the provision of a Benefit Package of Health Care Services paid from funds created by pooling the contributions of participants.