National Health Insurance Scheme

What National Health Insurance Scheme does

The National Health Insurance Authority (NHIA) is a Nigerian government parastatal operating under the Federal Ministry of Health and Social Welfare, established by the NHIA Act 2022 to replace the predecessor National Health Insurance Scheme (NHIS) created under the 1999 Act. The Authority administers Nigeria's national health insurance framework and serves approximately 20 million enrollees — equivalent to 97% coverage of the population formally enrolled — through programs including the Public Sector Programme, OPSSHIP, GIFSHIP, TISHIP, and the Vulnerable Group Fund (VGF). It accredits and supervises Health Maintenance Organizations, healthcare providers, and State Social Health Insurance Agencies, with 50+ accredited HMOs and 37 SSHIAs across all 36 states plus the Federal Capital Territory. The current Director General/CEO is Dr. Kelechi Ohiri, and the Authority has set a stated target of 50 million enrollees by 2027.

Operationally, NHIA functions as regulator, payer, and program administrator. Its technology footprint includes a Self-Service Electronic Portal launched in September 2025 for enrollment, premium payment, and claims processing, alongside HMIS dashboards and an electronic claims platform. The Authority has scaled the Comprehensive Emergency Obstetric and Newborn Care (CEmONC) programme to 250+ facilities reaching 32,000+ mothers and has disbursed N26 billion under the Basic Health Care Provision Fund (BHCPF). Funding flows through a combination of statutory federal allocations, employer/employee contributions under the formal-sector scheme, voluntary premiums (GIFSHIP at N66,000 per individual per year), and earmarked government funding for vulnerable populations.

The business model combines mandated enrollment for the formal sector (employers contribute 3.25% of payroll under the Consolidated Payroll Salary Structure), voluntary premium-based enrollment for the informal sector and diaspora via GIFSHIP, and direct government funding for vulnerable groups. Capitation and fee-for-service tariffs are set at the national level and were repriced upward by more than 90% and 378% respectively in 2025. Enforcement of mandatory enrollment was strengthened by a 2025 Presidential Directive, signaling that future growth will be driven primarily by regulatory compulsion rather than voluntary demand.

Name

National Health Insurance Scheme

Legal name

National Health Insurance Authority

Website

https://nhia.gov.ng

Company type

Private

Founded year

2022

Operating status

Operating

Headcount range

11–50 employees

Short description

The National Health Insurance Authority (NHIA) is a Nigerian government parastatal that regulates and administers national health insurance, serving roughly 20 million enrollees through accredited HMOs and 37 state agencies, targeting 50 million by 2027.

Ownership category

akta.pro rank

Product category

National Health Insurance

NAICS

Direct Health and Medical Insurance Carriers (524114), Health and Welfare Funds (525120)

SIC

Hospital & Medical Service Plans (6324), Accident & Health Insurance (6321)

akta.pro primary industry

Health Policy & Legislation Authorities (HLAJACAA)

akta.pro secondary industry

Network-Model HMOs (HLAEAMAC)

Keywords

• National health insurance
• Social health insurance
• Health coverage schemes
• Healthcare financing
• Universal health coverage

Headquarters

HQ city

Abuja

HQ country

Nigeria

HQ region

Africa

Offices3 records

Markets served

GTM type

B2B and B2C

Offering type

Services

Cost components

Operations, Supply Chain, Personnel, Technology or R&D, Infrastructure, Marketing or Sales

Revenue model

1. Formal Sector Contributions: Public sector employees contribute 5% of basic salary while employers pay 10%, or alternatively 1.5% consolidated from employees and 3.5% from employers. Private sector follows similar structured contribution models based on salary.
2. GIFSHIP Premiums: Individual annual premium of ₦66,000 for 3 people; families pay ₦66,000 to ₦198,000 (for up to 9 persons). Group minimum is ₦220,000 for 10-person package with ₦22,000 per additional person.
3. Basic Health Care Provision Fund (BHCPF): Government-established fund to support healthcare delivery for the poor and vulnerable populations, providing financial access to healthcare particularly for those who cannot afford contributions.
4. Tertiary Institutions Social Health Insurance Programme (TISHIP): Students in tertiary institutions pay ₦2,000 annually for health coverage through their educational institutions.
5. NHIA ID Card Fee: One-time registration fee of ₦1,500 for NHIA ID card, excluding bank charges, required for all enrollees to access care.

