THE FORMAL SECTOR SOCIAL HEALTH INSURANCE PROGRAMME

The Formal Sector Social Health Insurance Programme is a social health security system in which the health care of employees in the Formal Sector is paid for from funds created by pooling the contributions of employees and employers.

The Formal Sector consists of the following: 

  1. Public Sector
  2. Organized Private Sector
  3. Armed Forces, Police and other Uniformed Services

Membership

Employees of the public sector and organized private sector organizations employing ten (10) or more persons shall participate in the Programme. 

Contributions

Contributions are earnings-related. For public (Federal) sector programme, the employer pays 3.5% while the employee pays 1.75% of the employee’s consolidated salary. For the private sector programme and other tiers of Government, the employer pays 10% while the employee pays 5% representing 15% of the employee’s basic salary. However, the employer may decide to pay the entire contribution. The employer may also undertake extra contributions for additional cover to the benefit package. 

Payment Mechanism

NHIS pays capitation for primary care and Fee-for-service upon referral through accredited HMOs to accredited Healthcare facilities

Waiting Period

There shall be a processing/waiting period of ninety (90) days before a participant can access health care services. 

Scope of Coverage 

  1. The contributions paid cover health care benefits for the employee, a spouse and four (4) biological children below the age of 18 years.
  2. More dependants or children above the age of 18 are covered on the payment of additional contributions by the principal beneficiary as determined by NHIS. 
  3. Principals are entitled to register four (4) biological children each, however a spouse or a child cannot be registered twice.