NATIONAL HEALTH INSURANCE AUTHORITY ACT, 2022

NATIONAL HEALTH INSURANCE AUTHORITY ACT, 2022

LAWS OF THE FEDERATION OF NIGERIA

ARRANGEMENT OF SECTIONS

PART I — ESTABLISHMENT OF THE NATIONAL HEALTH INSURANCE AUTHORITY.

1.     Establishment of the National Health Insurance Authority

2.     Objects of the Authority

3.     Functions of the Authority

4.     Establishment of the Governing Council

5.     Functions and powers of the Council

6.     Tenure of office for members of the Council

7.     Meetings of Council

8.     Disclosure of interest

9.     Committees of the Council

10.    Remuneration of members

11.    Cessation of membership and dissolution of the Council

12.    Ministerial directives

PART II — TYPES OF HEALTH INSURANCE SCHEMES

13.    Establishment of health insurance or contributory scheme

14.    Participation in health insurance to be mandatory

15.    Qualification for application

16.    Application for accreditation and licence

17.    Fee for issuance of licence

18.    Refusal to register and license a scheme

19.    Refusal to register or revocation of licence of a scheme

20.    Third Party Administrator

21.    Display of licence

22.    Prohibition on use of name unless licensed

23.    Transfer and joint operations

PART III — IMPLEMENTATION OF THE BASIC HEALTH CARE PROVISION FUND AND ESTABLISHMENT OF VULNERABLE GROUP FUND

24.    Implementation of the Basic Health Care Provision Fund

25.    Object of the Vulnerable Group Fund

26.    Sources of money for the Vulnerable Group Fund

27.    Formula for disbursement from the Vulnerable Group Fund

28.    Management of the Vulnerable Group Fund

29.    Investment of the Vulnerable Group Fund

30.    Expenses of the Vulnerable Group Fund

PART IV — CONTRIBUTIONS UNDER THE HEALTH INSURANCE SCHEMES

31.    Payment of contributions

32.    Registration of employers and employees

PART V — HEALTH MAINTENACE ORGANISATIONS, MUTUAL HEALTH ASSOCIATIONS AND THIRD-PARTY ADMINISTRATORS

33.    Accreditation of Health Maintenance Organisations, Mutual Health Associations and Third-Party          Administrators

34.    Functions of Health Maintenance Organisations and Mutual Health Associations

35.    Third Party Administrators

36.    Accreditation and functions of Health Care Providers

37.    Quality assurance

38.    Appointment of actuary

39.    Directives of the Authority

PART VI — STAFF OF THE AUTHORITY

40.    Director-General and other staff of the Authority

41.    Establishment of offices in States and FCT

PART VII — FINANCIAL PROVISIONS

42.    Establishment of Fund for the Authority

43.    Power to accept gifts

44.    Annual accounts

45.    Annual reports

46.    Exemption from tax

PART VIII — ARBITRATION

47.    Mediation, conciliation and arbitration

PART IX — OFFENCES, PENALTIES AND LEGAL PROCEEDINGS

48.    Offences and penalties

49.    Powers to sanction

50.    Limitation of suit against the Authority

51.    Service of documents

52.    Indemnity of officers

PART X — MISCELLANEOUS PROVISIONS

53.    Contributions to be inalienable

54.    Contributions to form part of tax deductible expense

55.    Transfer of liability

56.    Exclusion from the Trustee Investment Act

57.    Reciprocal agreement with other countries

58.    Repeal

59.    Interpretation

60.    Citation

NATIONAL HEALTH INSURANCE AUTHORITY ACT, 2021

An Act to repeal the National Health Insurance Scheme Act, Cap. N42, Laws of the Federation of Nigeria, 2004, and enact the National Health Insurance Authority Act, 2021 to provide for the promotion, regulation and integration of health insurance schemes in Nigeria; and for related matters.

[Commencement]                               [19th Day of May, 2022]

ENACTED by the National Assembly of the Federal Republic of Nigeria

PART I — ESTABLISHMENT OF THE NATIONAL HEALTH INSURANCE AUTHORITY

1.      Establishment of the National Health Insurance Authority

(1)    There is established the National Health Insurance Authority (in this Act referred to as ‘the Authority’).

(2)    The Authority-

        (a)    shall be a body corporate with perpetual succession and an official seal;

        (b)    may sue and be sued in its corporate name;

(c)    may, for the performance of its functions under this Act acquire, hold, or dispose of any moveable and immovable property; and

(d)    may enter into contract or any other transaction in pursuance of its powers and functions under this Act.

2.      Objects of the Authority

The objects of the Authority are to-

        (a)    promote, regulate and integrate health insurance schemes;

        (b)    improve and harness private sector participation in the provision of health care services; and

(c)    do such other things that will assist the authority in achieving Universal Health Coverage to all Nigerians.

