Health insurance is obtained either through private insurers or the National Health Insurance Scheme (NHIS). About 5 million people are enrolled in the 3 NHIS Programs, which represents just about 3% of the population. In the Formal Sector Program, employees in the formal sector who pay premiums are covered, in addition to their spouse and up to 4 dependants. Companies that employ more than 10 workers are responsible for enrollment of their employees.
The benefits package for the National Health Insurance Scheme for workers in the formal sector is pre-determined and includes:
- Out-patient care, including necessary consumables
- Prescribed drugs, pharmaceutical care and diagnostic tests on the National
- Essential Drugs List and Diagnostic Test Lists
- Maternity care for up to 4 live births for every insured contributor
- Preventive care, including immunization, health education, family planning, antenatal and post-natal care
- Consultation with specialists with a referral
- Hospital in-patient care in a standard ward for a 15 cumulative days per year
- Eye examination and care, excluding the provision of spectacles and contact lenses
- A range of prostheses (limited to artificial limbs produced in Nigeria)
- Preventive dental care and pain relief (including consultation, dental health education, amalgam filling, and simple extraction)
Patients are allowed to choose their primary provider from the list of accredited facilities, which includes both public and private providers. The provider network is used for access and secondary referrals, which acts to control costs and maintain viability of the system. Provider payment mechanisms are primarily determined by the National Health Insurance System (NHIS) Governing Council.
NHIS is funded primarily by contributions from members based on income. For the Formal Sector Social Health Insurance Program contributions are premiums that make up 15% of an individual’s basic salary, with the employer contributing 10% while the employee pays 5% for coverage of themselves, their spouse, and up to 4 children. Participants in the Informal Sector Program are expected to make a monthly contribution based on the benefits package of their choice as well as other factors. The poor, elderly, veterans, and disabled are exempted from paying membership premiums.