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Senate plans repeal of NHIS Act, raises hope for informal-sector participants

…to subsidise health insurance premium payments

The Senate has resolved to repeal the National Health Insurance Scheme (NHIS) Act, the Upper Chamber of the National Assembly has indicated.

This was announced on Monday, when the Senate held a one-day public hearing to consider a bill for an Act to repeal the NHIS Act, CAP N42 2004 and to enact the National Health Insurance Commission Bill 2019.

The bill is sponsored by Senator Ibrahim Oloriegbe. He stated that over sixty million Nigerians are living below poverty line and cannot afford insurance premium, and that making health insurance compulsory without sufficient arrangement for subsidy would not work.

In place of the NHIS, the Senate is seeking to enact a new bill and establish a commission to ensure a more implementation of a health insurance policy that can create affordability to healthcare services to not only the rich but people without adequate finance.

Also, the commission when established will ensure the provision and effective regulation of health insurance schemes across all states in the country.

This is the fourth time the NHIS bill will be amended and or repealed due to its inability to provide health insurance to all Nigerians, irrespective of their economic and political status.

The current NHIS was established by Decree 35 of 1999 and commenced operations in 2005 with a formal programme that only covered federal government employees, private and community schemes.

The Senate is concerned that despite NHIS, the coverage currently stands at less than three per cent of the Nigerian population because people without viable economic status find it difficult to sponsor treatment.

The new bill seeks to address NHIS challenges and also make health insurance mandatory and not optional.

Also, the new bill is recommending a basic minimum package of services – fifty per cent of basic healthcare provision Fund (BHCPF).

“The role of the state in the current NHIS Act is not stated. And the new bill would ensure states are allowed to set up their SSHIS, subsidized pools an enforce individual and employer mandates.

“The current Act does not empower the governing council with sufficient powers to effectively regulate the health insurance industry in Nigeria in its dual roles as both a regulator and promoter of health insurance for the poor and vulnerable,” Senator Oloriegbe said.

Meanwhile, the new bill is comprised of nine parts and seventy nine clauses/sections.

Specifically, “Section 39 (1) mandates HMO Organisation referred to in subsection (1) of Section 41 of this Bill shall have responsibility for:(a) perform such roles as may be assigned to it by the State health schemes (SHS) including but not limited to the role of third-party administrator;(b) where employed to collect contributions, ensure prompt remittance of contributions to State pools;

“(c) perform other administrative actions as required under this Bill;(d) pay administrative charges to the Commission for purposes of regulation and related issues.(e) for services rendered by healthcare providers accredited under the Commission in accordance with the Operational Guidelines. (f) establish a Quality Assurance system to ensure that qualitative care is given by the healthcare providers to enrolees, and

“(g) render to the Commission returns on its activities as may be required by the Council. (2) Notwithstanding any provisions contained in this Bill, a Health Maintenance Organisation shall not be involved in the direct delivery of health care services,” it stated.

Further, “Section 40 (1) stipulates that “the accreditation of health care providers shall be in such form and manner as may be determined by the Commission, from time to time, under this Bill.(2) A health care provider including telemedicine outlets (linked to a provider) accredited under the Commission shall, in consideration for a capitation payment in respect of each insured person registered with it, or for payment of approved fees for services rendered and to that extent and in the manner prescribed by this Bill, provide in accordance with:(a) the approved benefit packages as shall be determined from time to time by the Commission; and(b) the provisions of the Operational Guidelines.

Also, Section 56(1) of the provides that “any person who:(a) fails to pay into the account of the Commission and/or a State Health Scheme, or any health insurance fund under this Bill, or HMO and within the specified period any contribution liable to be paid under this Bill; or(b) deducts the contribution from the employee’s wages and withholds the contribution or refuses or neglects to remit the contribution to the appropriate fund concerned within the

specified time; or

“(c) fails to remit capitation to Healthcare Providers within the specified period indicated in the Operational Guidelines; or (d) fails to settle fee-for-service or other claims from the Healthcare Providers within the stipulated time allowed in the Operational Guidelines;(e) deliberately manipulates the enrollee register for the benefit of other parties before or after

the release of the register by the Health Insurance Schemes;(f) deliberately refuses to provide care to a duly registered enrollee; or(g) deliberately issues dud cheque(s), commits an offence.

“(2) A who person commits an offence under subsection (1) under paragraph (g) is liable on conviction:(a) in the case of first offence, to a fine of not less than N1,000,000 or imprisonment for a term not exceeding two years or to both such fine and imprisonment; and(b) in the case of a second or subsequent offence, to a fine of not less than N2,000,000 or for a term not exceeding five years or to both such fine and imprisonment,” it stated.

 

 

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