Ultimate HMO drives health insurance uptake in informal sector with GIFSHIP

To deepen health insurance uptake and advance Universal Health Coverage, Ultimate Health Management Services has formally launched its Group, Individual and Family Social Health Insurance Programme targeting Nigeria’s 85 per cent informal sector.

GIFSHIP, also known as U-Health, is the Federal Government’s actuarially developed health insurance benefit package for federal civil servants and their dependents.

To extend the benefits of the health insurance programme to the informal sector and small and medium-sized enterprises, the National Health Insurance Authority and HMOs jointly agreed that this product should be denominated and adopted for the informal sector and small and medium-scale businesses.

The product was initially known as the Voluntary Contributors Social Health Insurance Programme.

Unveiling the product in Lagos, the Managing Director and Chief Executive Officer of Ultimate Health HMO, Otunba Lekan Ewenla, said that since the NHIA recalibrated the scheme, his organisation had actively marketed the product to operators in the informal sector and owners of small and medium-sized enterprises.

Ewenla said the initiative was designed to bridge the health insurance coverage gap in Nigeria by extending the benefits of the NHIA social health insurance package to informal sector operators and SMEs.

Health experts say Nigeria’s health insurance coverage remains below 10 per cent, leaving many citizens vulnerable to catastrophic healthcare costs. They also note that the country has one of the highest rates of out-of-pocket health expenditure in the world.

The Director-General of the NHIA, Dr Kelechi Ohiri, recently disclosed that health insurance coverage has reached 22 million Nigerians.

Ewenla described the launch as a bold step towards setting the right agenda for the gradual attainment of Universal Health Coverage in the country.

Chronicling the journey of U-Health, the health insurance expert with more than three decades of experience in the sector, said the lack of a solid foundation for implementing basic healthcare coverage necessitated the adaptation of the Federal Civil Servants’ benefit package for operators in the informal sector and owners of SMEs nationwide.

“The GIFSHIP is the sole actuarially developed benefit package for federal civil servants across the country. It was made mandatory for all federal civil servants, making it a social programme.

“Since the health insurance programme commenced in 2005, this benefit package has become widely accepted across nearly 10,000 NHIA-accredited healthcare facilities nationwide. Going by available statistics, about 15 per cent of Nigeria’s population is in the formal sector, while about 85 per cent is in the informal sector,” he said.

He explained that the Federal Government’s introduction of the health insurance programme for civil servants in 2005 involved converting the 10 per cent medical allowance in workers’ basic salaries into health insurance premiums.

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According to him, shortly after the programme commenced for the formal sector, there were widespread calls for its extension to the informal sector and SME operators.

“In order to establish standards for basic healthcare services for all Nigerians, the National Health Act succinctly captured the introduction of basic healthcare coverage for all Nigerians,” he added.

Ewenla noted that the adapted benefit package was designed for groups and associations operating in the informal sector, including market associations led by Iyalojas and members of the National Union of Road Transport Workers.

He also identified chambers of commerce and industry, spare parts dealers, mechanics, furniture makers, beauticians, the Road Transport Employers Association of Nigeria, and employees of healthcare providers as other target groups.

He said the company chose to focus on the informal sector because it remains largely underserved by health insurance providers.

Ewenla said, “The adoption of this Group, Individual and Family Social Health Insurance product by Ultimate Health HMO is aimed at strengthening our existing cordial working relationship with healthcare providers through the systematic pooling of enrollees to key healthcare facilities. This will help achieve reasonable enrolment volumes that support the provision of quality services, as primary healthcare facilities serve as risk bearers at the primary level.”

He added that the initiative was also intended to improve relationship management between HMOs and healthcare providers, change the negative perception of health insurance and foster mutually beneficial partnerships.

“Another good thing about this product is that it is strongly regulated by the National Health Insurance Authority. The benefit package is robust, while the premium was actuarially determined at ₦38,718 per person per annum and is non-negotiable.

“We are implementing this product in strict compliance with the NHIA Operational Guidelines, including the payment of ₦1,450 monthly capitation per enrollee, utilisation of ₦700 per enrollee monthly for fee-for-service, and adherence to all operational processes and procedures contained in the NHIA Operational Guidelines,” he said.

Ewenla disclosed that Ultimate Health HMO was already engaging transport unions, market associations and other informal sector groups to expand enrolment.

He added that the company had introduced flexible healthcare access options that allow enrollees to register at two hospitals—one close to their homes and another near their workplaces or markets.

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