Health Insurance: FCTA To Sanction Erring HMOs

The Federal Capital Territory Administration (FCTA) has said that appropriate sanctions will be meted out to Health Maintenance Organisation (HMOs) under FCT Health Insurance Scheme (FHIS), who failed to promptly remit payments to Healthcare providers.

The FHIS is a Social Health Insurance Programme, offering financial protection through access to quality, affordable and equitable healthcare to all FCT residents.

Free enrolment is opened to staff of the FCTA and Area Councils as well as vulnerable persons, including pregnant women, while other members of the public can enroll upon payment of N22,500 as premium per annum.

In a bid to improve the quality of healthcare services provided to the FHIS enrollees, about N4 billion, being outstanding/backlog payments for capitation and fee for service for years 2022 to 2024, was approved by the FCT Minister, Nyesom Wike, and paid between last year and this year.

According to a statement on Tuesday by the Senior Special Assistant to the FCT Minister on Public Communications and Social Media, Lere Olayinka, the Benefit Package of the FHIS includes the Basic Minimum Package of Health Care services (BMPHS) ranging from promotive, preventive, curative and some rehabilitative care services. The services include primary preventive care, screening, primary emergency services, and secondary level care such as dental, mental, eye, ear, nose and throat care, physiotherapy, surgeries, laboratory investigations, radiological investigations such as ultrasound scan, x-rays.

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However, complaints have been received from some Healthcare providers concerning non-remittance of their payments by some HMOs, under the excuse that bank details of the hospitals were not available, an excuse not acceptable to the government.

Therefore, compliance of the HMOs to the prompt remittance of payments to Healthcare providers, as well as commitment of the Healthcare providers to the discharge of their duties to the FHIS enrollees will be monitored with a view to sanctioning defaulters appropriately.

On implementation of the FHIS in the last one year, there have been payment of all outstanding capitations and fee for service backdated to year 2022 by the end of 2024, improved timeliness in the payment of capitation to HMOs, review and increment of the capitation to Healthcare providers for improved service delivery to enrollees, free enrolment of vulnerable persons especially pregnant women and under-five, poor and indigents, who have started enjoying healthcare services, and accreditation visits to 100 Primary Health Care (PHC) facilities to expand the number of PHC facilities in FCT and improve access to healthcare services in the communities.

Also, all pregnant women who enrolled through the Basic Health Care Provision Fund (BHCPF) Primary Health Care (PHC) Centres across the six Area Councils in the FCT will continue to enjoy free health education, medical consultation and treatment, routine antenatal drugs, laboratory investigations and delivery. Referral for secondary care including caesarean section, blood transfusion, and treatment of other obstetric complications such as eclampsia, at all the 14 General Hospitals in the FCT is also provided at no cost to the patient through the BHCPF.