How to enrol with NHIA and use your cover

Health insurance helps you pay for care before you fall ill, so that a hospital visit does not become a financial crisis for your family. The National Health Insurance Authority (NHIA) oversees health insurance in Nigeria, working with health maintenance organisations (HMOs) and state health insurance schemes. Almadina Hospital is accredited by NHIA and treats patients covered under participating plans.

This guide explains the main ways people enrol, how to choose a hospital, and what happens when you use your cover.

Why enrol

Without insurance, most people pay for consultations, tests, medicines and admissions out of pocket, often at the moment they can least afford it. Health insurance spreads those costs across many people over time. Once enrolled, many common services are covered, and you pay little or nothing at the point of care for covered treatment.

The main ways to enrol

How you enrol depends on your situation. The main routes are:

Through your employer. Many government and private employers enrol staff in a health insurance plan. Ask your human resources or welfare office whether you are covered, which HMO manages your plan, and how to register your spouse and children.

Through the state scheme. Kaduna State, like other states, runs a contributory health scheme for residents, including people who are self-employed or work in the informal sector. Ask at the state scheme's offices or at a participating health facility about registration and contributions.

Through a private plan. You can buy a plan directly from an HMO for yourself or your family. Compare what each plan covers, the hospitals it works with, and the cost.

Through community and support programmes. Some vulnerable groups, including pregnant women, young children and older people on low incomes, may be enrolled through government-funded programmes. Ask at your local primary health centre.

Choosing your hospital

When you enrol, you choose, or are assigned, a primary health care provider. This is the hospital or clinic you visit first for most of your care. If you would like Almadina Hospital as your provider, ask your HMO or scheme whether it works with us. Our NHIA desk can also tell you which plans we currently accept.

You can usually change your provider at set times. Ask your HMO how.

What your plan covers

Cover varies between plans. Many include:

• Consultations with doctors.
• Many common laboratory tests.
• Medicines on the plan's list.
• Antenatal care and delivery.
• Some admissions and procedures.

Some services need prior authorisation from your HMO before they are provided, and a few may not be covered at all. Specialist referrals often need authorisation too. Our NHIA team will explain before treatment begins whether a service is covered, needs authorisation, or must be paid for directly. Emergency care is never delayed while authorisation is sought.

What to bring to the hospital

• Your NHIA or HMO card, or your enrolment letter and number.
• A form of identification.
• Any referral letter, if you were referred from another facility.
• Your previous medical records, if you have them.

At Almadina Hospital, go to reception first. You will be directed to the NHIA desk, where your eligibility is confirmed.

Keeping your cover active

• Make sure contributions are paid on time, whether by you or your employer.
• Update your details if you move, change jobs or have a baby.
• Register new family members as soon as possible.
• Keep your card safe and bring it to every visit.

If something goes wrong

If you are asked to pay for a service you believe your plan covers, ask our NHIA desk to explain. If you are still unsure, contact your HMO directly. Your feedback also helps us improve, and you can share it through the patient feedback form on this website.

Questions to ask your HMO

Before you need care, it helps to know the answers to these questions:

• Which hospital is my primary care provider, and how do I change it?
• Which services need prior authorisation, and how long does approval usually take?
• Which medicines are on my plan's list?
• Are antenatal care, delivery and caesarean section covered?
• Is there a waiting period before certain services can be used after I enrol?
• How are my spouse and children registered, and up to what age are children covered?
• What should I do if I need care while travelling outside the state?

Keep your HMO's telephone number with your card, so you or a family member can reach them quickly if needed.

Common questions at the NHIA desk

"Why must I go to my primary provider first?" The scheme is designed so that your primary provider coordinates your care and refers you to specialists when needed. Going elsewhere without a referral may not be covered, except in emergencies.

"Why am I asked to pay for some medicines?" Plans cover medicines on an approved list. If a doctor prescribes something outside that list, the NHIA team will explain the options, including covered alternatives.

When to come to the hospital

Come to Almadina Hospital with your NHIA or HMO card for any covered care, and ask our NHIA desk if you have questions about your plan. In an emergency, come straight away, day or night, whether or not your cover is confirmed. We are at 1-4 Chikaji Road, Sabon Gari, Zaria. Call 0806 083 9148 and ask for the NHIA team.