Types of Health Insurance in Nigeria (Best Health Insurance 2023)

Last Updated on January 27, 2023

Health insurance in Nigeria can be the difference between life and death. Because of how expensive medical care can be, it makes sense to buy a health insurance policy for yourself and your family.

So whenever a medical emergency arises, you’ll have less stress on your financial resources. Finding the best health insurance in Nigeria that fits your criteria can be a bit tricky.

Common criteria can include plan prices, policy offerings, customer service ratings, claims service, coverage benefits, and provider choices.

However, your best decision will be based on depending on the type of health insurance you need, your budget, and what is available in your area.

An ideal health insurance policy will cover expenses made towards hospitalisation, doctor consultation, and medical tests.

Sometimes post-hospitalization recovery costs can also be covered to a certain extent.

Access to health insurance in Nigeria may vary from state to state because where you live, will determine which health insurance companies are available to you and the coverage offerings they offer.

The penetration of health insurance is still relatively low in Nigeria. This guide seeks to answer all the pertinent questions you may have regarding health insurance in Nigeria. 

Also See: Comprehensive Car Insurance in Nigeria

What is Health Insurance?

Health insurance is an agreement whereby an organisation (insurance company) is paid a set amount of money each month (premium).

In turn, the insurance company agrees to pay doctors, hospitals, and pharmacies when you get sick, get examined, or buy prescription drugs.

When an insurance company pays for your health care, it is called “covering” your services.

Is there Health Insurance in Nigeria?

Health insurance in Nigeria is provided by the government through a health insurance scheme in Nigeria and also by private companies in partnership with private health care providers.

Types of Health Insurance in Nigeria

Currently, there are basically two types of health insurance available to Nigerians. These are:

• The private-owned Health Insurance Companies (Exclusive Provider Organization (EPO), Preferred or Participating Provider Organization (PPO) & Health Maintenance Organizations (HMOs))
• The Government powered the National Health Insurance Scheme (NHIS). 

While there are usually four major types of health insurance plans;

• HSA (Health Savings Account)
• HDHPs (high deductible plans)
• POS (Point Of Service)

The companies that provide private health insurance in Nigeria have plans/packages that are targeted at Nigerians.

Who isn’t covered by the National Health Insurance Scheme (NHIS) or for which the NHIS does not provide sufficient enough covering?

These private health insurance providers have to go through an accreditation process with the National Health Insurance Scheme. Before they are allowed to operate as health insurance providers.

Adults can enrol for any health insurance plan of their choice.

They can also sign up to four dependents including their spouse with both the NHIS and private health insurance providers.

However, dependents must not be older than eighteen years of age, except for the spouse.

When an enrolled dependent turns eighteen, they will register separately.

Also See: Top Insurance Companies in Nigeria

What are the Health Insurance Plans/Packages in Nigeria

A health insurance plan offers a particular set of health care benefits based on the premium agreed between the enrollee and the health insurance company.

There are usually four major types of health insurance plans; EPOs, HMOs, HDHPs and POs. However, Health maintenance organization plans (HMOs) are more popular in Nigeria than their other counterparts.

HMOs, require that you choose a primary care physician or provider that is on their list of providers. This primary provider coordinates all of your healthcare needs.

Although HMO plans usually prohibit you from seeing out-of-network providers unless it is prearranged by your primary care provider and approved by the insurance or it is an emergency.

HMOs in Nigeria provide different health insurance packages for individuals, families, and businesses.

These packages also include different tiers e.g Gold, silver, bronze and platinum. Some of these packages allow you to pay monthly, quarterly or annually

Which HMO is the best in Nigeria? – Best Health Insurance in Nigeria

Based on affordability, nationwide hospital network, instant access (No need for filling long forms), awesome customer care and a loyalty reward program. We have listed some of the Best HMOs in Nigeria:

• Reliance HMO
• Avon HMO
• Hygeia HMO

What is the National Health Insurance Scheme in Nigeria?

The National Health Insurance Scheme in Nigeria was created by the government, and covers Nigerian citizens.

These citizens must either be government employees, in the organised private or informal sector, children under five, permanently disabled persons and prison inmates. However, less than 5% of Nigerians are covered by NHIS.

What Does NHIS Cover in Nigeria?

NHIS coverage and benefits in Nigeria include the following:

1. Receive Outpatient care or treatment (that is, a treatment that does not require an overnight stay in a hospital or medical facility), including necessary drugs, injections, and drip.
2. Receive prescribed drugs, pharmaceutical cares as well as diagnostic tests.
3. Receive maternity care for up to four (4) live births for every insured contributor/couple in the formal sector Program. Additional care is also available if any stillbirth occurs.
4. All live births requiring covering or incubation will be incubated appropriately during the post-natal period of twelve (12) weeks from the date of delivery.
5. All preterm/premature babies eligible for covering or incubation shall be covered for twelve (12) weeks from the date of delivery.
6. Preventive care includes immunisation as it applies in the National immunisation program, Health Education, Family planning (counselling), antenatal and post-natal care, as well as adult immunisation against Human papillomavirus (HPV) and hepatitis.
7. Consultation with a specialist such as physicians, paediatrics, obstetricians, gynaecologists, general surgeons, orthopaedic surgeons, ENT, dental surgeons, radiologists, psychiatrists, ophthalmologists and physiotherapists, etc.
8. Hospital care in a standard ward for a cumulative limited stay of 21days per year.
9. Eye examination and care, the provision of low-priced spectacles but excluding contact lenses.
10. All ophthalmological cases can be handled at the primary level except those requiring tertiary care or on the exclusion list.
11. A range of prostheses (limited to artificial limbs produced in Nigeria).
12. Preventive dental care and pain relief (including consultation, dental Health education, amalgam filling and simple extraction).
13. Root-canal treatment; treatment is needed when an injury or a large cavity damages the tooth’s root (maximum of two treatments).

How is Healthcare Funded in Nigeria?

In Nigeria, revenue for financing the health sector is collected majorly from pooled and unpooled sources.

The pooled sources are collected from the budgetary allocation, direct and indirect taxation as well as donor funding.

The unpooled sources contribute over 70% of total health expenditure (THE). This is usually in the form of fees (informal or formal direct payments to healthcare providers at the time of service) which accounts for 90%.

And also payments for goods (medical products such as bed-nets, or condoms) which account for 10%.

Even with these health financing options in Nigeria, the healthcare industry is rife with regional expenditure inequity.

The country needs to find a way to proportionately distribute funds across the healthcare system.