Weak Standards and Actuarial Gaps Stall Health Insurance Coverage in Nigeria
Ultimate Health HMO has identified weak standardisation and the absence of clear actuarial guidance as primary obstacles to the growth of health insurance coverage in Nigeria. According to the organisation, these deficiencies are significantly limiting enrolment rates, undermining the quality of services provided, and perpetuating fragmentation within the sector.
Historical Challenges and Systemic Issues
The managing director and chief executive officer of Ultimate Health HMO, Lekan Ewenla, explained that many of the current challenges trace back to the late 1990s. During this period, private health insurance providers introduced family-based plans with variable benefits, leading to inconsistent service delivery and frequent disputes over premiums and capitation fees.
Ewenla further highlighted that the former National Health Insurance Scheme (NHIS) Act of 1999 exacerbated these issues. Its voluntary provisions and fragmented implementation constrained uptake, leaving many private employers unaware of their statutory responsibilities and limiting the scale necessary for effective risk pooling.
Launch of GIFSHIP Initiative
Speaking at the launch of the Group, Individual and Family Social Health Insurance Programme (GIFSHIP), Ewenla emphasised that the lack of standardised operations, effective regulatory oversight, and actuarial clarity has historically weakened the system and discouraged broader participation.
This initiative is introduced amid renewed enforcement of mandatory enrolment for employers and employees across both the organised private sector and the informal economy. Stakeholders are pushing for expanded access, improved service delivery, and sustainable healthcare financing.
Features and Benefits of GIFSHIP
Priced at N38,718 per person annually, GIFSHIP is designed to address existing gaps through a clearly defined contributory benefit package regulated by the National Health Insurance Authority (NHIA). The plan covers individuals, families, and groups, while separating individual enrolment from the traditional family model that previously constrained service delivery.
Standardising premiums and operational processes is expected to reduce disputes between healthcare providers and health maintenance organisations (HMOs), ensuring consistent quality of care across all service levels.
Importance of Scale and Compliance
Ewenla stressed that sufficient enrolment volume is critical for effective risk management and the sustainability of health insurance schemes. He urged private employers to convert existing medical allowances into structured health insurance contributions and encouraged informal sector participants to leverage associations and mobile platforms to drive wider enrolment.
The organisation also disclosed that it has become the first HMO to submit actuarially developed complementary and supplementary benefit packages for approval and coding by the NHIA. This reflects a commitment to delivering tailored services for high-income groups while expanding access for the broader population through GIFSHIP.
Regulatory Framework and Future Outlook
Ewenla noted that the NHIA Act 2022 provides the necessary regulatory framework to ensure access to essential healthcare services for all Nigerians. He emphasised the need for the sector to shift from assumptions to full compliance and from reactive treatment to preventive healthcare.
With a growing base of enrollees across Nigeria's 36 states and the Federal Capital Territory, GIFSHIP is positioned as a scalable solution for bridging healthcare gaps, improving service delivery, and strengthening social and economic resilience.
The organisation urged Nigerians to take proactive steps towards enrolment, noting that compliance with the NHIA Act is not only a legal obligation but also a safeguard against the financial burden of medical emergencies. Achieving universal health coverage will require stronger adherence to standardised systems and actuarial principles, with GIFSHIP described as a sustainable model capable of expanding access to quality healthcare for millions while reducing fragmentation in the sector.
