Ultimate Health Management Services has unveiled its Group, Individual and Family Social Health Insurance Programme (GIFSHIP), a new initiative designed to increase health insurance penetration among Nigeria’s vast informal sector as part of efforts to advance Universal Health Coverage (UHC).

The programme, also known as U-Health, is the Federal Government’s actuarially developed health insurance benefit package originally created for federal civil servants and their dependents.

According to the framework agreed by the National Health Insurance Authority (NHIA) and Health Maintenance Organisations (HMOs), the package has now been adapted for operators in the informal sector as well as small and medium-sized enterprises (SMEs). Before its rebranding, the initiative was known as the Voluntary Contributors Social Health Insurance Programme.

Speaking during the official unveiling of the product in Lagos, the Managing Director and Chief Executive Officer of Ultimate Health HMO, Otunba Lekan Ewenla, said the company had intensified efforts to promote the scheme following the NHIA’s recalibration of the programme.

He explained that the initiative is intended to close Nigeria’s health insurance coverage gap by extending the NHIA social health insurance package to millions of informal sector workers and SME operators.

Health experts estimate that fewer than 10 per cent of Nigerians currently have health insurance coverage, leaving a significant portion of the population exposed to catastrophic healthcare expenses. They also note that Nigeria ranks among countries with the highest levels of out-of-pocket healthcare spending globally.

Recently, the Director-General of the NHIA, Dr Kelechi Ohiri, disclosed that health insurance coverage has expanded to 22 million Nigerians.

Ewenla described the rollout of the programme as a significant milestone in Nigeria’s journey toward achieving Universal Health Coverage.

Providing background on the U-Health initiative, the health insurance professional, who has more than 30 years of industry experience, explained that the absence of a strong foundation for implementing basic healthcare coverage prompted the adaptation of the Federal Civil Servants’ health insurance benefit package for the informal sector and SMEs across the country.

“The GIFSHIP is the sole actuarially developed benefit package for federal civil servants across the country. It was made mandatory for all federal civil servants, making it a social programme.

“Since the health insurance programme commenced in 2005, this benefit package has become widely accepted across nearly 10,000 NHIA-accredited healthcare facilities nationwide. Going by available statistics, about 15 per cent of Nigeria’s population is in the formal sector, while about 85 per cent is in the informal sector,” he said.

Ewenla explained that when the Federal Government introduced the health insurance programme for civil servants in 2005, the 10 per cent medical allowance contained in workers’ basic salaries was converted into health insurance premiums.

He added that demands for broader inclusion soon followed the programme’s implementation within the formal sector, prompting calls for similar access for informal sector workers and SME operators.

“In order to establish standards for basic healthcare services for all Nigerians, the National Health Act succinctly captured the introduction of basic healthcare coverage for all Nigerians,” he added.

According to Ewenla, the adapted health insurance package targets organised groups and associations operating within the informal economy, including market associations led by Iyalojas and members of the National Union of Road Transport Workers (NURTW).

Other intended beneficiaries include chambers of commerce and industry, spare parts dealers, mechanics, furniture makers, beauticians, the Road Transport Employers Association of Nigeria (RTEAN), and employees of healthcare providers.

He noted that Ultimate Health HMO deliberately prioritised the informal sector because it remains one of the least served segments of Nigeria’s health insurance market.

Ewenla said:

“The adoption of this Group, Individual and Family Social Health Insurance product by Ultimate Health HMO is aimed at strengthening our existing cordial working relationship with healthcare providers through the systematic pooling of enrollees to key healthcare facilities. This will help achieve reasonable enrolment volumes that support the provision of quality services, as primary healthcare facilities serve as risk bearers at the primary level.”

He added that the initiative is expected to strengthen collaboration between HMOs and healthcare providers, improve public perception of health insurance and promote mutually beneficial partnerships.

“Another good thing about this product is that it is strongly regulated by the National Health Insurance Authority. The benefit package is robust, while the premium was actuarially determined at ₦38,718 per person per annum and is non-negotiable.

“We are implementing this product in strict compliance with the NHIA Operational Guidelines, including the payment of ₦1,450 monthly capitation per enrollee, utilisation of ₦700 per enrollee monthly for fee-for-service, and adherence to all operational processes and procedures contained in the NHIA Operational Guidelines,” he said.

Ewenla also disclosed that the company has already begun engaging transport unions, market associations and other informal sector organisations to accelerate enrolment under the programme.

In addition, Ultimate Health HMO has introduced a flexible healthcare access model that enables enrollees to register with two hospitals one located near their residence and another close to their workplace or business location.

Source: Punch Newspaper