Pricing tiers

Go-to-market motion3 records

Distribution channels5 records

Marketing channels5 records

Core offering

The National Health Insurance Authority (NHIA) administers Nigeria's statutory national health insurance scheme, providing financial access to quality healthcare for all Nigerians and legal residents through contributory programs (FSSHIP, OPSSHIP, GIFSHIP, TISHIP, private health plans via HMOs) and non-contributory programs (BHCPF, VGF, CEmONC). Coverage extends to the enrollee, spouse, and up to four biological children under 18, with cashless treatment at accredited facilities and only a 10% drug co-payment.

Product overview

The National Health Insurance Authority (NHIA) operates a multi-programme health insurance platform designed to achieve universal health coverage in Nigeria. The portfolio consists of ten distinct programmes/products: the Public Sector Social Health Insurance Programme for government workers, OPSSHIP for private sector employees, GIFSHIP for informal sector and individuals, Private Health Plans via HMOs, TISHIP for students, SSHIAs for state-level coverage, BHCPF and VGF for vulnerable populations, CEmONC for emergency maternal care, and a Self-Service Electronic Portal for digital transactions. These programmes are coordinated under the NHIA Act 2022 and administered through partnerships with Health Maintenance Organisations (HMOs), Healthcare Providers (HCPs), and State Social Health Insurance Agencies (SSHIAs).

Differentiator

Problem solved

Functional benefit

Brands

• GIFSHIP (Group, Individual, and Family Social Health Insurance Programme): Health insurance program for different categories of people whether employed or not, including small businesses, self-employed individuals, retirees, and foreigners residing in Nigeria.
• OPSSHIP (Organized Private Sector Social Health Insurance Programme)
• Public Sector Social Health Insurance Programme
• TISHIP (Tertiary Institutions Social Health Insurance Programme)
• Basic Health Care Provision Fund (BHCPF)
• Vulnerable Group Fund (VGF)

