The National Health Insurance Authority (NHIA) has announced plans to enforce strict compliance by Health Maintenance Organisations (HMOs) with established regulations, warning that sanctions will be imposed on non-compliant operators.
An HMO is a network or organisation that provides health insurance coverage for a monthly or annual fee. It typically limits member coverage to medical services offered by healthcare providers within its network, except in emergencies or cases requiring urgent care outside the area.
The NHIA Zonal Director for the South-South Zone, Mr Ologbo Obaro, made this known during a stakeholders meeting held in Port Harcourt on Friday.
Obaro said the meeting aimed to review the current operational system, gather feedback, and identify areas requiring improvement.
According to him, HMOs are expected to process claims promptly and issue referral codes without delay. He warned that failure to meet these obligations would attract penalties.
He explained that the agency was committed to ensuring that all Nigerians are covered under the Universal Health Insurance programme to ease the financial burden associated with healthcare.
“Our mandate is to ensure that every Nigerian is covered, leaving no one behind. Nobody should suffer health issues in silence or die from malaria because they cannot afford medical bills,” he said.
“We are committed to ensuring that HMOs adhere to the regulations to provide quality healthcare services to Nigerians.”
The director outlined benefits under the scheme, including free medical care for citizens and financial relief for individuals facing health challenges. Coverage also extends to pregnant women, children under five, the elderly, civil servants, and other vulnerable groups.
He encouraged the public to visit any NHIS office across the 36 states and the FCT to register, or complete their registration online using their national identification number via the newly launched digital platform.
“NHIS has improved with a more robust ICT system for online registration and payment. Citizens can now register from the comfort of their homes using their phones,” he said.
Obaro also highlighted various innovations and programmes supporting vulnerable populations. These include the Basic Healthcare Provision Fund, Fistula Free Programme (FFP), NHIA-Roche Cancer Initiative, NHIA-HIV & TB Programme, and the GIFSHIP-N programme.
“We appeal to everyone to share information about these programmes within their communities. We aim to give Nigerians access to an equitable, world-class health insurance system,” he emphasised.
He noted that capitation had been increased, and the agency expected improved quality of care and service delivery. Additionally, he said the NHIA was actively addressing complaints and providing follow-up support to ensure Nigerians receive proper medical attention in health facilities.
In a remark, Dr Vetty Agala, Executive Secretary of the Rivers Contributory Health Protection Programme, commended NHIA for fostering collaboration and building synergy among stakeholders.
Agala, represented by Dr Ireju Ajie, Head of Health Services at the Rivers Contributory Protection Programme, praised the NHIA leadership for its role in strengthening health insurance implementation across the country.
“Your leadership in strengthening health insurance implementation across Nigeria is commendable,” she said.
She reaffirmed the state’s commitment to partnering with NHIA and other stakeholders to promote efficient service delivery and expand coverage, especially for vulnerable populations.
Agala also called for actionable strategies aligned with national goals to improve accountability and enhance health outcomes nationwide.
(NAN)