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Understanding the differences between NHIS and HMOs in Nigeria is essential for anyone looking to choose the right health insurance. In a country where out-of-pocket medical expenses often push families into financial distress, selecting the right plan can save lives and protect your income.
This comprehensive guide by TJ News Nigeria explains what NHIS (now NHIA) and HMOs are, how they function, the services they offer, and how to decide which one suits your needs best.
What Is NHIS in Nigeria?
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NHIS stands for the National Health Insurance Scheme, which has now transitioned into the National Health Insurance Authority (NHIA) under the 2022 NHIA Act. It is a government-run health insurance program aimed at achieving universal health coverage (UHC) in Nigeria.
Key Features:
- Managed and funded by the Federal Government
- Targets formal sector employees and vulnerable populations
- Premiums are often deducted directly from salaries
- Covers basic medical services: consultations, drugs, maternal care, and chronic conditions
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TJ News Nigeria learnt that the NHIA now regulates both public and private health insurance providers, including HMOs.
What Are HMOs in Nigeria?
Health Maintenance Organizations (HMOs) are privately owned companies licensed by the NHIA to provide health insurance to individuals, families, and corporate groups. They act as intermediaries between enrollees and hospitals, managing access to medical care and services.
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Key Features:
- Private sector-based and regulated by NHIA
- Offer a wide range of plans: Basic, Standard, Premium
- Include outpatient, inpatient, surgical, dental, and specialist services
- Provide access to private and public hospitals
NHIS vs HMO in Nigeria: Full Comparison Table
Here’s a side-by-side comparison to help you understand the main differences:
| Criteria | NHIS / NHIA | HMOs (Private) |
|---|---|---|
| Management | Federal Government (NHIA) | Private firms regulated by NHIA |
| Target Audience | Public sector employees, retirees | General public, private workers, SMEs |
| Coverage Scope | Basic services (limited) | Comprehensive, with customizable plans |
| Premium Payment | Salary deductions, government funding | Direct payments by individuals/employers |
| Hospital Network | Mostly public and partner hospitals | Wide: private, public, specialist hospitals |
| Claim Processing Speed | Slower due to bureaucracy | Faster with dedicated support teams |
| Flexibility | Low: pre-set packages | High: flexible and plan-based |
| Enrolment Process | Through employer or zonal NHIA office | Online, mobile, or in-person with HMO |
| Use in Rural Areas | Less effective, limited facilities | HMOs may offer mobile care partnerships |
| Cost | Lower (government subsidized) | Varies depending on plan and provider |
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Why the Change from NHIS to NHIA Matters
The shift from NHIS to NHIA in 2022 was part of Nigeria’s move toward universal healthcare. Under the new law:
- All Nigerians must be enrolled in a health insurance scheme (either NHIA or HMO).
- NHIA now regulates all health insurance providers, including state-run schemes and HMOs.
- There is greater oversight and a push for quality care across all regions.
Cost of NHIS vs HMO Plans as of 2025
NHIS/NHIA:
- Premiums are typically ₦15,000 – ₦20,000/year for an individual (often subsidized).
- Public workers usually do not pay directly.
- Services may be limited to specific government-approved hospitals.
HMO Plans:
- Basic Plan: ₦10,000 – ₦20,000/year
- Family Plan (up to 5): ₦50,000 – ₦150,000/year
- Premium Plan (including surgery, dental, optical): ₦100,000 – ₦250,000/year
TJ News Nigeria reports that more Nigerians are switching to HMOs for improved access to specialist services and shorter hospital wait times.
Which Option Should You Choose?
Choosing between NHIS and HMO depends on several factors:
Choose NHIS/NHIA if:
- You are a government employee or civil servant
- You want low-cost, basic healthcare coverage
- You live near government-approved hospitals
- You have limited medical needs
Choose HMO if:
- You want access to private hospitals and specialists
- You’re a business owner, freelancer, or private-sector worker
- You want customized plans for maternity, dental, or chronic diseases
- You live in urban areas with access to HMO-approved facilities
How to Register for NHIS/NHIA
- Visit any NHIA zonal or state office
- Fill the NHIA registration form
- Submit ID, passport photo, and employment letter
- Receive enrollee ID and start accessing care
For voluntary contributors or self-employed persons, visit www.nhia.gov.ng to register.
How to Register with an HMO
- Visit the HMO’s official website (e.g., Hygeia, AXA Mansard, Avon HMO)
- Choose a plan
- Complete online registration and upload supporting documents
- Make payment via bank transfer or online gateway
- Get HMO ID and start accessing services
Top NHIA-Accredited HMOs in Nigeria as of 2025
- Hygeia HMO
- AXA Mansard Health
- Reliance HMO
- Avon HMO
- Total Health Trust
- Clearline International
- MetroHealth HMO
Always verify HMO accreditation via NHIA’s portal.
Common Complaints About NHIS and HMOs
| NHIS Issues | HMO Issues |
|---|---|
| Long claim processing time | High premium for top-tier plans |
| Limited hospital options | Some hidden charges |
| Poor service in rural zones | Exclusion of pre-existing conditions |
| Lack of public awareness | Inconsistent hospital experience |
TJ News Nigeria learnt that NHIA has started addressing these issues by introducing stricter regulations and public complaint platforms.
FAQs – NHIS vs HMO
Q1: Can I be registered under both NHIS and an HMO?
A: Yes. Some institutions register staff with NHIS while allowing personal HMO coverage.
Q2: Are NHIS and HMO services the same?
A: No. HMOs generally provide more customized and premium services, while NHIS offers basic care.
Q3: Are all Nigerians required to register?
A: Yes. The NHIA Act mandates compulsory health insurance coverage for all Nigerians.
Q4: What if I relocate to another state?
A: HMO coverage is often nationwide, while NHIS may be limited to zonal access.
Q5: Can I upgrade my NHIS to include private hospitals?
A: No. NHIS services are tied to approved public facilities, but you can subscribe to a private HMO plan separately.
Final Thoughts: NHIS or HMO—What’s Best for You?
In today’s Nigeria, access to quality healthcare is no longer optional. While the NHIS/NHIA offers affordable and basic services for civil servants and low-income earners, HMOs provide faster, more diverse, and customizable healthcare options—especially for those in the private sector or urban areas.
If affordability is your concern, NHIS remains a solid choice. But if you value speed, hospital choice, and advanced medical services, then an HMO plan may be the better option.
TJ News Nigeria recommends comparing several HMO plans and reviewing your coverage needs annually.
Pay Attention To: How to Choose the Right Health Insurance in Nigeria (Latest Guide)
Useful Resources:
- www.nhia.gov.ng – Official regulator
- www.naicom.gov.ng – Insurance regulator
- TJ News Nigeria – Health – Verified health reports
If you found this guide helpful, visit TJ News Nigeria for more updates on health, insurance, and public services.
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