Ultimate Health HMO launched the Group, Individual, and Family Social Health Insurance Programme (GIFSHIP) in Lagos to provide affordable medical care for Nigerians.
Managing Director Otunba Lekan Ewenla announced the package during a press briefing. He stated the plan follows the National Health Insurance Authority (NHIA) Act 2022.
The law makes health insurance mandatory for every citizen and legal resident. Consequently, the firm intends to bridge the gap in healthcare accessibility.
The package carries a fixed premium of ₦38,718 per person per annum. Furthermore, it covers primary, secondary, and tertiary medical services for all enrollees.
“We need to shift from merely treating illness to creating health. A healthy nation is a wealthy nation,” Ewenla declared during the unveiling ceremony.
“The GIFSHIP package is a strategic step to strongly focus on the objectives of making healthcare affordable, accessible, and equitable,” he added.
The launch targets millions of Nigerians who previously lacked access to quality care. Meanwhile, the scheme operates under strict regulation by the NHIA.
National Health Insurance Authority Mandates Coverage
The NHIA Act 2022 replaces previous laws to ensure universal coverage. This statute provides the legal framework for the basic minimum package of health services.
“The Authority shall ensure that health insurance is mandatory to every Nigerian and final residents,” Ewenla stated while discussing the legal framework.
“The NHIA shall enforce the basic minimum package of health services for all Nigerians across all health insurance schemes,” the Managing Director added.
According to This Day Live, the program seeks to stop the financial ruin families face when illness strikes.
Previously, many HMOs struggled with arbitrary premium reductions. However, the new act provides a standardized code for private products to ensure quality.
“This is a game-changer for Nigeria’s healthcare sector,” Ewenla said. “The premium is not negotiable, the quality of care is guaranteed, and the premium is affordable.”
“We are committed to delivering quality healthcare services to Nigerians, and GIFSHIP is a significant step in that direction,” he further stated.
Risk Management And Financial Structure Of GIFSHIP
The GIFSHIP model adopts a Health Risk Management Framework. This system recognizes different risk managers for various levels of medical care in the country.
“In the social health insurance programme, the primary healthcare providers are the risk managers at the primary level,” Ewenla explained.
“While the health maintenance organizations are the risk managers at the secondary and tertiary levels of care,” the CEO further clarified.
Capitation is the method used to transfer risk management to primary providers. Meanwhile, 65% of the premium is paid for at least 2,500 enrollees.
“The capitation is paid to the primary providers by the NHIA through the health maintenance organizations,” Ewenla said regarding the payment structure.
HMOs earn a 10% administration fee from the public sector premium. Furthermore, a fee-for-service model covers specific secondary medical treatments.
“We are changing the narration of our poor health indices, and we invite everyone to join us on this journey,” Ewenla stated as he closed the briefing.
“The GIFSHIP package is a strategic step to strongly focus on the objectives of making healthcare affordable, accessible, and equitable,” he concluded.
Ultimate Health HMO already serves a significant number of public sector enrollees. Additionally, corporate organizations have begun joining the new scheme.
“We want to make healthcare accessible to every Nigerian, regardless of their social status or income level,” the Managing Director added.
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