Navigating Nigeria’s Health Insurance System: Essential Information You Should Know
Navigating Nigeria’s Health Insurance System: Essential Information You Should Know
Nobody prays for issues, but the truth is they happen, and it’s better to be prepared than to be at its mercy. “When Emmanuel’s dad was admitted in a Lagos hospital for an emergency kidney dialysis and other treatments, the bill totaled to over ₦450,000. Emmanuel had to clear his entire account as he had almost nothing saved. If he had enrolled in the ILERA EKO insurance scheme his friend talked about, the family plan would’ve cost ₦80,000/year (for a family of six), and much of that cost would be covered.”
Health insurance might seem far-fetched, but if you live in Nigeria, it’s important. It’s a stable system in most developed countries. And with new laws in 2025, the rules are moving in your favour.
Nigeria’s Health Insurance Landscape & Key Policy Moves
| Initiative | What it is | What’s new in 2025 / Why it matters |
| NHIA Act 2022 | Replaced NHIS. Sets the legal basis for universal health coverage. | The government is now enforcing mandatory health insurance across MDAs (Ministries, Departments, Agencies). Employers are required to comply. |
| Out-of-Pocket Spending | How much citizens pay directly for health services. | Still high — households pay ~75% of health expenditures by themselves. FG has set a goal to reduce this to 20% (Nairametrics, 2024) |
| State Health Insurance Schemes | Insurance run at state level. Example: Lagos’ ILERA EKO. | New plans (ILERA EKO Standard Jaara, etc.) offer varied tiers and better coverage; virtual booths roll out to improve reach (LASG, 2024) |
Why You Should Care
- 75-76% of healthcare costs in Nigeria are paid out of pocket by citizens. This means the government contributes only about $30 per person per year, where total health spend per capita ~ $120.
- ILERA EKO (Lagos) has made health insurance more affordable: individual plans from ₦15,000/year; family plans up to ₦80,000/year depending on size. (LASG, 2025)
- The federal government wants to bring down out-of-pocket health spending from ~70% to under 20%.
Types of Health Coverage Available Now
Here are the main options, what they cover, and how much you’re likely to pay.
| Scheme / Provider | Who it’s for | What it covers | Approx Premium (2025) | Pros | Cons |
| NHIA / Federal scheme | Formal sector workers, federal employees, intended for all Nigerians eventually | Basic and essential services: outpatient, diagnostics, maternity, emergencies | Variable; many formal workers subsidized via their jobs or agencies | Legally backed; broader coverage; good network of providers | Implementation still patchy; less flexibility; claims delays in some places |
| State Scheme: Lagos – ILERA EKO | All Lagos residents (informal & formal) | Outpatient & inpatient, maternity, pediatrics, emergency, specialist care depending on plan | Individual: ₦15,000/year; Family of 4: ₦55,000; Family 6: ₦80,000/year (+ ₦10,000 for each extra dependent under 23) | Local control; easier registration; virtual booths; subsidized rates; monthly or quarterly payment possible | Only for Lagos; some exclusions; private hospitals may cost more; waiting for providers to fully comply |
| Private HMOs (AXA, Hygeia etc.) | Those wanting broader choice of hospitals, elective services, dental/optical add-ons | More flexible cover: higher end private hospitals, specialist care, often more speed in claims | Premiums higher; depends a lot on plan & hospital network | More options, better facilities, sometimes faster service | Costly; many plans exclude pre-existing conditions; accept only specific hospitals; risk of denied claims if fine print ignored |
What New Rules Affect You in 2025
- Mandatory Health Insurance for MDAs
President Tinubu has directed that all MDAs comply with the NHIA Act 2022. If you work for a government agency, watch out: your employer is legally required to enrol you. - Premium Transparency & Payment Channels
State schemes like ILERA EKO insist that premiums only go to official health fund accounts (e.g. LASHEF). Private-account collection is illegal. Always verify where your money is going (Lagos State Official Website). Lagos State Official Website+ - Tiered Premiums & Flexible Payment
Hop on payment options like “Pay Small Small”, monthly or quarterly contributions. This reduces the upfront barrier. - Policy Enforcement & Accountability
Under the NHIA Act, there are increasing calls for compliance monitoring. Premiums must be paid, provider networks accredited, complaints handled more effectively.
How to Register & Choose Wisely
- Check if your employer is required by law (MDAs etc.) and ask if they are enrolled under NHIA-approved cover. If yes, get the certificate.
- If you live in Lagos, compare ILERA EKO plans. Use their virtual booths or the official website. Verify the account (LASHEF) for payments. (My Advantage+2Lagos State Official Website+2)
- If private, study the provider network to find out what hospitals are available under the plan?
- Read policy documents. Know what is excluded as much as what’s included.
- Keep receipts and records.
Case Study: Lagos ILERA EKO — Local Cost & Plans
Here’s a snapshot of what Lagos is doing, what plans look like, and what households are saying.
| Plan Name | Who it covers | Annual Premium | Coverage Highlights |
| Standard Jaara (Individual) | Lagos resident, individual | ₦15,000/year | Out-patient, maternity, emergency, some specialist care under scheme |
| Jaara Family Plans: 4 persons | Father + mother + 2 children (<23) | ₦55,000/year | Full cover in accredited facilities; delayed payments reduced; many clinics participating |
| Jaara Family Plans: 6 persons | Parents + 4 children (<23) | ₦80,000/year | Similar coverage; subsidised; covers more dependents |
| Additional dependents | Extra children <23 | + ₦10,000 each/year | Added into families without full plan change |
Also, The Lagos state government introduced virtual booths in markets and transport hubs to encourage registrations for informal sector workers.
Tips to Get the Most Out of Your Health Insurance
- Always carry your ID card, enrolment document.
- Use hospitals/clinics accredited under your plan.
- Choose the best plan your budget allows. A more expensive plan may save you much more in a serious situation.
- Pay premiums on time and via official channels.
- Use family plans if possible to cut costs.
- Keep track of the service you receive.
- For the informal sector, use flexible payment options (e.g. monthly, quarterly, or “pay-small-small”) if offered.
What To Expect as Reforms Roll Out
- More MDAs will begin enforcing mandatory health insurance under NHIA Act. Expect your employer to ask for proof.
- State schemes will continue expanding, especially in large states (Lagos, Ogun, Rivers).
- Possibly new models for the indigent and vulnerable via Vulnerable Group Funds, with more subsidy.
- You may lose access to covered benefits if premiums aren’t paid, access might be restricted until arrears are cleared.
Final Word
Don’t wait until your next emergency.
Today: check your state scheme, see if your employer is complying, verify payment channels, pick the best plan you can manage. Investing in the right health insurance now could spare you and your family huge financial pain later.
