By Sola Ogundipe & Chioma Obinna
Health insurance options for the informal sector as well as small and medium-scale businesses have been boosted with the official launch of the Group, Individual and Family Social Health Insurance Programme (GIFSHIP) by Ultimate Health Management Organisation (HMO).
The launch comes on the heels of the NHIA Act of 2022, which mandates that all private health insurance products must be approv ed and coded by the Authority. The regulation aims to curb arbitrary premium reductions and ensure uniform benefit packages for both the organised private sector and the informal sector.
Announcing its adoption, the Managing Director/CEO of Ultimate Health HMO, Otunba Lekan Ewenla said the new plan, regulated by the National Health Insurance Authority (NHIA), is designed to provide affordable and guaranteed healthcare coverage. With a premium set at N38,718 per person annually.
Speaking in Lagos, Ewenla, a former governing council member of the Lagos State health insurance scheme, said GIFSHIP offers a robust benefits package widely recognised by NHIA-accredited healthcare facilities, even as he raised concerns that without urgent reforms focused on enrollment, transparency, and enforcement, the country risks deepening inequities in access to care.
According to him, while the package is not as extensive as that offered to federal civil servants, it has gained popularity among operators of small and medium-scale businesses and those in the informal sector.
“The benefits package regulated by the National Health Insurance Authority is rich, the premium is not negotiable, the quality of care is guaranteed and the premium is affordable.
“We are formally announcing adoption of GIFSHIP benefit package as the basic benefit package of Ultimate Health HMO for individual,family, associations, groups, the Organised Private Sector, the informal sector in Lagos and across the country.
“The adoption of GIFSHIP as the basic benefit package was a strategic step to strongly focus on the objectives of making healthcare affordable, accessible and equitable and the premium for the GIFSHIP is N38,718 per person per annum. The business development strategy of Ultimate Health HMO is to target and focus on the mass market in order to change the narration of our poor health indices which is the main objective of all nations to adopt health insurance programmes for their populace.
“Ultimate Health HMO already manages a reasonable number of public sector enrollees that runs into hundreds of thousands and have quite a number of small, medium and big corporate organisations on this product across the 36 states of the federation including the Federal Capital Territory,” Ewenla noted.
With reference to Sections 34(2) and 15(9) of the Act, he said it reinforces NHIA’s oversight that all private health insurance plans marketed by HMOs must be subject to approval and regulation by the Authority.
“The healthcare providers are familiar with the services covered at the three levels and have a better understanding of the operational process like calling the HMOs for pre-authorisation codes and utilizing the NHIA tariffs for the secondary and tertiary services.
“It is time to shift from assumptions to what the NHIA Act says. We need to shift from merely treating illness to creating health as we all know that a healthy nation is a wealthy nation,” he noted.
Further, on GIFSHIP, he said it originated from the need to extend health insurance to communities.
“Initially, the benefit package cost about N15,000, later increased to N20,000, and now about N38,718. It was first called the Voluntary Contributors Social Health Insurance Programme.
However, individual plans led to adverse selection, where only sick individuals enrolled, used services, and did not renew.
“To address this, the model shifted to group and family enrollment, now, individuals must enroll with at least two additional people to spread risk.
“There is also a 90-day waiting period, this reduces abuse and ensures sustainability. GIFSHIP is now being promoted because providers understand it clearly, and it reduces negotiation issues with private sector clients.”
With GIFSHIP now positioned as the basic benefit package of Ultimate Health HMO, Ewenla reiterated its commitment to expanding access to affordable, quality healthcare for Nigerians across diverse sectors.
“HMOs must step up, intensifying education campaigns targeted at both employers and workers.
Awareness remains critically low, particularly in the informal sector, which accounts for roughly 60 percent of Nigeria’s population.
“Insurance is a game of numbers, without volume, the system cannot function. Policy enforcement also remains a weak link. While regulations exist requiring private sector participation, compliance is inconsistent.
“GIFSHIP is designed to extend coverage to communities through a more sustainable model. Unlike earlier individual plans that suffered from adverse selection, where only sick individuals enrolled, GIFSHIP requires group or family participation to spread risk more evenly.”
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