Understanding Health Insurance in Nigeria: A Simple Guide
Understanding Health Insurance in Nigeria 2025: Why It’s Not Just Another Insurance Thing
“No be small wahala when hospital bills land, especially when it comes unexpectedly.” The last-minute cash scramble, borrowing, sometimes selling prized items to stabilize. Reminding yourself that a life is better than wealth to console yourself — true. You or somebody you know has been there.
Spinning it around, imagine walking into a hospital and not worrying about payments at all because your health plan has you covered. That’s what good health insurance offers.
As of early 2025, approximately 20 million Nigerians are covered by health insurance, thanks to major reforms under the NHIA ( formerly NHIS). But still, only about 10% of Nigerians are actually covered, meaning 90% are exposed.
This guide will show you how health insurance works today in Nigeria,
What Health Insurance Really Means in Nigeria
It’s not just paying a small fee so one day a hospital will treat you. Here’s how it really works:
- You pay a regular amount depending on your ability called a premium to a provider (NHIA, state agency, or private HMO).
- The money is pooled together with what others pay.
- You choose a hospital or doctor from your insurer’s approved list. If the hospital is outside the network, you may pay more or not be covered.
- When you need a hospital service the claims or payment is between insurer & hospital. Sometimes there’s upfront payment, sometimes you present your insurance ID.
(Click on this article to read up on the types of health insurance one can use)
Real Costs and Real Examples
Here are actual plans in Nigeria as of early 2025, from reliable sources:
| Provider | Plan Name / Type | Annual Premium | What You Get |
| Reliance HMO | Basic Individual Plan | ~₦42,000 | Essential outpatient & hospital services, emergencies |
| AXA Mansard | EasyCare Plan | ₦20,000/year or ₦12,000 for six months | Cover for consultations, maternity, diagnostics in network hospitals |
| Well Health Network | Basic Plan | ~₦18,500/year | Outpatient, emergency, limited diagnostics, smaller hospital networks |
What’s Covered vs What’s Usually Not
| Type of Service | Usually Covered | Usually Not Covered |
| Consultations | ✅ Yes | Chronic pre-existing conditions till after waiting periods |
| Drugs / Prescriptions | ✅ Yes (if approved & within network) | Brand new or imported expensive drugs unless plan premium is high |
| Surgeries / Hospital Admission | ✅ Yes with plan limit or cap | Cosmetic surgeries, overseas treatment unless premium plan |
| Maternity & Childbirth | ✅ Usually in many plans | Fertility treatments, IVF |
| Screenings / Preventive Care | ✅ Some plans include | Premium -only in many cases |
| Dental & Eye Care | ⚠️ Sometimes in premium plans | Not in basic or public plans |
Benefits Of Hospital Insurance.
- No “hospital surprise”:
- More predictable health expenses
- Better health outcomes – earlier diagnoses, less severity.
- Value for money – small investment avoids large bills.
What to Check Before You Sign
- Verify your HMO or insurer is accredited by NHIA.
- Check the hospital network, if it is nearby and trusted.
- Read “authorisation code” rules: how long it takes to process claims. There’s a one-hour authorisation mandate from NHIA, 2025.
- Understand waiting periods and exclusions like pre-existing conditions.
Challenges That Still Suck
- Premium increases are real. NHIA raised rates because hospital costs, medicines, and inflation have exploded.
- Rural areas often have fewer accredited hospitals. Sometimes people with insurance still pay out of pocket for travel, transport.
- Some HMOs delay authorisation or decline services.
- Even with 19–20 million enrollees, that’s just about 10-12% of Nigeria’s ~220 million people.
Final
If you’re reading this and thinking, “I don’t want hospital bills to eat my savings,” then start now. A basic plan for around ₦20,000-₦40,000/year can prevent major financial shocks.
