Ultimate Health HMO Launches GIFSHIP to Expand Health Insurance Access
Ultimate Health Management Organisation (HMO) has officially launched its Group, Individual and Family Social Health Insurance Programme (GIFSHIP), a significant development aimed at broadening healthcare coverage for individuals in the informal sector and small to medium-scale enterprises (SMEs). This initiative arrives in the wake of the National Health Insurance Authority (NHIA) Act of 2022, which mandates that all private health insurance products undergo approval and coding by the Authority. The regulatory framework seeks to prevent arbitrary premium reductions and ensure consistent benefit packages for both the organised private sector and the informal economy.
The Managing Director and CEO of Ultimate Health HMO, Otunba Lekan Ewenla, announced the adoption of GIFSHIP, highlighting that the programme, regulated by the NHIA, is designed to provide accessible and guaranteed healthcare coverage at an annual premium of N38,718 per person.
Speaking from Lagos, Ewenla, who is also a former governing council member of the Lagos State health insurance scheme, described GIFSHIP as offering a comprehensive benefits package recognised by NHIA-accredited healthcare facilities. He also voiced concerns that without immediate reforms focused on enrollment processes, transparency, and enforcement, Nigeria risks exacerbating existing inequalities in healthcare access.
Ewenla noted that while the GIFSHIP benefits package may not be as extensive as that provided to federal civil servants, it has garnered considerable interest among operators of SMEs and individuals within the informal sector.
Key Features and Objectives of GIFSHIP
The GIFSHIP programme is built upon several core principles aimed at making healthcare more equitable and sustainable:
- Regulated Benefits Package: The benefits package is governed by the NHIA, ensuring a standard of care and coverage.
- Fixed and Affordable Premium: The annual premium is set at N38,718 per person and is non-negotiable, contributing to the programme’s financial stability.
- Guaranteed Quality of Care: The programme aims to ensure that enrollees receive a high standard of medical attention.
- Strategic Focus on Mass Market: Ultimate Health HMO’s business development strategy prioritises the mass market with the overarching goal of improving Nigeria’s health indices, aligning with national objectives for universal health insurance.
Ewenla stated, “We are formally announcing the adoption of the GIFSHIP benefit package as the basic benefit package of Ultimate Health HMO for individuals, families, associations, groups, the Organised Private Sector, and the informal sector in Lagos and across the country.” He further elaborated on the strategic importance of GIFSHIP: “The adoption of GIFSHIP as the basic benefit package was a strategic step to strongly focus on the objectives of making healthcare affordable, accessible, and equitable.”
Ultimate Health HMO currently manages a substantial number of enrollees from the public sector, numbering in the hundreds of thousands, and also serves a significant portfolio of small, medium, and large corporate organisations across all 36 states of Nigeria and the Federal Capital Territory.
Regulatory Compliance and Shifting Healthcare Paradigms
Ewenla referenced Sections 34(2) and 15(9) of the NHIA Act, underscoring the Authority’s oversight role in ensuring that all private health insurance plans marketed by HMOs are subject to approval and regulation. This regulatory framework is crucial for standardising the healthcare insurance landscape.
He added that healthcare providers are well-acquainted with the services covered across different levels of care and have a clearer understanding of operational procedures, such as obtaining pre-authorisation codes from HMOs and adhering to NHIA tariffs for secondary and tertiary services.
“It is time to shift from assumptions to what the NHIA Act says,” Ewenla urged. “We need to shift from merely treating illness to creating health, as we all know that a healthy nation is a wealthy nation.”
Evolution and Sustainability of GIFSHIP
The development of GIFSHIP was driven by the necessity to extend health insurance coverage to broader communities. Initially, the benefit package was available at lower price points, around N15,000 and later N20,000, before reaching its current N38,718 annual premium. The programme was initially known as the Voluntary Contributors Social Health Insurance Programme.
However, individual enrollment plans faced challenges, particularly adverse selection, where only individuals with pre-existing conditions tended to enroll, leading to high utilisation of services without sustained contributions.
To counteract this, the model evolved towards group and family enrollment. Under the current GIFSHIP structure, individuals must enrol with at least two additional people to effectively spread the risk across a larger pool. Furthermore, a 90-day waiting period has been implemented to mitigate abuse and ensure the long-term sustainability of the programme. GIFSHIP is now being actively promoted because healthcare providers have a clearer understanding of its operational framework, which simplifies negotiation processes with private sector clients.
The Path Forward: Education and Enforcement
With GIFSHIP now serving as the foundational benefit package for Ultimate Health HMO, Ewenla reiterated the organisation’s commitment to enhancing access to affordable, high-quality healthcare for all Nigerians, irrespective of their sector.
“HMOs must step up, intensifying education campaigns targeted at both employers and workers,” Ewenla emphasised. He highlighted that awareness regarding health insurance remains critically low, especially within the informal sector, which constitutes a significant portion of Nigeria’s population.
“Insurance is a game of numbers; without volume, the system cannot function,” he stated. Policy enforcement also remains a persistent challenge. While regulations mandate private sector participation in health insurance, consistent compliance is lacking.
GIFSHIP is strategically designed to extend coverage to communities through a more sustainable model. Unlike earlier individual plans that struggled with adverse selection, GIFSHIP’s emphasis on group or family participation ensures a more equitable distribution of risk.
