The recently launched Lagos State Health Insurance Scheme (LSHIS) is compulsory for every resident in the State while any other form of health insurance is a top-up, the General Manager, Dr Peju Adenusi has affirmed.
Adenusi who was guest of the Knowledge Management and Communications Committee of the Lagos State Accountability Mechanism for Maternal and Newborn Child Health (KMC-LASAM) explained that regardless of whether a resident already has an existing health insurance, it is compulsory to buy-in into the state-owned insurance to enjoy privileges of the ongoing reformed healthcare services.
According to Adenusi, “If you are a civil servant in Lagos, the state health insurance scheme is replacing the free healthcare as government is paying 75 percent of the premium while a civil servant will then be paying (balance of) 25 percent.
“(However), just like any other residents in Lagos state, if you already have a private plan, nobody is going to say stop your plan. But, remember that the Lagos state health plan is just one health plan which is the basic health plan.
“However, when a state says something is mandatory, I think it is the duty of the residents to come on board, if you now choose to have a private plan as a top up, fine”, says Adenusi.
The General Manager said the State Scheme is designed mainly to cater for the majority of residents who constitute the vulnerable group who have been found to commonly seek medical support due to inability to pay out of pocket.
“We are talking about a group of people that form almost 70 percent, which is the vulnerable group of the population of Lagos state, the informal sector, who don’t have any plan at all and who are most hit when these health conditions come. I think this is an area to focus on.
“However, since it is mandatory, it is expected that every resident living in Lagos state be part of the State Health Insurance scheme”, averred Adenusi.
In enrolling for the State Health Insurance Scheme, Adenusi listed the benefits especially at family level saying, “Lagos state government decided to come up with the LSHIS by looking at the common ailments that make people come to the hospital and can actually cause financial burden to the people.
“The Government developed the scheme with the needs of the people, at least the basic needs, so if we look around us, we would find out that the common illnesses are malaria, common childhood diseases that are preventable through immunization, common diarrhea, and the long communicable diseases like hypertension, diabetes and all these services can be rendered at the Primary HealthCare level which is what the benefit package seeks to address. That is, common ailments that can be handled at the PHC level”, said Adenusi.
She explained further that for a family of six, (a father, mother and four children below 18 years), the annual premium package is N40,000 but where the children are above 18 years, the family will pay the mandatory enrolment premium of N40,000 and in addition, N8, 500 per older child.
“There is an accommodation for individual enrollment into the Scheme because not everyone that resides in Lagos state is already married or reside with their family.
“We have people who are living alone, so for single individuals, they can come and be enrolled into the scheme and pay a premium of N8,500.
“We know(also) that there are families that are larger than six, so every additional family member, that is less than 18 years, attracts N6,000 per person, per year. But if the person is above 18 years of age, then it will be N8,500 per person per year, remember the duration of the policy is for a year” the General Manager said.
One other feature of the State Health Insurance Scheme, is that enrollees can only choose a health facility for use per year as there is no room for switching facilities.
This Adenusi explained is due to the way the scheme is designed and providers would be paid an agreed sum per person, per month throughout the period of the policy and the policy runs for a year, so its annual renewal.
“So whether or not a client come to the hospital, it is an agreement between the Lagos State Health Insurance Management Agency (LASHMA) and the provider, to provide these services, and because of such a method, it will be difficult for an enrollee to move from one facility to the other” said, Adenusi.