Health Insurance In Nigeria: Why You Need It

Recently, I came across a video of a Nigerian Actress; kemi Afolabi who has been critically ill for quite some years now. In fact I got to realise that she has been going through this illness for over two years. She affirmed that she has spent all of her business capital on the sickness, as well as her savings, noting that she spends one million Naira (1 million Naira) on treatment on a weekly basis (can you guess how much that will be for two years now). Yet she’s still very ill and now she needs to be taken abroad for medical treatment.

Mercy Aigbe in the video pleaded and I quote “This is a matter of emergency “. Meaning that when sickness comes, taking care of it becomes a matter of emergency so as to save the life of such an individual.  Also, I learnt that the only daughter of this woman is only but 11 years old( such a young age). Now imagine what will be the outcome of the 11 years old girl (God forbid) If anything happens to the mother; This is why it is important that every individual; be it rich or average, or poor, takes up a backup plan that will help insure the person’s health.

Sickness is not a friend to one’s body, and most times, it doesn’t give you notice before showing up. Unfortunately for humans, critical illness is not only for the Rich and abled individual…,it is even the poor that are more disadvantaged when these illnesses surface.

This article will be addressing the purpose of health insurance in Nigeria, and why every individual needs it!

WHAT IS HEALTH INSURANCE?

Health Insurance refers to the type of insurance that provides cover for the costs of the Medical, Surgical, and hospital expenses of the person (people) insured. It is one of the form of life insurance that helps protect an individual’s health. Hence the insured is the sole owner(s) of the health insurance policy or coverage.

There are different types or groups of health insurance In Nigeria. They are explained below;

TYPES OF HEALTH INSURANCE IN NIGERIA

There are two main types of health insurance in Nigeria. They are;

1. Private health insurance
2. Public/government health insurance

PRIVATE HEALTH INSURANCE: This is the type of health insurance that is provided by private companies for individuals, families, or for a group of individuals in a common background or workspace (corporate). With this type of insurance, it is the private insurance company that determines the premium to be charged based on the health risk coverage of the insured.  In Nigeria, it is only but a few; especially the wealthy few, who has one form of private health insurance or the other. An example of a private health insurance provider is the Avon Healthcare (AVON HMO).

PUBLIC/GOVERNMENT HEALTH INSURANCE: In this type of health insurance, it is the government that provides healthcare plans for the masses in the state. With this type of health insurance, the government subsidises or reduce the cost of healthcare for the masses in exchange for a fixed regular low premium. The National Health Insurance Scheme(NHIS) is an example of the public health insurance in Nigeria.

INSIGHTS TO PRIVATE HEALTH INSURANCE IN NIGERIA

The private organisation that offers health care insurance in Nigeria includes but are not limited to the following;

• Enterprise Life Nigeria ( their IPP PLAN covers for critical illnesses)
• Avon healthcare Insurance
• AXA Mansard Health Insurance
• Hygeia Health Insurance
• Reliance HMO
• Stanbic IBTC insurance
• Leadway insurance health plan. …..amongst others.

Each and every of the above mentioned health insurance providers has their mode of operations, and the kinds of sicknesses or diseases covered will determine the premium to be charged.  Avon HMO for example; provides health insurance using these six plans below;

1. Family health plan
2. Individual health plan
3. Couple’s health plan
4. Sme and small groups health plan
5. Companies and large groups health plan
6. International health plan.

Now, the charge of premium for an individual health plan will be different from the family health plan which covers for everyone in a family or others. Reason being that the number of entities covered and the degree of health risk in a family can’t be compared with just an individual. In their plan, for an individual that opts for “Life starter plan”; the individual is required to pay a yearly premium of Twenty-Five Thousand (25k) Naira,  while for a family that opts for a  “Life plus plan” is expected to pay a yearly premium of Two Hundred and Two Thousand, Five Hundred(202,500) Naira. Can you then see the difference in figures? I’m well sure you can!

Also in each of these plans , they specified the treatments, Sicknesses and Surgeries covered. Of course,  it is not all the sicknesses that is covered in a plan. If you pick up a plan that covers ALL sicknesses, then you have to be ready to pay higher premiums. The reason it’s so, is so that the insurance company won’t be open to excess risks to avoid it leading to bankruptcy. This is why we noted in our previous article on “Types of Insurance In Nigeria, under the healthcare section, that the health insurance policies covered can either be generic or specific.

