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The National Health Insurance Authority (NHIA) has announced plans to clamp down on Health Maintenance Organisations (HMOs) that fail to comply with its operational guidelines.
The Agency Zonal Director South-South Zone, Ologbo Obaro, disclosed this during a stakeholder meeting organised by the agency in Port Harcourt on Friday.
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HMO is a network or organisation that provides health insurance coverage for a monthly or annual fee.
An HMO typically limits member coverage to medical care provided by doctors, hospitals, and other healthcare providers within its network, except for emergencies and out-of-area urgent care.
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Mr Obaro said the aim of the meeting is to review the current system, get feedback, and identify areas for improvement.
According to him, HMOs must pay claims on time and issue referral codes promptly, warning that failure to do so would attract penalties.
He added that the agency is working to ensure all Nigerians are covered under its Universal Health Insurance programme, to ease the financial burden of healthcare.
He said the agency’s mandate is to ensure that every Nigerian is covered, leaving no one behind.
“Nobody should suffer health issues in one corner or die from malaria because you don’t have money to pay your medical bills,” he said.
“We are committed to ensuring that HMOs adhere to the regulations to provide quality healthcare services to Nigerians.”
The director highlighted some benefits of the scheme, including free medical treatment for all citizens, and reduced financial burden for individuals with health challenges.
Other benefits include coverage for pregnant women, children under five, the elderly, civil servants, and other vulnerable groups.
He urged the public to walk into any National Health Insurance Scheme(NHIS) office in the 36 states and FCT to register, or register online using the NHIS launched digital platform with their national identification number for registration.
“NHIS has improved more on a robust ICT system for online registration and payment; citizens can register from home using their phones,” he said.
“We have various innovations/programmes to support vulnerable persons, such as the Basic Healthcare Provision Fund, fistula free programme (FFP) NHIA- Roche cancer initiative, NHIA-HIV& TB programme, Gifship-n, among others.
“We appeal that you spread the information about these programmes to your communities and neighbours.
“We want to give back equality world-class health insurance agency and ecosystem to Nigerians,” he emphasised.
He explained that the agency has increased capitation and is expecting improved quality care and delivery service.
According to him, the agency is addressing complaints and providing follow-up support to ensure that Nigerians receive quality attention in hospitals.
In her remark, the Executive Secretary of the Rivers Contributory Health Protection Programme, Vetty Agala, commended NHIA for its efforts in fostering collaboration and building synergy among stakeholders.
Ms Agala, who was represented by Ireju Ajie, the Head, Health Services Rivers Contributory Protection Programme commended the NHIA leadership in strengthening health insurance implementation across Nigeria, saying it underscored a shared vision for universal health coverage.
“Your leadership in strengthening health insurance implementation across Nigeria is commendable,” she said.
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She reaffirmed the state’s commitment to strengthening partnerships with the NHIA and other stakeholders.
According to her, such synergy will promote efficient service delivery and expand coverage, particularly for the most vulnerable.
Ms Agala also called for actionable strategies that aligned with national goals, improve accountability, and enhance health outcomes across the country.
(NAN)
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