NHIS Official Accreditation Guidelines For Health Maintenance Organization

The National Health Insurance Scheme is Nigeria’s health insurance regulatory body, established under Act 35 of 1999 Constitution by the Federal Government of Nigeria to improve the health of all Nigerians at an affordable cost.  through various prepayment systems.

The scheme works closely with the health maintenance organization and health providers to securing universal coverage and access to adequate and affordable healthcare in order to improve the health status of Nigerians, especially for those participating in the various programmes/products of the Scheme.

This post is to aid our readers who have been sending emails or messages to us requesting for the role of HMOs and how they are formed.

HMO Accreditation Guide

A Health Maintenance Organization (HMO) is a private or public incorporated company registered by the Scheme solely to manage the provision of health care services through Health Care Facilities accredited by the Scheme.

Eligibility 

Any group of persons or organization of proven and impeccable character may be eligible to form a company (private or public) and apply for registration as an HMO under the Scheme.

No HMO shall  appoint or have in its employment a Director, Chief Executive, Manager or Secretary if he/she:

  1. Is or becomes of unsound mind , or as a result of ill health, is incapable of carrying out his duties;
  2. Is convicted of any offence involving dishonesty or fraud;
  3. Is not a fit and proper person for the position;
  4. Is guilty of serious misconduct in relation to his duties;
  5. In the case of a person with professional qualification; has been disqualified or suspended from practising his profession in Nigeria by the order of any competent authority made in respect of him personally.

Conditions for Accreditation

Any company applying for accreditation under the Scheme shall meet the following requirements:

1)      Register with the Corporate Affairs Commission.

2)      Original Certificate of Incorporation, Articles and Memorandum of Association would be sighted and verified

3)      Provide Statement of Affairs of the Company or Audited Accounts for the past 3 years (where applicable)

4)      Provide evidence of Fidelity Guarantee/Indemnity Insurance Cover with an NHIS-accredited insurance company to the value of the paid up share capital

5)  Complete the prescribed application forms providing the following information:

  1. Ownership structure and composition of the organization
  2. Names, addresses and detailed CV of the principal officers

6)      A minimum paid-up share capital requirement of HMOs shall be as follows:

  1. National HMO shall be required to have a fully paid up share capital of N400 million naira andsubject to review by the NHIS
  2. Zonal HMO shall be required to have a fully paid up share capital of N200 Million and subject to review by the NHIS
  3. State HMO shall be required to have a minimum paid up share capital of N100 Million and subject to review by the NHIS

Note 

  1. A maximum of 30% of the paid up share capital can be held in form of fixed asset for a fresh applicant.
  2. For currently accredited HMOs, a maximum of 40% of the paid up share capital can be held in form of fixed asset. 50% can be held as working capital and 10% in form of cash at hand.

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The Admin is a Medical and Dental Council of Nigeria Certified Medical Doctor. He is popular for being a fast rising online voice in Nigeria, with a flair for animated writing. He is a professional health content writer. He loves to swim, read and play board games. He see himself as one who is destined to play a role in the way health services are rendered to the human race.