handbook nhis.pdf

7/27/2019 handbook nhis.pdf

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N A T

I

O N A

L H E A

L T H IN S U R A N C E

S C H E

M E

THE NATIONAL HEALTH INSURANCE SCHEME

HANDBOOK


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CONTENTS Page

1. Introduction 2

2. The Need for the Scheme 2

3. The Objectives of the Scheme 2

4. Classification of NHIS Programmes 2

5. Stakeholders in the NHIS 7

6. NHIS Offices 8

7. Additional Information 8


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4.3.2. Contributions

This will be in cash, paid as a flat monthly rate or instalmentally by participants.This contribution rate will depend on the health package chosen by members of theUser Group.

4.3.3 Administration A seven-member Board of Trustees, elected from among the members, i.e., Chairman,Secretary, Treasurer and four others, will manage the funds and run the User Group

formed.

4.3.4 How The Programme Works A prospective participant must be a member of a community. The individuals of thecommunity come together to form a User Group. There must be a membership of at least 500 participants for each User Group to ensure adequate pooling of resources.

The User Group will elect its Board of Trustees which will administer it, and set upQuality Assurance and Health Education Committees.

Each contributor will be given an identity card with which he/she will obtain healthcare from the chosen Health Care Provider (public or private), after a specifiedwaiting period.

4.4 Children Under-Five Social Health Insurance Programme

This programme is designed for children under the age of five years, nationwide.

4.4.1 Health Care Benefits

The children will benefit from a health care package covering common childhoodillnesses.

4.4.2. Contributions The contributions will be fully paid by the Federal Government.

4.4.3 Administration The National Health Insurance Scheme, using public and private health facilities thmeet NHIS standards, will directly administer the Programme.

4.4.4 How The Programme Works A child under the age five years will be registered and issued an identity card,which will be presented to a designated Health Care Provider whenever the child ill. The NHIS will be responsible for paying the Health Care Provider for servirendered.

4.5 Permanently Disabled Persons Social Health Insurance ProgrammeThis is a programme designed to provide health security for permanently disablepersons in the Nigerian society who, due to their disability, cannot engage in anyeconomically productive activity.

4.5.1 Health Care Benefits The health care benefits cover common illnesses.

4.5.2. Contributions The contribution will be fully paid by the Federal Government.

4.5.3 Administration The National Health Insurance Scheme, using private and public health facilities thmeet NHIS standards, will directly administer the Programme.

4.5.4 How The Programme Works


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Maintenance of quality assurance in the delivery of healthcare benefits inthe Formal Sector Social Health Insurance Programme.

Note: All HMOs must be insured with NHIS-approved nsurance companies.

f. Board Of Trustees (BOTs) Participants in the Urban Self-employed and the Rural Community SocialHealth Insurance Programmes, through their elected Boards of Trustees,plan, run and manage their own health care, thereby engendering a sense

of ownership and true community participation.

g. Health Care Providers A Health Care Provider as provided for in theNHIS Act , is a licensedgovernment or private health care practitioner or facility, registered by theScheme for the provision of prescribed health benefits to contributors andtheir dependants. Health Care Providers can either be Primary, Secondary,or Tertiary.

i. Primary Health Care Providers Primary Health Care Providers will serve as the first contact withinthe health care system, and they include:

Private clinics/hospitals; Primary Health Care Centres; Nursing and Maternity homes; and Out-patient departments of General Hospitals, Out-patient

departments of the Armed Forces, the Police and otheruniformed services, University Medical Centres and FederalStaff Clinics

ii. Secondary and Tertiary Health Care Providers (Fee-for-serv providers) These include:

General hospitals (Out-patient and in-patient care for medical,surgical, paediatric, obstetric gynaecological patients, etc)

Specialist hospitals Pharmacies Laboratories Dental Clinics

Physiotherapy clinics Radiography, etc

Note: All Health Care Providers are required to take malpracticeinsurance (professional indemnity) with NHIS approved insuranccompanies.

h. Other Stakeholders i. International Organizations and Collaborating Partners Their role includes the provision of technical and financial support toensure the successful implementation of the Scheme, especially among thurban self-employed, rural communities, permanently disabled personchildren under-five tertiary institutions and voluntary contributors.

ii. Non-Governmental Organizations (NGOs )These organizations will assist in the areas of sensitization and massmobilization to ensure adequate participation.

iii. Community Leaders They will assist in community mobilization and coordination.


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iv. The Media The media will assist in sensitization, assist health providers to disseminate

knowledge of the Scheme and guarantee mass participation.

v. Banks Banks responsibilities under the Scheme include:

a) Take custody of all the funds accruing to the HMOs affiliated to it;b) Ensure the safety of all funds for the operation of the programme;c) Provide on request, by the NHIS, information on the accounts of an

HMO with the knowledge of the HMOd) Forward monthly statement of accounts of the HMOs on authorization

by the HMOs to the NHIS.

vi. Insurance Companies Insurance companies are to provide cover (malpractice and indemnityinsurance) for Health Maintenance Organizations (HMOs) in the Scheme.

vii. Insurance Brokers To coordinate and ensure that HMOs and healthcare providers take upindemnity insurance cover. NHIS accredited Insurance Brokers willmonitor and ensure compliance by accredited HMOs, healthcare providersand the insurance companies.

ix. Professional bodies Professional bodies will assist in sensitization and mobilization of healthprofessionals, as well guarantee their participation.

6. NHIS Offices:

Headquarters OfficeThe Headquarters of the National Health Insurance Scheme is located at

Plot No. 347F, Custom Close, off Adetokunbo Ademola Crescent, Wuse Abuja.

Zonal Offices:

Kaduna: No. 2, Waziri Drive, off Alkali Road, Kaduna.Enugu: 23, Umuoji Street, Independence Layout, Enugu.Lagos: Plot 314A, Akin Ogunlewe Street, off Ligali Ayorinde Street,

Victoria Island, Lagos.Ilorin: Block B, Commercial Complex, Opposite Kwara Hotel, Ahmadu

Bello Way, Ilorin.Benin: No. 21, Liberty Road (Now Tony Anenih Avenue), GRA, Benin

City.Ibadan: 15A, Paul Hendrickse Road (Tolulope Walls), New Bodija Estate

Ibadan.

Maiduguri: No. 3, Shehu Laminu Way, Main GRA, Maiduguri

7. Additional Information

For further enquiries, please contact:

Head, Public Enlightenment and Mobilization Unit,Office of the Executive SecretaryNational Health Insurance Scheme, Plot No. 347F, Custom Close, ofAdetokunbo Ademola Crescent, Wuse II, Abuja.

Telephone No: +234-9-4130027, 4130028Fax No: +234-9-4130026Web site: www.nhis.gov.ng

Documents

handbook nhis.pdf