By Maryam Habeeb
The Health and Managed Care Association of Nigena (HMCAN), has congratulated President Muhammadu Buhari, the Director General National Health insurance Authonty (NHIA) Prof. Mohammed Sambo for passing NHIA Act 2022 into law.
The professional association of leading health insurance practitioners also commended the National Assembly and the jount Senate and House Committees on Health, all stakeholders in the health insurance industry and all healthcare industry stakeholders in the roles they play in the development.
In a statement signed by the Chairman HMCAN, Dr. Leke Oshunniyi, the association believes that implementation of the new NHIA Act 2022 will lead to a more robust health insurance sector and greater access to care for more Nigerians.
According to him, HMCAN has over the years clamoured for the implementation of a holistic law that seeks to make health insurance mandatory in Nigeria and has worked extensively with the defunct NHIS, several state schemes and the organized private sector, in driving awareness for health insurance across the country for the last 30 years.
Therefore, the Association, has through the press release clarifies its understanding of the provisions of the NHIA Act, as it concerns their participation in the industry.
The statement reads in full:
‘’Members of HMCAN received a WhatsApp message which went viral, the content of which was that: on the 27% July, 2022, the Chartered Institute of Personnel Management of Nigeria (CIPMN) held an online virtual meeting on the new National Health Insurance Authority (NHIA) Act, and its Implications for Employees and Employers.
“The message went on to state that at the forum, it was disclosed that the new NHIA Board will have offices across all states of Nigeria and the FCT. Employers were advised not to renew their current Health Insurance contract with the HMOs at the expiration of their policies this year.
“This is because ALL Employers /Employees will be mandated to make contributions (10% Employer and 5% Employee of basic salary) to the new NHIA scheme. Subsequently, our members have been inundated with E mails, messages and telephone calls from our enrollees, clients, employees, members of the public, international organisations, Nigenans in the Diaspora and other stakeholders, to verify, comment on, or refute the information.
“HMCAN acknowledges the clarity provided by the NHIA Act 2022 which now provides mandatory health insurance across the country and the clearly defined roles of HMOs in the provision of health insurance in addition to supporting the social schemes for federal MDAs and state social schemes. HMCAN supports the NHIA Act’s focus to promote, regulate and integrate health insurance schemes across the country and to harness private sector participation.
“Without prejudice to the anticipated Operational Guidelines to be issued by the NHIA, HMCAN wishes to prowde the following clanficanons for the general public and all stakeholders in respect of the provisions of the NHIA Act: 1. The NHIA as an Authonty is vested with the regulatory responsibility for all parhcipants under the health insurance arrangement including state health insurance agencies, healthcare provnders, HMOs, TPAs and even banks and insurance companies that wish to participate in the health insurance sector
“The NHIA is responsible for managing the Federal Public Service Scheme which had always been managed by the erstwhile NHIS. The NHIA may choose to appoint HMOs (as TPAs) or TPAs to administer the scheme for them or may chooee to create an in-house team to do so.
“Only the State Health Insurance Agencies are authonzed to establish Basic Health Care packages in the states. The BHCP are to be defined by each state and they may appoint HMOe/TPAs to assist them with the administration of their echemes. Participation 1s mandatory for residents of the relevant states and payments for subsecnption ts expected to be paid directly to the State HIA by the individual or employer.
“The State HIAs are also expected to define and create Vulnerable Person echemes or arrangement to ensure that such persons are property catered for. This is a significant milestone which must not be overlooked.
“HMOs are empowered to operate private plans. Licensed HMOs can create and offer their plans to all Nigenans provided that the people also have a BHCP. Payments for private plans are to be made to the HMOs directly and HMOs must pay providers for care that has been rendered to their beneficianes.
“Only accredited HCPa can operate under the NHIA Act and tanfis once agreed upon are valid for 3 years followng which they can be reviewed to the mutual satisfaction of all parties.
“The above are a few salient points from the NHIA Act 2022. HMCAN believes that where the Act 1s clear, there is no room for interpretavon. The Operational Guidelines to be issued by the NHIA and subsequently by the State HIAs must be consistent with the provisions of the NHIA Act and only operatonalize areas that are not specifically addreased by the Act.
“HMCAN however will like to address the following possibly coatentious issues that have been brought to our attention as regards the proposed implementation of the new NHIA Act 2022: @ Need to clearly define and separate the functions of the NHIA in respect of the | administration of the social schemes for all federal MDAs, supervision of all State Social Schemes and the licensing of HMOs and TPAs. Plans by the NHIA to assume the function of HMOs in paying capitation and fee-for-service for the federal social scheme
“Conflict arising between the NHIA social scheme for MDAs and the State-run social schemes across the country in the implementanon of mandatory health insurance in each state.
“Also recently, we have received documented presentations by the NHIA to employer groups on mandatory contnbutions (10% -Employer, 5%-Employee} for the organized private sector with mmstructons to the organized private sector not to renew their current pnvate health insurance plans.
“More than 10 weeks after passage of the NHIA Act, the delay by the NHIA in holding a stakeholders’ conference where all HMOs, State Schemes, healthcare providers and NHIA can brainstorm together to address all concerns of all partes. This has led to various misleading interpretanons of the NHIA Act 2022,” the statement concluded.