Products and services

• Public Sector Social Health Insurance Programme (FSSHIP) Health insurance programme for federal, state, and local government workers and their families (spouse and up to four biological children under 18). Provides comprehensive coverage including hospital visits, consultations, emergency care, surgeries, and medications with only a 10% co-payment for drugs.
• Organized Private Sector Social Health Insurance Programme (OPSSHIP) Health insurance coverage administered directly by NHIA for private sector workers at companies with five or more employees. Covers employees, spouses, and up to four children under 18, with minimum basic salary threshold of ₦30,000 and minimum 12-month initial contribution.
• Group, Individual, and Family Social Health Insurance Programme (GIFSHIP) Comprehensive voluntary health insurance for various categories including small businesses, associations, self-employed individuals, retirees, diaspora members paying for relatives, and foreigners residing in Nigeria. Includes sub-programmes GIFSHIP-g (general), GIFSHIP-c (legislators), GIFSHIP-r (retirees), and GIFSHIP-n (NYSC members). Annual premium ₦66,000 for 3 people; ₦66,000–₦198,000 for families (4–9 persons); ₦220,000 minimum for 10-person groups.
• Private Health Plans via Accredited HMOs Health plans provided by accredited Health Maintenance Organisations (HMOs) for employed individuals including self-employed, corporation staff, families, and community groups. Covers doctors' visits, hospital stays, emergency care, and medications through HMO-managed provider networks.
• Tertiary Institutions Social Health Insurance Programme (TISHIP) Healthcare coverage for students in federal, state, and private universities, polytechnics, and other tertiary institutions. Students pay ₦2,000 per academic year through their institution's health center.
• State Social Health Insurance Schemes (SSHIAs) State-level health insurance schemes organized by State Social Health Insurance Agencies in each of Nigeria's 36 states plus FCT, in partnership with NHIA. States create equity funds (25% of federal contribution) to cover poor and vulnerable groups, with coverage up to 100% of costs for state residents.
• Basic Health Care Provision Fund (BHCPF) Non-contributory government-funded program providing health insurance coverage for the poor and vulnerable populations. Delivers Basic Minimum Package of Health Services (BMPHS) and Emergency Medical Treatment (EMT) to support primary and secondary healthcare delivery. ₦26 billion disbursed under NHIA gateway.
• Vulnerable Group Fund (VGF) Non-contributory program providing health insurance coverage for vulnerable populations as part of the NHIA Act 2022 mandate to achieve Universal Health Coverage.
• Comprehensive Emergency Obstetric and Neonatal Care (CEmONC) Life-saving emergency care programme for women and newborns in underserved areas. Provides free emergency obstetric interventions including caesarean sections for vulnerable pregnant women across 250+ facilities in all 36+1 states. Has reached over 32,000 mothers and 1,700 newborns.
• Self-Service Electronic Portal Digital platform enabling enrollees and prospective beneficiaries to conduct health insurance transactions including enrollment, addition of dependents, change of healthcare provider, and other services electronically via phones and electronic gadgets, reducing the need for physical office visits.

Quantifiable outcome

• 32,000+ mothers and 1,700 newborns have benefited from emergency obstetric care through CEmONC program
• +4 more outcomes

Named customers3 records

Segments7 records

Ideal customer profiles5 records

Technology focussed No

API detail

Has API

No

API docs

API detail

Core technology

AI maturity

App detail

Feature3 records

Partnerships

Seven partnerships are on record, tiered core and minor.

• State Social Health Insurance Agencies (SSHIAs)coreChannel Partner/ Reseller/ Distributor37 SSHIAs operate in all 36 states plus FCT as implementing partners for state-level health insurance schemes. Each SSHIA creates state equity funds equivalent to 25% of federal government contribution to cover the poor and vulnerable populations. NHIA provides technical support and coordinates with SSHIAs under the 'Health Insurance Under One Roof' framework.
• Health Maintenance Organisations (HMOs)coreChannel Partner/ Reseller/ DistributorOver 50 accredited HMOs deliver private health plans to enrollees. HMOs manage provider networks, process claims, and deliver customer service for enrolled populations. NHIA accredits and regulates HMO operations under the scheme.
• Healthcare Providers (HCPs)coreOthersAccredited healthcare providers deliver services to NHIA enrollees. The network includes primary, secondary, and tertiary facilities across Nigeria. Providers receive capitated payments and fee-for-service reimbursements from HMOs and NHIA.
• National Primary Health Care Development Agency (NPHCDA)coreStrategic or Co-development PartnerJoint implementation of Basic Health Care Provision Fund (BHCPF). NPHCDA receives BHCPF funds alongside NHIA for primary healthcare service delivery. Both agencies coordinate under the Ministerial Oversight Committee to improve health outcomes including antenatal coverage, skilled birth attendance, and immunization rates.
• Federal Ministry of Health and Social WelfarecoreStrategic or Co-development PartnerNHIA operates under the supervision of the Federal Ministry of Health. The Ministry, led by Coordinating Minister Prof. Muhammad Ali Pate, sets policy direction including the Health Sector Renewal Initiative and BHCPF oversight. Minister announced major fee increases (90%+ capitation, 378% fee-for-service) to strengthen the healthcare system.
• Development PartnersminorOthersNHIA collaborates with international development partners supporting Universal Health Coverage goals in Nigeria. Referenced in context of the Health Renewal Compact signed by Federal and State Governments with development partners in December 2023.
• Research Institutions, Academic Institutions, NGOs, Development PartnersminorStrategic or Co-development PartnerNHIA issued Expression of Interest invitation for priority research in four thematic areas: Expanding Coverage, Improving Quality of Care, Improving Equity, and Improving Market Efficiency. Submission deadline was January 26, 2026.

