Demystifying Ghana’s NHIS

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.

Membership & Registration

1. 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.
2. 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.
3. If you are registering as a member of the exempt category, please note that you will be required to have proof of exemption, e.g.:
   • A pregnant woman will have to present proof of pregnancy such as current antenatal card, a signed note from a doctor or midwife, pregnancy test result endorsed by a doctor or midwife or other prescriber or an ultrasound scan report.
   • A SSNIT contributor should be active in the SSNIT database presented to NHIA by SSNIT.
   • A SSNIT pensioner should show his/her SSNIT number. ou will be registered without paying premium.

You will then be registered without paying premium. The following people in the exempt categories do not pay processing fee:

• Pregnant women
• Indigents
• 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 will be required to renew your membership every year.

4. 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
   • Age
   • Marital status
   • Mobile phone number(s)
   • Community of residence/residential address.
5. 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
     • Your two thumbs

6. 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.
7. After registration, the district office will give you a list of health care facilities within your area operating under the NHIS.