HMCAN PRESS CONFERENCE ON THE NHIA ACT 2022
The Health and Managed Care Association of Nigeria (HMCAN), the professional association of leading health insurance practitioners in Nigeria wishes to congratulate President Muhammadu Buhari (GCFR), the Director General National Health Insurance Authority (NHIA) Prof. Mohammed Sambo, the National Assembly and the joint Senate and House Committees on Health, all stakeholders in the health insurance industry and all healthcare industry stakeholders for the passing into the law, the NHIA Act 2022.
Members of HMCAN received a WhatsApp message which went viral, the content of which was that: on the 27th July, 2022, the Chartered Institute of Personnel Management of Nigeria (CIPMN) held an online virtual meeting on the new National Health Insurance Authority (NHIA) Act, and its Implications for Employees and Employers.
The message went on to state that at the forum, it was disclosed that the new NHIA Board will have offices across all states of Nigeria and the FCT. Employers were advised not to renew their current Health Insurance contract with the HMOs at the expiration of their policies this year. This is because ALL Employers/Employees will be mandated to make contributions (10% Employer and 5% Employee of basic salary) to the new NHIA scheme.
Subsequently, our members have been inundated with E-mails, messages and telephone calls from our enrollees, clients, employees, members of the public, international organisations, Nigerians in the Diaspora and other stakeholders, to verify, comment on, or refute the information. This press release is therefore being made, to clarify our understanding of the provisions of the NHIA Act, as it concerns our participation in the industry.
HMCAN has over the years clamoured for the implementation of a holistic law that seeks to make health insurance mandatory in Nigeria and has worked extensively with the defunct NHIS, several state schemes and the organized private sector, in driving awareness for health insurance across the country for the last 30 years.
HMCAN acknowledges the clarity provided by the NHIA Act 2022 which now provides mandatory health insurance across the country and the clearly defined roles of HMOs in the provision of health insurance in addition to supporting the social schemes for federal MDAs and state social schemes.
HMCAN supports the NHIA Act’s focus to promote, regulate and integrate health insurance schemes across the country and to harness private sector participation. Without prejudice to the anticipated Operational Guidelines to be issued by the NHIA, HMCAN wishes to provide the following clarifications for the general public and all stakeholders in respect of the provisions of the NHIA Act:
1. The NHIA as an Authority is vested with the regulatory responsibility for all participants under the health insurance arrangement including state health insurance agencies, healthcare providers, HMOs, TPAs and even banks and insurance companies that wish to participate in the health insurance sector
2. The NHIA is responsible for managing the Federal Public Service Scheme which had always been managed by the erstwhile NHIS. The NHIA may choose to appoint HMOs (as TPAs) or TPAs to administer the scheme for them or may choose to create an in-house team to do so.
3. Only the State Health Insurance Agencies are authorized to establish Basic Health Care packages in the states. The BHCP are to be defined by each state and they may appoint HMOs/TPAs to assist them with the administration of their schemes. Participation is mandatory for residents of the relevant states and payments for subscription is expected to be paid directly to the State HIA by the individual or employer.
4. The State HIAs are also expected to define and create Vulnerable Person schemes or arrangement to ensure that such persons are properly catered for. This is a significant milestone which must not be overlooked.
5. HMOs are empowered to operate private plans. Licensed HMOs can create and offer their plans to all Nigerians provided that the people also have a BHCP. Payments for private plans are to be made to the HMOs directly and HMOs must pay providers for care that has been rendered to their beneficiaries.
6. Only accredited HCPs can operate under the NHIA Act and tariffs once agreed upon are valid for 3 years following which they can be reviewed to the mutual satisfaction of all parties.
The above are a few salient points from the NHIA Act 2022. HMCAN believes that where the Act is clear, there is no room for interpretation. The Operational Guidelines to be issued by the NHIA and subsequently by the State HIAs must be consistent with the provisions of the NHIA Act and only operationalize areas that are not specifically addressed by the Act.
HMCAN however will like to address the following possibly contentious issues that have been brought to our attention as regards the proposed implementation of the new NHIA Act 2022:
- Need to clearly define and separate the functions of the NHIA in respect of the administration of the social schemes for all federal MDAs; supervision of all State Social Schemes and the licensing of HMOs and TPAs
- Plans by the NHIA to assume the function of HMOs in paying capitation and fee-for-service for the federal social scheme
- Conflicts arising between the NHIA social scheme for MDAs and the State-run social schemes across the country in the implementation of mandatory health insurance in each state
- Also recently, we have received documented presentations by the NHIA to employer groups on mandatory contributions (10% -Employer, 5%-Employee) for the organized private sector with instructions to the organized private sector not to renew their current private health insurance plans.
- More than 10 weeks after passage of the NHIA Act, the delay by the NHIA in holding a stakeholders’ conference where all HMOs, State Schemes, healthcare providers and NHIA can brainstorm together to address all concerns of all parties. This has led to various misleading interpretations of the NHIA Act 2022.
- The clamour of state schemes to also regulate private health plans in clear violation of the NHIA Act 2022.
The Way Forward
- The adoption of a consultative approach to the definition of the implementation of the NHIA Act in order to achieve greater penetration of health insurance access
- Continue participation of HMOs in the Federal Public Service scheme as administrators in line with the NHIA Act 2022
- The closure of the existing formal sector schemes that are no longer provided for under the NHIA Act 2022
- Inclusion of representatives of HMCAN in the drafting of the operational guidelines as earlier promised by the DG, NHIA
- Clarification of the jurisdiction of the State schemes in regulation of HMOs private health plans in order to avoidance multiple regulation across the country
- Employers of labour in the private sector should be advised to enroll their staff in the relevant state social schemes in their states instead of being mandated to join the (now defunct) NHIA formal sector scheme plan which is no longer provided for under the NHIA Act.
- Employers of labour should be encouraged to maintain their private plans and subscribe to private plans where their states do not have a social scheme as envisaged by the Act instead of being compelled to join the NHIA Scheme that is not provided for by the Act
HMCAN believes that a considered implementation of the new NHIA Act 2022 will lead to a more robust health insurance sector and greater access to care for more Nigerians
For and on Behalf of the Health and Managed Care Association of Nigeria
Dr. Leke Oshunniyi
Chairman HMCAN
3rd August, 2022
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