Why do I have to wait until the following month to access care?
The cut-off date for enrollment is 25th. After the cut-off date, the enrollment team will need to complete necessary administrative processes before an enrollee can have access to care. These processes are completed by the end of the month, and access to care will then commence on the 1st day of the following month.
How long will it take to get my card after my enrollment is done?
The card should be ready before the beginning of the month when you will start accessing care.
If I don't go to the facility with my card, will I be able to access care?
Yes. The Agency will be adopting a biometric system for identification. Hence, you will be able to access care even when you don’t have a card at hand. The providers have other ways of verifying your eligibility
You are encouraged to carry your card with you at all times so that care is not delayed when you get to your provider.
Do I have to pay for drugs?
No, as long as the care is within the provision of the benefit package you won’t be required to pay for drugs.
How do I complain when I am not satisfied with the services I get in a facility?
The Agency has designed a complain mechanism for feedback and to provide channels through which enrollees and other stakeholders can make or resolve complaints.
Email: healthinsurance@kwarastate.gov.ng and kwaracare@gmail.com
Phone nos: 08001001001 (toll free).
Facebook: Kwara health insurance scheme
Twitter: @Kwaracare
Instagram: @kwaracare
Can I enroll in more than one hospital?
No, you can only be enrolled in one empaneled hospital of your choice at a time, except in emergencies, when you can have access to emergency care in other parts of the state
Can I choose a health care provider (hospital)?
Yes, you can choose any provider of your choice that has been empaneled for this scheme.
If my usual hospital is far, what do I do in case of emergency?
In a case of emergency you can access care at your nearest available health care provider contracted under the Scheme by presenting your ID card, or number so that the Health Care Provider can verify eligibility and provide care.
How many members of my family can the care cover?
During enrollment families can enroll as units. A family is considered as the head of the household (who is the principal), a spouse and a maximum of four (4) biological or legally adopted children under the age of 18 years.
. If I have more than one wife and four children, how will they be covered?
Additional dependents or children may be covered under this plan or on a separate cover, upon the payment of additional contributions by the principal beneficiary as determined by KWHIA.
How do I know the health plan that suites me?
You will have to identify what target group you belong to as the health plans are designed to suit the formal sector group, informal sector group, or the indigent group. People are also qualified to enroll in a plan that suits the individual, upon payment of the premium for the package desired.
How do I know the target group I fall under?
The scheme defines the formal sector group as civil servants, local government workers and private formal sector(with more than 5 employees), the informal sector group is made of individuals, cohesive groups and small businesses (with less than 5 employees) and the indigent group also referred to as the vulnerable as defined by the scheme. The vulnerable group includes poor pregnant women, children under 5 years, aged, mentally challenged, and the proven economically challenged residents of Kwara State.
What are the criteria for the private employer to enroll their employee for the scheme?
Must have not less than five (5) employees and must enroll as a group.
What administration software will the agency use for effective running of the scheme?
The scheme has engaged a robust ICT platform that emphasizes transparency and accountability, and convenience and ease of doing business.
Has the software integrity and effectiveness verified by the Agency?
Yes, the platform in use was thoroughly vetted for efficiency and accuracy. This platform is also being engaged by other customers in, and outside the country.
How will the HCP's in the rural location make use of the ICT platform with no internet and Mobile Network Access?
We at the agency have established networks in different parts of the state that we plan to engage. All our providers must also be ICT compliant. The systems also have offline capabilities.
What is the next action to take, if the pre-authorization code is not issued on time by the TPA's?
Escalate the issue through one of the Complaints Management System (CMS) tools to the Agency staff in charge.
What are the available means to report complaints to the agency?
- Registers or walk in to the agency office
- Web-Based Platform and Mobile App
- Email Messaging platform
- Toll-free Call-Centre
- Short Code SMS Messaging Platform
Will the capitation and Fee-For-Service be paid directly to the Public HCP's?
Yes, the capitation will be paid in advance at the beginning of every month, while the fee for service will be paid as claims after vetting within 45days of submission by the Health care provider.
How will the Agency manage the public HCP's that are not ready to comply with the Health Insurance Scheme law?
There are sanctions that can be placed on non-compliant providers, whether public or private. This may include termination of contracts in extreme cases
I learnt that Insurance companies is one of the Agency partners, what is their role in the scheme implementation?
At the moment the agency is not engaging insurance companies, but in the future may engage them in a non-insurance capacity.
Which phone number or Website address can people use in making more enquiries about the scheme?
We are currently developing our website and will communicate our website address once completed.
Phone no: 0800 100 1001 (toll-free)
Is the scheme only available in Government hospitals or are private hospitals included too?
Government hospitals and private hospitals have been empaneled in each Local Government for implementation of the scheme.
If Private hospitals are also included, what do they stand to gain or lose?
To enable reach of providers across the state, we have engaged both public and private providers. Since the agency is purchasing services, all providers will be paid for covered health services either in capitation or fee- for- service
When will the scheme commence?
The scheme will officially commence in April, 2020
What is the difference between NHIS and the state health insurance scheme?
- NHIS is a federal government program targeted at federal government workers at federal MDAs, while the state health insurance scheme targets all residents of the state
- NHIS still attaches a 10% co-payment at the point of accessing medical services after premium is paid, while the state insurance does not require any further payments after the annual payment has been made.
- NHIS does not cover all persons, only federal government workers, while the state health insurance scheme covers all including the poor (indigents)
Will the Local Government Areas be expanded?
All LGAs in Kwara State will benefit from the scheme. The current administration is also working assiduously to ensure many health facilities are rehabilitated to further expand reach in the very near future.
Is there a maximum number of family members who can benefit from the scheme?
No, there’s s no maximum as long as premiums for all enrollees are paid
How does it serve as a financial risk protection?
This is because everyone contributes to the risk pool, and risk pooling helps everyone access services that otherwise may be unaffordable. It also helps to reduce out of pocket expenses for healthcare services.
How do civil servants pay premiums?
The civil servants fall under the Formal Sector, thus, Premium payment by the Formal sector shall be done through payroll deductions from source before payments of salary
What happens to premiums paid for 3years but hasn’t been used?
Premium payment are made annually and subject to renewal at the end of every 12 calendar months, from the date of first premium payment. Premiums paid within a coverage year are not transferable
How does the scheme guide against misappropriation and embezzlement of funds?
The scheme is leveraging a robust ICT platform that protects funds in a transparent and accountable manner
How do you ensure that hospitals deliver standard and quality health care services to enrollees?
There is a world recognized standardized assessment tool that is used to assess the quality and quantity of care given by an HCP, and a cutoff point must be attained before they can be empaneled. Facilities have been evaluated using this tool and to ensure they deliver the quality and quantity necessary to be empaneled. Also, all empaneled providers have a working quality improvement that is specific to the provider. Improvements required within specific timelines must also be adhered to by the provider
How much is the premium payment?
There are 2 basic plans at the moment namely, the formal sector plan which is N9000, and the informal sector plan that is N6000.
Can premiums be paid in installments?
No, there is no provision to pay in installments at the moment.
How do I know the health plan that suites me?
You will have to identify what target group you belong to, as the health plans are designed to suit the formal sector group, informal sector, or indigent group.
How do I know the target group I fall under?
The scheme defines the formal sector group as civil servants, local government workers and private formal sector(with more than 5 employees), the informal sector group is made up of individuals, cohesive groups and small businesses (with less than 5 employees) and the indigent group also referred to as the vulnerable as defined by the scheme. The vulnerable group includes pregnant women, children under 5 years and the proven poor residents.