NHIS: HMO sensitise enrollees on rights

NHIS: HMO sensitise enrollees on rights
By Talatu Maiwada
Rights
Abuja, Aug.16, 2018 (NAN) Managed Healthcare Services, a Health Management Organisation (HMO), has urged enrollees of the News Agency of Nigeria (NAN) to uphold their rights in order to enjoy prompt and top quality healthcare under the National Health Insurance Scheme (NHIS).
Mr Roberts Ukeje, the Abuja Branch Manager of the organisation, made the call during an awareness programme on the rights of NHIS enrollees, at NAN Headquarters in Abuja.
Ukeje said that the organisation was one of the HMO’s accredited by the NHIS to make patients a better health care consumer and to promote benefits of wellness.
He explained that the HMO, in accordance with its statutory mandate and in commitment to its social responsibility, recognises the enrollee as the central figure of the health insurance practice.
“The enrollees are supposed to know their rights and benefits package entitled to them, they are the kings and major stakeholders and we are committed to ensuring that they are fully abreast of their benefits.
“The scheme therefore is determined to ensure that the enrollees enjoy prompt and adequate healthcare at all times,” he said.
The manager said the services, also known as `benefit package’ are what enrollees stand to gain.
Ukeje however regretted that paucity of and controlled funds have hindered the scheme from covering all ailments.
He explained that the benefits package was categorised under the primary, secondary and tertiary health care levels.
According to him, the primary health care level includes out-patient care, drugs, maternity care for up to four live births, routine immunisation, child welfare services, family planning services, emergency care, obstetrics and gynaecology.
The manager said that the secondary and tertiary health care categories undertake all procedures that could not be handled at the primary and secondary levels with a referral letter due to need for specialised investigation.
Ukeje noted that the secondary and tertiary levels handle surgical procedures, consultation with specialists such as physicians, dental surgeons, paediatrician, psychiatrist, orthopaedic, radiologist, physiotherapist and dental health, among others.
According to him, exclusion packages which are services not covered by the NHIS comprised partial and total exclusion.
He said the partial exclusion involved high technology investigations during which the HMO pays 50 per cent while the enrollees pay 50 per cent of the medical bill.
“This includes dialysis for acute renal failure, CT scan and life threatening emergencies,’’ Ukeje said.
Total exclusion, he explained, were services excluded from the benefit package of the NHIS, including occupational and industrial injuries, injuries resulting from natural disasters, epidemics, treatment of congenital abnormalities and cosmetic surgeries.
The manager added that enrollees were supposed to pay only 10 per cent total cost of their prescribed drugs and not for the entire treatment, emphasising that other cost incurred has been covered by the capitation fee.
He therefore urged enrollees to be well informed about the packages and give feedback to the agency as well as their HMOs on any challenges encountered while receiving services in facilities under the scheme.
Ukeje said that the scheme could be contacted on various platforms and call centre lines, including NHIS E-mail: mailto:info@nhis.gov.ng”; info@nhis.gov.ng; Website: http://www.nhis.gov.ng”; and www.nhis.gov.ng.
He also gave the contacts for Managed Health Care call centre lines as: 08079992600; 08079992842; 09071348217; 08054706468, and 070010008000. (NAN)
TIM/MS/MST
Edited by Mustapha Sumaila/Muhammad Suleiman Tola