Ultimate Health HMO Unveils GIFSHIP: A New Dawn for Health Insurance
In a significant stride towards expanding healthcare accessibility, Ultimate Health Management Organisation (HMO) has officially rolled out its Group, Individual and Family Social Health Insurance Programme (GIFSHIP). This pivotal initiative is set to bolster health insurance options for millions in Nigeria's burgeoning informal sector and the vital small and medium-scale business community.
The launch comes hot on the heels of the landmark National Health Insurance Authority (NHIA) Act of 2022. This legislation mandates strict approval and coding for all private health insurance products, a move designed to eliminate arbitrary premium reductions and ensure consistent benefit packages across both the organised private sector and the informal economy.
Ensuring Affordable, Standardized Care
Announcing the program's adoption in Lagos, Otunba Lekan Ewenla, Managing Director/CEO of Ultimate Health HMO, highlighted GIFSHIP’s core mission. “The new plan, regulated by the National Health Insurance Authority (NHIA), is meticulously designed to provide affordable and guaranteed healthcare coverage,” Ewenla stated. The annual premium for GIFSHIP is set at an accessible N38,718 per person.
Ewenla, a former governing council member of the Lagos State health insurance scheme, emphasized that GIFSHIP offers a comprehensive benefits package widely recognized by NHIA-accredited healthcare facilities nationwide. He noted its growing popularity, particularly among operators of small and medium-scale businesses and those within the informal sector.
“The benefits package regulated by the National Health Insurance Authority is rich, the premium is not negotiable, the quality of care is guaranteed and the premium is affordable,” Ewenla affirmed. “We are formally announcing adoption of GIFSHIP benefit package as the basic benefit package of Ultimate Health HMO for individual, family, associations, groups, the Organised Private Sector, the informal sector in Lagos and across the country.”
Strategic Focus on Mass Market Healthcare
Ultimate Health HMO views the adoption of GIFSHIP as a strategic imperative to drive its objective of making healthcare affordable, accessible, and equitable. The organization's business development strategy is squarely focused on the mass market, aiming to positively impact Nigeria's critical health indices. Ultimate Health HMO currently manages hundreds of thousands of public sector enrollees and a significant number of corporate organizations across all 36 states and the Federal Capital Territory.
The NHIA Act reinforces the Authority's crucial oversight role, with Sections 34(2) and 15(9) stipulating that all private health insurance plans marketed by HMOs must be approved and regulated by the NHIA. This regulatory clarity ensures that healthcare providers are well-versed in covered services across all three levels of care and understand operational processes, including pre-authorization codes and utilizing NHIA tariffs for secondary and tertiary services.
Overcoming Challenges and Building a Sustainable Model
Ewenla, however, did not shy away from highlighting the systemic challenges facing healthcare access in Nigeria. He expressed concerns that without urgent reforms in enrollment, transparency, and enforcement, the country risks exacerbating existing inequities in access to care. His call to action for the healthcare sector is clear: “It is time to shift from merely treating illness to creating health as we all know that a healthy nation is a wealthy nation.”
GIFSHIP itself is a product of evolution, born from the need to extend health insurance to communities efficiently and sustainably. Originally termed the ‘Voluntary Contributors Social Health Insurance Programme,’ its premium has evolved from N15,000 to N20,000, and now to the current N38,718. The program’s design addresses critical issues encountered in earlier models:
- Adverse Selection: Previous individual plans often suffered from adverse selection, where only sick individuals enrolled, utilized services heavily, and then failed to renew their subscriptions.
- Risk Spreading: To counter this, GIFSHIP shifted to a group and family enrollment model. Individuals are now required to enroll with at least two additional people, effectively spreading the risk more evenly across the insured pool.
- Sustainability Measures: A 90-day waiting period has been implemented. This critical feature helps reduce potential abuse and ensures the long-term sustainability of the program.
- Provider Familiarity: GIFSHIP is widely promoted because healthcare providers have a clear understanding of its structure and benefits, which streamlines operations and reduces negotiation complexities with private sector clients.
Ewenla reiterated Ultimate Health HMO’s unwavering commitment to expanding access to affordable, quality healthcare for all Nigerians. He urged fellow HMOs to intensify education campaigns targeting both employers and workers, especially within the informal sector, which constitutes roughly 60 percent of Nigeria’s population yet suffers from critically low awareness regarding health insurance.
“Insurance is a game of numbers; without volume, the system cannot function,” Ewenla emphasized. He also pointed out that inconsistent compliance with regulations requiring private sector participation remains a weak link, underscoring the ongoing need for robust policy enforcement to ensure wider health insurance coverage across the nation.