National Health Insurance Scheme

Stakeholders in the National Health Insurance Scheme
Government
Government, through the National Health Insurance Scheme, sets standards and guidelines, while protecting the rights and enforcing the  obligations of all stakeholders.

Employees
These are the contributors in the Formal Sector Social Health Insurance Programme.  Their contributions (5% of basic salary), paid regularly in advance will guarantee them and their dependants good quality healthcare whenever they fall ill.

Employers
These are public or private sector organizations employing ten (10) or more persons, for whom they are required to pay contributions (i.e., 10% of an employee’s basic salary).  In the Formal Sector Social Health Insurance Programme, employers are guaranteed good quality health care for their workers at cheaper rates and a resultant increase in productivity.  In addition, employers with in-house health facilities will run them cheaper and make them earn income by registering them as Providers under the Scheme.

Other Contributors
Contributors making small, affordable regular payments in the Urban Self-employed and Rural Community Social Health Insurance Programmes are guaranteed access to quality healthcare whenever they fall ill.

Health Maintenance Organisations
These are limited liability companies which may be formed by private or public establishments or individuals for the sole purpose of participating in the Scheme.  They are registered by the Scheme to facilitate the provision of health care benefits to contributors in the Formal Sector Social Health Insurance Programme.
Their functions include the following:-
-    Receive/collect contributions from eligible employers and employees
-    Collection of contributions from voluntary contributors
-    Payment of Health Care Providers for services rendered
-    Maintenance of quality assurance in the delivery of healthcare benefits in the Formal Sector Social Health Insurance Programme.

Board Of Trustees (BOTs)
Participants in the Urban Self-employed and the Rural Community Social Health Insurance Programmes, through their elected Boards of Trustees, plan, run and manage their own health care, thereby engendering a sense of ownership and true community participation.

Healthcare Providers
A Health Care Provider as provided for in the NHIS Act, is a licensed government or private health care practitioner or facility, registered by the Scheme for the provision of prescribed health benefits to contributors and their dependants.  Health Care Providers can either be Primary, Secondary, or Tertiary.
i.    Primary Health Care Providers
Primary Health Care Providers will serve as the first contact within the health care system, and they include:
· Private clinics/hospitals;
· Primary Health Care Centres;
· Nursing and Maternity homes; and
· Out-patient departments of General Hospitals, Out-patient departments of the Armed Forces, the Police and other uniformed services, University Medical Centres and Federal Staff Clinics
ii.    Secondary and Tertiary Health Care Providers (Fee-for-service providers)
These include:
·    General hospitals (Out-patient and in-patient care for medical, surgical, paediatric, obstetric gynaecological patients, etc)
·    Specialist hospitals
· Pharmacies
· Laboratories
·    Dental Clinics
· Physiotherapy clinics
· Radiography, etc

Other Stakeholders
i.    International Organizations and Collaborating Partners
Their role includes the provision of technical and financial support to ensure the successful implementation of the Scheme, especially among the urban self-employed, rural communities, permanently disabled persons, children under-five tertiary institutions and voluntary contributors.
ii.    Non-Governmental Organizations (NGOs)These organizations will assist in the areas of sensitization and mass mobilization to ensure adequate participation.
iii. Community Leaders
They will assist in community mobilization and coordination.
iv. The Media
The media will assist in sensitization, assist health providers to disseminate knowledge of the Scheme and guarantee mass participation.
v.    Banks

Banks’ responsibilities under the Scheme include:
a)    Take custody of all the funds accruing to the HMOs affiliated to it;
b)    Ensure the safety of all funds for the operation of the programme;
c)    Provide on request, by the NHIS, information on the accounts of an HMO with the knowledge of the HMO
d)    Forward monthly statement of accounts of the HMOs on authorization by the HMOs to the NHIS.
vi.    Insurance Companies
Insurance companies are to provide cover (malpractice and indemnity insurance) for Health Maintenance Organizations (HMOs) in the Scheme.
vii.    Insurance Brokers
To coordinate and ensure that HMOs and healthcare providers take up indemnity insurance cover.    NHIS accredited Insurance Brokers will monitor and ensure compliance by accredited HMOs,  healthcare providers and the insurance companies.
viii.    Professional bodies
Professional bodies will assist in sensitization and mobilization of health professionals, as well guarantee their participation.