The Ultimate Health Management Services, a health maintenance organisation (HMO), on Tuesday, called for an effective enforcement of the National Health Insurance Authority (NHIA) Act 2022 to ensure health insurance coverage for all Nigerian employees, including those in the private sector.
“The organised private sector are not expected to borrow money to provide health insurance for their staff,” the Managing Director and Chief Executive Officer (CEO) of the Ultimate, Lekan Ewenla, said, explaining that staff members should be entitled to the health insurance premium worth the value of medical allowance their employers are expected to pay them.
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“With the NHIA Act 2022, participation is now mandatory, and enforcement is key to ensuring all employers comply and employees receive the coverage they are entitled to,” Mr Ewenla said.
He spoke in Lagos at the rollout of his organisation’s new social health insurance product introduced as part of efforts to expand health coverage among Nigeria’s largely uninsured population.
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Ultimate’s new initiative, tagged Group, Individual and Family Social Health Insurance Programme (GIFSHIP), comes amid the ongoing implementation of the NHIA Act 2022, which makes the insurance compulsory for all Nigerians and seeks to deepen access to affordable healthcare.
Speaking with journalists in Lagos on Tuesday, the Managing Director and Chief Executive Officer (CEO) of the Ultimate, Otunba Ewenla, said the product is designed to cater to individuals, families, associations and organisations across both the organized private and informal sectors.
‘’The benefits package is rich, the premium is not negotiable, the quality of care is guaranteed, and the premium is affordable.
‘’The benefit package is regulated by the National Health Insurance Authority (NHIA) and is very robust. The healthcare providers are familiar with the services covered at the three levels and have a better understanding of the operational process, like calling the HMOs for pre-authorisation codes and utilising the NHIA tariffs for the secondary and tertiary services,’’ he noted.
Mr Ewenla, who spoke on the theme, ‘’Setting the right agenda for the enrollment of the organised private sector, individual, family, groups, associations and the informal sector in the health insurance programme based on the NHIA act 2022,’’ said the standardised health insurance introduced under the NHIA scheme would reduce arbitrary pricing and ensure more consistent benefits for all across the health insurance ecosystem.
‘’Health insurance is a volume-driven system. Without sufficient enrolment, it becomes difficult to structure capitation effectively and sustain service delivery,’’ he said.
Despite these efforts, gaps in health coverage remain significant. Findings show that only 20 per cent of Nigerians are covered by health insurance, highlighting persistent gaps in access to affordable healthcare.
Also, many Nigerians significantly rely on out-of-pocket healthcare payments, a system experts say exposes households to financial hardship.
Mr Ewenla called for stronger enforcement of the NHIA Act and greater public awareness, noting that low participation is often driven by poor understanding of how the system works.
The HMO, he added, is working with public and private sector stakeholders to scale the rollout of the product nationwide, including the introduction of flexible payment options to attract participants in the informal sector.
Push for informal sector inclusion
Addressing journalists on the sidelines, the President of the Healthcare Providers Association of Nigeria, Austin Aipoh, emphasised the need for targeted strategies to bring informal sector workers into the health insurance system.
He noted that about 60 per cent of Nigerians operate within the informal sector, yet remain largely excluded from structured health financing schemes.
“The informal sector is not entirely unorganised. There are associations and leadership structures that can be engaged to drive enrolment,” he said.
While acknowledging that the organised private sector is more structured, he said weak enforcement has limited compliance with existing health insurance requirements.
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Mr Aipoh described insurance as “a game of numbers,” stressing that broader participation is critical to improving sustainability and expanding access to care.
He, however, raised concerns about affordability, noting that the current annual premium of N38,718 may still be beyond the reach of many Nigerians given prevailing economic conditions.
“The premium remains high for the average Nigerian. We must align pricing with economic realities if we want to achieve widespread coverage,” he said.
He also highlighted funding challenges faced by healthcare providers, arguing that inadequate reimbursements undermine service delivery.
“You cannot receive N1 and be expected to spend N100. That is not sustainable,” he added.
To improve compliance, Mr Aipoh proposed stricter measures for the organised private sector, including linking business registration renewals to proof of employee enrolment in health insurance schemes, alongside tax incentives to encourage participation.
He further urged regulators to enforce policies that make health insurance a standard component of employment, describing it as a critical step toward achieving universal health coverage in Nigeria.