Hence as a policyholder who is picking up a plan , endeavour to ask the scope of health coverage the company includes in such a policy to be sure it’s what meet your needs as regarding healthcare. Please ask and never you assume that a particular health plan is supposed to cover all your health needs to avoid being disappointed later.

Another thing I will like to bring to our minds is the health insurance for groups of individuals,  or the corporate companies health insurance . This is mostly referred to HMO amongst other names,, and it is attached to our benefits in the workspace. It is as a result of this health plan which is given as additional benefits for working for an employer, that a good number of individuals has a form of healthcare plan in the country. But I will suggest that despite having this HMO in a company, endeavour to pick up a personal healthcare plan, as having an HMO doesn’t necessarily mean your health is covered for life.

Many individuals, especially the employees are at risk of losing their health insurance that was provided by the company they currently work for, in the event that you change your job or you lose your job. The company will automatically take away their healthcare benefits from you. This is why it is important that each individual has a personal health insurance cover even when your company gives you an HMO plan.

INSIGHTS TO PUBLIC HEALTH INSURANCE IN NIGERIA

Generally, it is the wealthy who most times factors in health insurance. Reason being that they are mostly passionate about their health, hence they easily subscribe to any form of healthcare plans that will aid them live long and enjoy their wealth with their loved one’s.  While the poor die prematurely mostly due to bad health, and lack of access to unique and standard healthcare. The government in a bid to curb this; has initiated an insurance scheme that caters for the health of all Nigerians. This insurance scheme is called – National Health Insurance Scheme (NHIS).

The mission of the NHIS  is to mobilise and pool financial resources for strategic purchasing of affordable and quality healthcare for all Nigerians. The National Health Insurance Scheme has developed various programmes to cover the health of Nigerians in the different segments of the society. This is in a bid to ensure that Nigerians has access to good healthcare services. Hence as a citizen in the country, you have no excuse for not incorporating a form of healthcare plan in your life as you journey through.

Below are the different segments that the National Health Insurance covers ;

1. The formal sector : This programme focuses on Individuals, Families, or corporate personnel in the formal sector and based on that provides social health insurance programmes that meets their needs.

2. The Informal Sector: This programme focuses on individuals in the informal sector, and based on that provides health plans such as; “ Tertiary institution social health insurance plan, Community based social health insurance plans or programmes, and public private partnership social health insurance programmes.

3. The Vulnerable Groups: This programme focuses on providing social health insurance plans for people who are either; pregnant, Children under the ages of five years, prison inmates, Retirees, or Aged individuals.

The National Health Insurance Scheme was established by the government to improve the health of all Nigerians at an affordable cost.

How Does The NHIS work?

In order to provide social health insurance in Nigeria, the National Health Insurance Scheme adopted 3 different groups as explained above. Now when you choose a desired programme, you as a participant will be required to contribute a fixed regular amount of money monthly or yearly. As you do this , when the need for a medical treatment is demanded at your registered hospital or in the event of a critical illnesses, the NHIS will then ensure to pay for the costs of the medical treatment by making available the funds to you. In some cases, if your health provider is registered with the scheme HMO, then the National health insurance schemes takes care of the medical fees, while you go and enjoy good health care services.

The National Health Insurance Scheme are able to pay for the participants medical bills from the pool of funds contributed by the various participants of this scheme.

Hence, the National health Insurance scheme is a prepayment plan, where the general participants of the scheme pays a certain fixed regular amount. These amounts are then collated, and it is from this collated amount that the Health Maintenance Organisation (HMOs) are paid for the health care services rendered to the citizens.

Hence, National Health Insurance Scheme is primarily a risky sharing arrangements which can improve resource mobilisation and equity.

WHAT TYPE OF HEALTH INSURANCE IS BEST?

The both types of health insurance explained above are good; be it private health insurance or public health insurance. However, if you are the type that prefers faster and efficient experience when getting your medical claims, It is advisable that you go for the private health insurance if your financial is above or between average, as you are likely to pay a bit higher premium here than in the public settings (most of the private health insurance policy are affordable when you budget your income efficiently). As this will provide prompt claim payment when the need arises. Also, most private health insurance providers have gone digital, thus there will be less paperwork as compared with the public health insurance.

In the event that your financials are a bit lower, by all means take up the public health insurance scheme. You will only need to keep tab of every documents necessary in receiving your claims , as well as make sure to follow up on your claim request doggedly, for fast results. Seeing that the number of people who might be making claims in a particular day might be greater than one. So in order to avoid number delay, have all of your health programmes records available and complete at all times when making a claim in the public health insurance scheme.

