NHIS Operational Guidelines: The Children Under Five Social Health Insurance Programme (CUFSHIP)

According to CUFSHIP, all Nigerian children under five years of age can receive free medical care to cover the major causes of death. If your child is suffering from malaria, diarrhoea, respiratory tract infection, pneumonia, measles, skin infections, domestic accidents or typhoid you are entitled to get medical help for free. Immunization and hospital care expenses are also included under CUFSHIP.

NHIS Operational Guidelines: HMO Responsibilities

HMO stands for Health Maintenance Organization. In an HMO health insurance plan, policyholders consult their Primary Care Physican (PCP) first in the event of a medical problem. If the PCP determines that the help of a specialist is needed, he schedules an appointment for the patient. Under NHIS, HMOs must ensure that policyholders understand their benefits. They must also recommend specialist advice when necessary and fully disclose all exclusions or restrictions on coverage that may exist in the contract. HMOs are prohibited from imposing hidden charges. Additionally, HMOs may not prevent PCPs from helping their patients get the coverage that they are entitled to under the plan.

NHIS Operational Guidelines: Private sector healthcare obligations

In Nigeria, all business that have 10 employees or more must offer healthcare. The employer must pay for at least 10% of the coverage cost. The employee is only responsible for contributing no more than 5% of the cost. The rest of the cost of healthcare is paid for by the government. If you are paying for more than 5% of your healthcare cost, contact the NHIS and report your employer.

NHIS Operational Guidelines: NHIS member rights

Once you enroll in the NHIS, you can choose to change your primary healthcare facility after six months if you are unsatisfied with the service. Once you are fully enrolled and registered, you have a right to receive medical care. You can also add up to 4 dependents to your plan. If you have more than 4 dependents, you can add more if you agree to pay a fee.

NHIS Operational Guidelines: Responsibilities of NHIS healthcare facilities

All NHIS healthcare facilities must secure a NHIS accreditation and provide services in accordance with HMO benefit packages. Also, all NHIS facilities must provide data to the NHIS and ensure patient satisfaction. Any complaints from NHIS enrolled patients must be forwarded to the NHIS for review.

NHIS Operational Guidelines: Penalties

If a NHIS accredited hospital refuses to treat a NHIS enrolled patient, the facility will be issued a fine of no less than N100,000 along with a warning and a suspension of no less than 3 months. Similarly, if an employee of a NHIS accredited hospital charges any extra fees for health services, all money must be refunded to the enrollee and the hospital will be fined no less than N100,000.