The National Health Insurance Authority is a corporate body that seeks to attain a universal health coverage in relation to
- persons resident in Ghana
- persons not resident in the Ghana but who are on a visit to the country
- and to provide access to healthcare services to the persons covered by the Scheme.
Table of Contents
What are the functions of the authority?
For the purposes of achieving its objective of providing universal and quality health to Ghanaians, the Authority may
- Implement, operate and manage the National Health Insurance Scheme
- Determine in consultation with the Minister contributions that should be made by members of the National Health Insurance Scheme;
- Register members of the National Health Insurance Scheme;
- Register and supervise private health insurance schemes
- Issue identity cards to members of the National Health Insurance Scheme
- Ensure equity in health care coverage
- Ensure access by the poor to healthcare services
- Ensure protection of the poor and vulnerable against financial risk
- Grant credentials to healthcare providers and facilities that provide healthcare services to members of the National Health Insurance Scheme
Manage the National Health Insurance Fund
- Provide a decentralized system to receive and resolve complaints by members of the National Health Insurance Scheme and healthcare providers
- Receive, process and pay claims for services rendered by healthcare providers
- Undertake public education on health insurance on its own or in collaboration with other bodies
- Make proposals to the Minister for the formulation of policies on health insurance
- Undertake programmes that further the sustainability of the National Health Insurance Scheme
- Develop guidelines, processes and manuals for the effective implementation and management of the National Health Insurance Scheme
- Ensure the efficiency and quality of services under the national and private health insurance schemes
- Protect the interest of members of private health insurance schemes
- Identify and enrol persons exempt from payment of contribution to. National Health Insurance into the National Health Insurance Scheme
- Monitor and ensure compliance with this Act and any Regulations, guidelines, policies, processes and manuals made under this Act for National Health Insurance.
- Perform any other function conferred on it by this Act or that are ancillary to the obj.ect of the Authority.
What benefits do you get from registering with the authority?
The National Health Insurance Authority provides a range of paid healthcare services to its members. They are listed below;
Out Patient Services
The scheme covers consultations including reviews of conditions that are treated at outpatient setting which are;
- Malaria, acute respiratory tract infection, diarrhoeal disease, skin disease and ulcers, hypertension, acute eye infection, rheumatism, anaemia, intestinal worms disorders, acute ear infection, typhoid fever, dental caries, diabetes mellitus, STIs, asthma and others (general and specialist)
- Investigations, including laboratory investigations, x-rays
ultrasound scans for general and specialist out-patient services.
- HIV/AIDS symptomatic treatment for opportunistic infections.
- Out-patient/day surgical operations, including hernia repairs, incision and drainage of abscesses, and excision of lumps and haemorrhoidectomy.
- Out-patient physiotherapy.
- Medication, namely, prescription medicines on the National Health
- Insurance Scheme Medicines List, traditional medicines approved by the Food and Drugs Board and prescribed by accredited medical and traditional medicine practitioners.
- Any other services approved by the Minister of Health.
The authority caters for oral health services like;
- Pain relief, which includes incision and
- Drainage, tooth extraction and temporary relief.
- Dental restoration, which includes simple amalgam
- Fillings and temporary dressing
All emergencies are covered. These are crisis health situations that demand urgent intervention and include:
- Medical emergencies and surgical emergencies, including brain surgery or heart surgery due to accidents.
- Paediatric emergencies.
- Obstetric and Gynaecological emergencies including Caesarean sections.
- Road Traffic Accidents.
- Industrial and workplace accidents
Maternity services catered for by the scheme are;
- Antenatal care
- Deliveries (normal and assisted)
- Caesarean section
- Post-natal care
In Patient Service
- General and specialist in-patient care.
- Investigations including laboratory
- Investigations, x-rays and ultrasound scans for in-patient care.
- Cervical and breast cancer treatment.
- Diagnosis and complications from other cancers, e.g. anaemia or obstruction
- Surgical operations, including appendicectomy (removal of the appendix).
- In-patient physiotherapy.
- Accommodation in general ward.
How do you become a member?
To register as a subscriber of NHIS, you will be interviewed to know which category you belong to, whether you are registering as:
- An annual premium paying member, or
- A member of the exempt group.
If you are registering as an annual premium paying member, please note that you will pay premium and processing fee once every year for renewal.
However, if you are registering as a member of the exempt category, take note that you will be required to have proof of exemption. This is the list of exempt category members who do not pay processing fee;
- Pregnant women
- Categories of differently-abled persons determined by the Minister responsible for Social Welfare
- Persons with mental disorder
- SSNIT contributors
- SSNIT pensioners
- Persons above seventy years of age (the elderly)
- Other categories prescribed by the Minister
You must however bear in mind that you will be required to renew your membership every year.
What processes do you follow to register?
- At registration, the registration officer will assist you to fill a registration form. You will need to provide the following personal particulars;
- Full name
- Date of birth
- Marital status
- Mobile phone number(s)
- Community of residence.
- After taking your personal particulars and payments, the registration officer will take your photograph and biometric information.
- During the taking of your photograph, you should open your eyes and look straight into the camera. You should also close your mouth.
- The biometric information required is fingerprints of your ten fingers. The prints will be taken in this order:The four fingers of your right hand,the four fingers of your left hand and your two thumbs.
- During registration, you will be required to select your preferred primary provider (PPP).
The PPP should be a primary care provider, which should either be a clinic/health centre, polyclinic or a primary hospital. You should make the choice yourself otherwise you will be assigned to an available primary care provider.When you fall ill, you should first of all visit your PPP for treatment. If your illness cannot be treated at the primary care level, you will be referred to a higher level health care facility.
- In an emergency, you may access health care at any health care facility.
- You may change your PPP at determined intervals or when you change your permanent residence.
- After registration, the district office will give you a list of health care facilities within your area operating under the NHIS
The article has concretely described the simple steps an individual can take easily to become a member of the National Health Insurance Scheme.