HOW HEALTH INSURANCE CAN HELP PROTECT YOUR PRESTIGE IN THE SOCIETY

In the first paragraph of this article, we can all note that critical illness doesn’t respect persons. It can happen to anyone irrespective of our financial standing. All we can do is to pray and believe that God will never allow us suffer shame and dreadful sicknesses. After we have done that, we should by all means also put some plans in place that will help absorb any unpleasant experience as regarding our health concerns.

By subscribing to health care plan or policy, we are transferring the risk of paying heavily on medical bills and health expenses to the insurance companies. And in the event of of a critical illness or accident, we won’t be posted on the social platforms asking for alms to cater for the medical bills and treatments.

These days, the costs of treating dreadful diseases are so huge that you see people coming on the social platforms to seek for alms from masses. This then will mostly led to the masses being the decision maker whether you will remain alive by their prompt support, or that you won’t,  if they delay to provide the necessary support needed. No one wishes to be in this shoe.

Hence as you are living life and enjoying the good things of life, take up a plan or health policy today that will be there for you as a backup plan should you become critically ill in the future, to avoid becoming an object of topic for the masses when things don’t go well with our health. You are more than unique to be at the mercy of others before your health challenges can be restored. But the onus is on you now to do the needful as regarding your health both now, and in the future.

For example, Enterprising Life Nigeria, offers a maximum of (32.5 million Naira) Thirty Two Million, Five hundred Thousand Naira sum assured in the event of a critical illness of a policy holder. But trust me , despite this huge amount of sum assured, some sicknesses will swallow this amount and still demand for  more before the individual’s health is restored. And sometimes as well, this amount will solve the medical fees and an individual will still have more to cater for other immediate needs.

Now imagine  what an individual would have done for him or herself by picking up a policy that caters for critical illnesses and dreadful diseases. Of course the persons prestige won’t be affected when an unpleasant event occurs to attack his or her health. The sum assured will at least solve some major problems and little or no help will be needed afterwards.

THINGS TO DO TO PROTECT OUR HEALTH AGAINST CRITICAL ILLNESSES…

1. Take up as many health policy you can get. Of course you can insure your life in different multiple times and place. They will all be paid when something unpleasant happens to our health, and we need the heavy medication fees  sorted fast.
2. Make sure to exercise often
3. Eat healthy food at all times
4. Reduce or avoid excessive alcohol intake
5. Avoid inhaling smoke, do not smoke or use tobacco
6. Try to trim your weight if you are overweight
7. Adopt a lifestyle of resting once per week
8. Protect yourself from transmittable diseases
9. Watch your blood pressure – avoid it being too high or too low
10. Always check your cholesterol level
11. Avoid excess sugar intake
12. Go for screenings as often as possible from age 30.
13. Eat more of live food…vegetables, fruits, (Practice vegetarian)
14. Enjoy good laughter
15. Visit your health provider anytime you feel sick

SOME EXAMPLES OF HEALTH PROVIDERS ORGANISATIONS

There are different health provider organisation, some are common while some are yet to gain full popularity in the country. They include the following;

1. HEALTH MAINTENANCE ORGANISATION(HMO): This is common in Nigeria. When you have this health benefits, the doctors you can see for medical treatment and consultations are those strictly registered in the HMO network. Hence you are limited to getting health services from the list provided here.

2. PREFERRED PROVIDER ORGANISATION (PPO): With this organisation, an individual has a considerably amount of freedom to choose his/ her Preferred health care provider more than in the HMO settings.

3. EXCLUSIVE PROVIDER ORGANISATION(EPO): With this organisation, an individual also, has a moderate amount of freedom to choose his/her exclusive health care provider.

4. POINT OF SERVICE PLAN(POS): This incorporates features of the HMO, and the PPO – hence with this health plan, you have more freedom to choose your health care provider than any of the single organisation.

CONCLUSION

Our health is our wealth – if you lose your health to diseases or critical illnesses, you will automatically lose your wealth in the course of correcting that. Hence it is important that we protect our health at all times. And while we do that, also it is paramount that we ensure that plans are put in place that will aid us when an unpleasant event occurs that might terribly affect our health.

Take up a health plan from either a private health insurance company, or sign up with the National Health Insurance Scheme (NHIS), even as you practice the tips given for healthy living. Whatever you do…Always choose health first!