Scale indicators13 records

Recent moves7 records

Expansion highlights4 records

Direct peers

• Ghana National Health Insurance Authority (NHIA): Ghana's NHIA is the closest functional peer—shares the same name and statutory mandate to operate a national health insurance scheme achieving universal coverage in a West African context. Operates the National Health Insurance Scheme (NHIS) with similar contributory programs, accreditation of providers, and vulnerable population coverage.
• India's Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB PMJAY): India's PMJAY is the world's largest government-funded health insurance scheme covering 500M+ beneficiaries for secondary and tertiary care. Similar to NHIA's BHCPF/VGF in providing vulnerable-population coverage, but on a dramatically larger scale with similar emerging-market execution challenges.
• Philippines Health Insurance Corporation (PhilHealth): PhilHealth is the national health insurance corporation of the Philippines implementing universal coverage through contributory and sponsored programs for poor and vulnerable populations. Operates a similar multi-program architecture with NHIA and serves as a model for emerging-market national health insurance.
• Kenya National Hospital Insurance Fund (NHIF): Kenya's NHIF operates a statutory national health insurance scheme with mandatory enrollment for formal sector employees and voluntary enrollment for informal sector, mirroring NHIA's OPSSHIP/GIFSHIP structure. Comparable African emerging-market context with similar regulatory and provider network challenges.
• Thailand National Health Security Office (NHSO): NHSO administers Thailand's Universal Coverage Scheme (UCS) covering ~70% of the population, including informal sector and vulnerable groups. Operates a purchaser-provider split model with capitation payments to providers—directly comparable to NHIA's capitation/FFS reimbursement model.

Broad incumbents

• Australia Medicare: Australia's Medicare provides universal health coverage through a hybrid public-private model with mandatory levy and private insurance supplements. Comparable to NHIA in providing universal coverage mandate, though operates in a higher-income context with more developed provider infrastructure.
• UK National Health Service (NHS): The NHS provides tax-funded universal healthcare to the UK population, comparable to NHIA's mandate for universal coverage. While NHS is direct provider rather than insurer, NHIA aspires to similar universal coverage outcomes and faces analogous questions about funding sustainability and provider capacity.
• US Centers for Medicare & Medicaid Services (CMS): CMS administers Medicare, Medicaid, and ACA marketplace plans in the US—directly analogous to NHIA's role in administering contributory and vulnerable-population health insurance programs. Similar regulatory, accreditation, and provider reimbursement functions, though at much larger scale.

Emerging players

• Rwanda Community-Based Health Insurance (CBHI): Rwanda's CBHI achieves ~90% population coverage through community-based schemes and is widely cited as a model for African universal health coverage. Comparable to NHIA's GIFSHIP informal-sector model but operates at higher penetration in a smaller population.

Regional players

• Tanzania National Health Insurance Fund (NHIF): Tanzania's NHIF operates a comparable statutory health insurance scheme in East Africa with mandatory formal sector enrollment and voluntary informal sector membership. Shares similar regulatory architecture and emerging-market provider challenges with NHIA Nigeria.

Market position

Strengths5 records

Weaknesses5 records

Competitive moat5 records

Key highlights7 records

Customer concentration

• Xx.com/nhia_nigeria
• Facebookfacebook.com/OfficialNhisNg
• LinkedInlinkedin.com/company/nimsa-hctf-nhia

Revenue estimate

Valuation estimate

Number of profiles

Profiles1 record

Subsidiaries1 record

Funding overview

Funding rounds

Investors

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M&A

Investments

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Frequently asked questions about National Health Insurance Scheme