Health Insurance

What is Health Insurance?
Health insurance is a type of insurance coverage that pays for medical, surgical, and sometimes dental expenses incurred by the insured. Health insurance can reimburse the insured for expenses incurred from illness or injury, or pay the care provider directly.
What is a Health Insurance Policy?
A health insurance policy is a contract between an insurance provider (e.g an insurance company or a government) and an individual or his/her sponsor (e.g. an employer or a community organization). The contract can be renewable (e.g annually, monthly) or lifelong in the case of private insurance or be mandatory for all citizens in the case of national plans. The type and amount of health care costs that will be covered by the health insurance provider are specified in writing, in a member contract or “Evidence of Coverage” booklet for private insurance, or in national health policy for public insurance. The individual insured person’s obligations require payment of a premium.

What is a Premium?
This is the amount the policy-holder or their sponsor (e.g. an employer) pays to the health plan to purchase health coverage. A premium is calculated using 5 specific factors regarding the insured person. They include:
  • Age
  • Location
  • Tobacco use
  • Individual vs family enrollment
  • Plan category the insured chooses
Types of services/benefit covered in Health Insurance
  • Hospitalization cover: Types of services covered: Inpatient cover provides for medically necessary hospital admission costs including bed charges, doctor’s bills, and anesthetist’s bills, operating theatre fees, pharmacy, laboratory, and other investigations incurred by an insured member during hospitalization. This also includes cover for MRI and CT scans.
  • Out of patients cover: Outpatient cover provides for out of hospital treatment or medical treatment that does not require admission/hospitalization. It includes consultations (specialist and general), laboratory tests, X-rays, ultrasounds, medication, and casualty/emergency services.
  • Maternity cover: This category covers expenses related to both delivery options – cesarean and normal delivery. It also includes pre/post-natal care and complications arising out of delivery.
  • Dental cover: This covers basic dental procedures including consultation, removal of teeth, fillings, X- rays, scaling, and polishing. It also includes specialized dentistry procedures such as root canal treatment and crowns.
  • Optical cover: This cover includes consultation, eye testing, frames, and lenses for correction of eyesight.
  • Rescue and Evacuation: Emergency rescue and evacuation provides for medical emergencies and is intended to cover the transfer of an insured member by air or road ambulance to the nearest hospital where required services are available.
  • Foreign treatment: This category covers inpatient treatment including air fare for a member (and an accompanying person) who has been referred out of the country for services unavailable within Nigeria. Employees wellness: Employee wellness programs are designed to maintain/improve well-being through proper nutrition, weight loss, preventive education, and psychology by way of counseling at workplace and chronic condition management programs.
  • Funeral and Repatriation: This cover is designed to assist with funeral costs following the death of a member. Repatriation covers the costs of transporting the remains following the death of a member who was receiving treatment abroad due to an international referral.
Who is eligible for Health Insurance?
  • Individuals and families Health Insurance you buy on your own, not through an employer or association is called Individual coverage. The maximum principal age limit is 60 years and the dependant age limit is 18 years.
  • Groups
    Health insurance provided to employees by an employer or by an association to its members is called group coverage.
    The business must have at least one qualified full-time employee other than the business owner or a spouse. The company must be considered a legal business entity according to its state’s regulations. All current employees aged between 18 – 60 years are eligible.
    Any dependents of eligible employees are generally eligible for coverage under a group plan such as spouses and children.
    Dependents cannot enroll for coverage unless the employee has enrolled.

There are several providers for health insurance and they include:

National Health Insurance Scheme
Hygeia HMO
Oceanic Health Management Limited
Lagos State Health Scheme