FAQs

1: What is Social Health Insurance (SHI)?
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.

2: What is National Health insurance Scheme (NHIS)?

National health Insurance Scheme Is a body corporate established under Act 35 of 1999 by the Federal Government of Nigeria to improve the health of all Nigerians at an affordable cost.

3: 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.

4: How many members of my family are covered by my Contribution?
Contributor, spouse and four biological children under 18 years of age. However, extra dependant can be covered by payment of additional contribution.

5: Any special arrangement for contributors having more than one wife and four Children?
Any member of the family outside the allowable six can be registered as extra dependant

6: Can my child above 18 years benefit from my contribution?
No. However students in tertiary institution can be covered under the Tertiary institution and voluntary participants Social Health Insurance Programme. Children above 18 years of age and are not in Tertiary institution can be covered as extra dependants.

7: If I am single, can my relations benefit from my contributions?
No. However, spouses are entitled to only four (4) biological children.

8: If two working spouses both contribute, would there be rebate?
No. However spouses are entitled to only four (4) biological children.

9: Of what advantage is the programme to me?
Beneficiaries do not need cash to access treatment when required. Thus
problem of converting assets to cash especially in catastrophic illnesses can
be avoided. Furthermore, the benefit package is among the most Comprehensive in the world.

10: 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.

11: What happens to my contributions if for a long period my family members and I do not access care?
Payment to the primary provider is by capitation and that means that a certain amount is paid to your primary provider monthly in advance whether you utilized his services or not. Secondly like it was stated in question 7, the healthy subsidizes the sick so that the necessary pool of fund can be created. It will therefore not be possible to refund any monies or grant rebates to contributors.

12: What do I do if prescribed drugs are out of stock?
It is the responsibility of the pharmacy provider to make all prescribed drugs available to the beneficiary, even if it means sourcing it from other pharmacy providers. However, where necessary, the prescription may be changed to a close substitute by the prescriber where necessary.

13: Are illnesses like HIV/AIDS covered under the programme?
Associated opportunistic illnesses/diseases like diarrhea, tuberculosis etc are included in the benefit package. However, National Action Committee for AIDS (NACA) is handling supply of antiretroviral drugs.

14: Supposing I prefer a provider outside NHIS List of providers?
The beneficiary is only allowed to patronize NHIS-accredited providers to ensure high standard health care delivery within the system. Nevertheless, accreditation of providers is an on going exercise.

15: How do I change my provider in case of transfer to another town?
Contact your nearest NHIS office or HMO early enough. A list of providers in your new location will be given to you to choose from.

16: 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

17: What happens if life is lost through the negligence of a provider?
Arbitration Boards will be set up to address cases where parties are aggrieved. In addition, aggrieved party can seek redress in a court of law if he/she suffers injury/lost as the result of the providers professional negligence.

18: If I am living apart from my family how would I and my family access health care?
There is provision in the NHIS registration form for alternate primary provider in the case of participants that live in different locations.

19: 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 the location, who would later be reimbursed by the HMO covering the beneficiary's organization.

20: 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.

21: There are other funds to which workers are making compulsory contributions, would it not be overwhelming with the inclusion of NHIS?
Unlike these other programmes, the benefits of NHIS are immediate on the other hand unless one is healthy and lives long, one may not be able to utilize benefits of these other programmes

Health Tips

Avoid alcohol

Regular exercise

Eat balance diet

Adequate rest

Avoid stress

Avoid self medication

Regular medical checkup

 


 

NHIS VCSHIP

 


 

FCT CBHIS

 

 

 


 

 

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