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NATIONAL HEALTH INSURANCE SCHEME -FAQ

NATIONAL HEALTH INSURANCE SCHEME

FREQUENTLY ASKED QUESTIONS AND ANSWERS

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1. What is NHI Scheme?

*This is a health insurance scheme which entitles contributing members to a predetermined set of healthcare benefits.
*Health insurance is separate from general tax that the Government collects. It is going to support health care service delivery

2. What is National Health Insurance Act number 2 of 2018?

This is law enacted by Parliament and assented by His Excellence the President of Zambia, on 25th April, 2018;

* The Act provides for sound financing for the national health system;
* This will support universal access to quality insured health care services
* Provides for establishment of the National Health Insurance Management Authority
and provides for its functions and powers
* The Act will lead to establishment of National Health Insurance Scheme and National Health Insurance Fund, later provide for contributions to and payments from the fund
* Provides for the progressive establishment for provincial and district health offices of the authority

3. Why the NHI Act was enacted?

This was established to introduce the National health Insurance Scheme that will require all Zambians and established residents to be registered

4. To whom does the NHI Act apply?

This applies to you all Zambians and established residents in the country.

5. Who will benefit from the National Health Insurance Scheme?

* You will benefit as well as all registered members of your household.
* when you contribute, your spouse, biological and adopted children, and other eligible dependents will be covered and entitled to insured healthcare benefits

6. What does NHI seek to promote?

* This will promote Universal Health Coverage through continuum of care that encompasses:
* Health promotion, Prevention of Disease, Quality curative services and Palliative and rehabilitative care

7. What are the guiding principles of NHI?

* Universality- to ensure that no one is left behind
* Solidarity- those who contribute to the scheme will cross subsidize the poor,
old and vulnerable
*Contributions to the scheme will be based on your ability to pay
*NHI is a pro poor scheme which is based on subsidizing for the vulnerable

7. What methods/approaches will NHI use?

*NHI is based on solidarity model, where contributions from those who are healthy, young and wealthy will subsidize the cost of care for those who are ill, old and poor.
*Providers for the insured health services will be accreditated in respect of insured health care services at national, provincial and district levels

8. Who will contribute to the Scheme?

* Employees from both the informal and formal sectors according to their ability to pay *Employers will part contribute for their employees ad remit contributions to the Authority *Government will continue to subsidize for the poor and vulnerable

9. Who will implement the NHI Scheme?

The National Health Insurance Management Authority will implement the scheme which will be formed according to the National Health Insurance Act no. 2 of 2018

10. How does one become a member?

* You will be registered with the Authority and a card will be given to you
* If you are an employee from the formal sector you will automatically be registered
by your employer.
* If you are an employee from the informal sector you will register through your
association or directly with the National Health Insurance Authority.
* The poor and vulnerable will be identified and registered through mechanisms already
existing in the Ministry in charge of social welfare.
11. Who will be eligible to become a member of the NHI Scheme?

All Zambians and established residents are eligible to register and benefit from the insurance scheme

12. Who will be exempted from contributions for NHI Scheme?

* A person above the age of 65 years will not contribute to the scheme but will benefit
* Poor and vulnerable people will be exempted after being assessed by the Ministry
Community Development and Social Welfare
* Mentally or physically disabled persons who are unable to work and any other person as may be prescribed by the Minister

13. What are the advantages of the NHI Scheme?

* This will bring about affordable health insurance plan for contributors and their eligible dependents
* Being on this insurance scheme will provide you peace of mind as you will be able to access quality health services
* Those exempted will still access health services
* You will not have to pay money when you are sick
* This insurance will benefit everyone as health cuts across political affiliations
* Having the insurance will contribute to the attainment of Universal Health Coverage *The benefits of this insurance will cover beneficiaries through the continuum of care
without financial barriers
* There will be reduced risk of paying employee/dependent medical expenses when sick *This will result in a healthy and productive workforce
*The scheme will cover both public and private health facilities, therefore gives you
choice of where to go for health services
*You will contribute to the scheme according to your ability to pay

13. How will health care providers join the scheme?

All Health care providers wishing to provide insured health care services to scheme holders shall apply to the Insurance Authority for accreditation.

14. How will an accredited health care provider ensure quality ?

Accredited Health Care Providers shall take part in programs for quality assurance and performance review to ensure that they provide quality health care services

* Accredited Health Care Providers shall appoint persons, on their personnel establishment, whose responsibility is to;
* Ensure quality and cost effective health care service delivery in conformity with national standards;
* Manage the patient record system;
*Ensure accurate and expedient, submission of claims in accordance with prescribed
procedures

The National Health Insurance Authority shall only accredit providers who meet accreditation standards set by the Authority, to ensure quality health service delivery.

15. How will accredited providers benefit?

Accredited health care providers will benefit from timely settlement of claims and the revenue generated by providing services to members. This will then improve the quality of health service delivery.

16. How will services be provided in the rural areas?

*Reliable and sustainable financing to the health system will ensure strengthened referral systems, infrastructure, drugs, supplies and human resources to provide services in every part of Zambia. This is the ultimate goal of Universal Health Coverage.

*It has also been seen in other countries such as Tanzania that Private Hospitals, pharmacies and laboratories are incentivized to set up operations in the rural areas because of the business opportunities National Health Insurance brings.

Be Part of the Natioanl Health Insurance Scheme

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