Health insurance operators have intensified calls for wider enrollment into Nigeria’s health insurance scheme, as Ultimate Health HMO unveiled a N38,718 annual plan aimed at expanding coverage among the organised private sector and informal workforce.
The initiative was announced at a media briefing held in Lagos, where stakeholders highlighted gaps in compliance and implementation that have hindered the growth of health insurance in the country.
Speaking at the event, the Managing Director/Chief Executive Officer of Ultimate Health HMO, Otunba Lekan Ewenla, said the new plan, known as the Group, Individual and Family Social Health Insurance Programme (GIFSHIP), is designed to standardise benefits, eliminate arbitrary pricing and improve access to quality healthcare.
He explained that poor uptake of health insurance in the past was largely due to limitations in the former National Health Insurance Scheme (NHIS) Act of 1999, which did not make participation compulsory for private sector employers.
According to him, the use of the word “may” in the law allowed organisations to opt out of enrolling their workers, resulting in low compliance across the organised private sector.
“The organised private sector did not fully key into the programme because the law did not make it mandatory. That gap has now been addressed by the NHIA Act 2022, which makes health insurance compulsory for all residents,” he said.
Ewenla noted that the new law mandates employers with at least five staff, as well as individuals in the informal sector, to enroll in health insurance schemes, describing it as a major step towards achieving universal health coverage.
He said beyond legal gaps, misinterpretation of employer obligations, lack of standardised operational frameworks, and inconsistent benefit packages had also contributed to low enrollment over the years.
Tracing the evolution of the sector, he explained that private health insurance operators began offering services before the establishment of a regulatory framework, leading to inconsistencies in pricing and service delivery.
“As far back as the late 1990s, there was no unified structure. Different HMOs were marketing different products, especially family plans, which led to arbitrary pricing and operational conflicts with healthcare providers,” he said.
He added that the practice of negotiating premiums based on employees’ medical allowances often resulted in inadequate funding, poor service delivery, and disputes between health maintenance organisations and healthcare providers.
To address these challenges, he said Ultimate Health HMO has adopted GIFSHIP as its standard benefit package for individuals, families, groups and organisations across the country.
He explained that the plan, regulated by the National Health Insurance Authority (NHIA), comes with a fixed annual premium of ₦38,718 per enrollee and is not subject to negotiation.
“The essence of adopting GIFSHIP is to remove negotiation of premiums and ensure uniformity in benefits. It is regulated, affordable, and guarantees quality care,” he said.
Ewenla added that the programme shifts emphasis from family-based enrolment to individual coverage, while allowing dependents to be added through contributory payments where necessary.
He stressed that health insurance is designed as a contributory system, noting that employers are expected to convert employees’ medical allowances into insurance premiums, while workers can cover additional costs for dependents.
“Health insurance is contributory, just like the pension scheme. Employers are not expected to borrow money to fund healthcare. What is required is to utilise the medical allowance already provided for staff,” he said.
On implementation, Ewenla disclosed that the company currently manages over 200,000 public sector enrollees and works with more than 4,000 healthcare facilities nationwide, a network he said would support expansion into the private and informal sectors.
He further noted that the NHIA Act 2022 empowers the regulatory authority to approve and standardise all private health insurance products, a move expected to curb unhealthy competition and improve transparency in the industry.
Ewenla called on employers, small and medium enterprises, and operators in the informal sector to embrace the new framework, stressing that increased enrollment is critical to improving Nigeria’s health outcomes.
“We must move from assumptions to what the law clearly provides. Health insurance is no longer optional. A healthy nation is a wealthy nation,” he said.