3.      Functions of the Authority Act No. 8, 2014

The Authority shall-

        (a)    promote, integrate and regulate all health insurance schemes that operate in Nigeria;

        (b)    ensure that health insurance is mandatory for every Nigerian and legal residents;

(c)    enforce the basic minimum package of health services for all Nigerians across all health insurance schemes operating within the country, including Federal, States, FCT as well as private health insurance schemes;

(d)    promote, support and collaborate with States through State Health Insurance Schemes to ensure that Nigerians have access to quality health care that meets national health regulatory standards;

(e)    ensure the implementation and utilisation of the Basic Health Care Provision Fund as required under the National Health Act and any guidelines as approved by the Minister under that Act;

(f)     grant accreditation and re-accreditation to Health Maintenance Organisations, Mutual Health Associations, Third Party Administrators and Healthcare Facilities and monitor their performance;

(g)    subject to section 133, approve contributions to be made by members of the various health insurance schemes;

(h)    provide or require the establishment of mechanisms for receiving and resolving complaints by members of the schemes and Healthcare Facilities, Health Maintenance Organisations, Mutual Health Associations and Third Party Administrators;

(i)     make proposals to the Council for the formulation of policies on health insurance;

        (j)     provide technical and other relevant support to State Health Insurance schemes;

        (k)    seek and advocate for funds for the Basic Health Care Provision Fund;

(l)     provide and maintain information and communication technology (ICT) infrastructure and capability for the integration of all data on health schemes in Nigeria including the State Health Insurance Schemes;

(m)   undertake on its own or in collaboration with other relevant bodies a sustained public education on health insurance;

(n)    devise a mechanism for ensuring that the basic healthcare needs of indigents are adequately provided for;

        (o)    maintain a register of licensed health insurance schemes and accredited healthcare facilities;

(p)    valuate any new proposal in relation to extending the coverage of a health insurance scheme to any group of Nigerians;

(q)    in conjunction with the States, devised a mechanism for ensuring that the basic healthcare needs of vulnerable persons are adequately provided for;

(r)     accredit insurance companies, insurance brokers and banks desirous of participating in health insurance schemes under the Authority;

(s)    regulating all health insurance schemes in Nigeria in accordance with the provisions of this Act;

(t)     approve, after consultation with the Health Care Facilities, formats of contracts for    health service purchasing proposed by the Health Maintenance Organisations and the Mutual Health Associations for all Health Care Facilities;

(u)    approve after consultation with Health Care Facilities and the bodies representing the Health Care Facilities, capitation and other payments due to health care facilities by the Health Maintenance Organisations and Mutual Health Associations;

(v)    undertake research and generate statistics on matters relating to the Authority;

(w)    exchange information and data with the National Health Management Information System, financial institutions, Federal Inland Revenue Service, State Internal Revenue Services, National Bureau of Statistics, professional regulatory bodies and other relevant bodies and individuals for research purposes upon their request;

(x)    ensure manpower development of the Authority;

        (y)    develop operational guidelines for the Authority and ensure it is reviewed at least once in five years;

(z)    sanction erring parties in accordance with the provisions of the Operational Guidelines;

(aa)  ensure that tariffs agreed with Health Care Facilities are reviewed on a three-yearly basis to the mutual satisfaction of Health Care Facilities Health Maintenance Organisation, Health Insurance Schemes and the Health Insurance Authority; and

(bb)  carry out such other activities as are necessary or expedient for the purpose         of achieving the objectives of the Authority under this Act.

4.      Establishment of the Governing Council

(1)    There is established a Governing Council (in this Act referred to as “the Council”) which shall consist                       of-

        (a)    the Chairman;

        (b)    one representative each of —

                (i)     the Federal Ministry of Health not below the rank of a Director,

                (ii)    the Federal Ministry of Finance not below the rank of a Director,

                (iii)    the Nigeria Employers Consultative Association, and

                (iv)   the Armed Forces;

        (c)    Two representatives of organised labour;

        (d)    Director-General of the Authority who shall also serve as the Secretary to the Council;

(e)    a representative of each geo-political zone to represent the States, such representation to be rotated between States every two years within the zone; and

(f)     a representative of a Civil Society Organisation whose main activities focus on health.

(2)    Members of the Council, other than the Director General, shall be part-time members.

(3)    All members shall within one month of appointment declare in writing to the Council their personal                     interests known to them in any organisation under this Act.

(4)    If upon declaration a member is found to hold personal interests in conflict with the objects of this Act in whatever form, the appointment shall be withdrawn.

(5)    The Chairman and other members of the Council shall be appointed by the President of the Federal Republic of Nigeria on the recommendation of the Minister, and shall be persons of relevant high education, experience and integrity.

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LAWS OF THE FEDERAL REPUBLIC OF NIGERIA

LAWS OF THE FEDERATION OF NIGERIA BY YEARS (MADE BETWEEN 1999-DATE)