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NHISNHIS

National Health Insurance Scheme

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BRIEF INTRODUCTION TO THE NHIS

The National Health Insurance Scheme (NHIS) is a social intervention program introduced by government to provide financial access to quality health care for residents in Ghana. The NHIS is largely funded by:

  • The National Health Insurance Levy (NHIL), which is 2.5% levy on goods and services collected under the Value Added Tax (VAT).
  • 2.5 percentage points of Social Security and National Insurance Trust (SSNIT) contributions per month
  • return on National Health Insurance Fund (NHIF) investments
  • premium paid by informal sector subscribers.
Government allocation complements the funding of the scheme.

    NHIS subscribers fall into two broad groups, the informal and exempt groups. It is only the informal group that pays premium. Members of the exempt group do not pay premium. They are:
  • Formal sector employees and the self-employed who contribute to the Social Security and National Insurance Trust (SSNIT contributors)
  • Children (persons under 18 years of age)
  • Persons in need of ante-natal, delivery and post-natal health care services (pregnant women)
  • Persons classified by the Minister for Social Welfare as indigents,
  • Categories of differently-abled persons determined by the Minister responsible for Social Welfare
  • Persons with mental disorder
  • Pensioners of the Social Security and National Insurance Trust (SSNIT pensioners)
  • Persons above seventy years of age (the elderly)
  • Other categories prescribed by the Minister.
In addition to the premium, subscribers are also required to pay a processing fee or renewal fee for their ID cards, except pregnant women and indigents. The table below depicts the different categories of subscribers, payments they have to make and whether or not they serve a waiting period.

Several categories of health care facilities have been credentialed by the National Health Insurance Authority (NHIA) to provide services to subscribers. These are:
  • Community-based Health Planning and Services (CHPS)
  • Maternity homes
  • Health centres
  • Clinics
  • Polyclinics
  • Primary hospitals (district hospitals, CHAG primary hospitals, quasi- Government primary hospitals and private primary hospitals)
  • Secondary hospitals
  • Tertiary hospitals
  • Pharmacies
  • Licensed chemical shops
  • Diagnostic centres
You must however visit your primary provider first when you fall ill. If necessary, he/she will refer you to a higher level facility. This ensures that regional and teaching hospitals are able to concentrate on more complicated diseases, to reduce overcrowding and ensure quality of care at all levels.

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