SSANIPOST

National Health Insurance Scheme

THE OBJECTIVES OF THE SCHEME:

1.     ensure that every Nigerian has access to good health care services.

2.     protect families from the financial hardship of huge medical bills.

3.     limit the rise in the cost of health care services

4.     ensure equitable distribution of health care costs among different income groups.

5.     maintain high standard of health care delivery services within the Scheme.

6.     ensure efficiency in health care services.

7.     improve and harness private sector participation in the provision of health care services.

8.     ensure adequate distribution of health facilities within the federation.

9.     ensure equitable patronage of all levels of health care

10. ensure the availability of funds to the health sector for improved services.

The Scheme shall be responsible for :

1. registering health maintenance organizations and health care providers under the scheme.

2. Issuing appropriate guidelines to maintain the viability of the scheme

3. Approving format of contracts proposed by the health maintenance organizations for all health care providers.

4. Determining, after negotiation, capitation and other payments due to health care providers, by the health maintenance organizations.

5. Advising the relevant bodies on inter-relationship of the scheme with other social security services.

6. Provide the research and statistics on matters relating to the scheme.

CONTRIBUTIONS:

·       An employer with a minimum of ten (10) employees may            together with every person in his employment, pay contributions under the scheme, at such rate and in such manner as may be determined, from time to time, by the Council.

·       An employer under the Scheme shall cause to be deducted from an employee’s wages the negotiated amount of any contribution payable by the employee and shall not, by reason of the employer’s liability for any contribution (or penalty thereon) made under this Decree, reduce, whether directly or indirectly, the renumeration or allowances of the employee in respect of whom the contribution is payable under this Decree.

·       For the purposes of the application of the provisions of the Pension Act, any power exercisable thereunder by a minister or other authority of the Government of the Federation, other than the power to make regulations under section 23 of the Act, is hereby vested in and shall be exercisable by the Council and not by any other person or authority.

·       An application for the registration of an employer under the Scheme shall be made in such form and manner as may be determined from time to time by the Council.

·       A person not liable to pay contributions under this Decree may apply to be registered as a voluntary contributor under the scheme and shall, after being so registered, be liable to pay the specified contributions as required under this Decree and be entitled to the health services referred to in subsection (1) of section 18 of this Decree.

·       A health care provider registered under the scheme shall, in consideration for a capitation payment in respect of each insured person registered with it, or for payment of approved fees for services rendered and to that extent and in the manner prescribed by this Decree, provide:

1. defined element of curative care;
2. prescribed drugs and diadnostic tests
3. maternity care for up to four live births for every insured person;
4. preventive care, including immunization, family planning, ante-natal and post-natal care;
5. consultation with defined range of specialists;
6. hospital care in a public or private hospital in standard ward during a stated duration of stay for physical or mental disorders;
7. eye examination and care, excluding test and the provision of spectacles; and
8. a range of prosthesis and dental care as defined.
   

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