Ghana’s National Health Insurance Scheme Fee Exemptions

2003

15,161,655 beneficiaries as of December 2021 Over 16 million active beneficiaries, out of a total population of 31 million. 64.9 percent of these beneficiaries are exempt from paying premiums, of which 1.3 million (or 8.3 percent of beneficiaries) are deemed to be poor or vulnerable. Active membership as at end September stood at 14.4 million, representing 45 percent of the targeted population of 20 million and active card holding indigents was 1.7 million representing 74 percent of the targeted 2.3 million indigent population.

The NHIA expenditure on claims reimbursement was GH₵1,396 million in 2017, reaching GH₵ 254,151,943 in 2023.

Nationwide

Groups exempt from premium fees: (i) Pregnant women (ii) Indigents (iii) Categories of persons with different abilities determined by the Minister responsible for Social Welfare (iv) Persons with mental disorder (v) SSNIT contributors (vi) SSNIT pensioners (vii) Persons above seventy years of age (the elderly) (viii) Other categories prescribed by the Minister

If the person wants to register as a member of the exempt category, they should note that they will be required to have proof of exemption, e.g.: (i) A pregnant woman will have to present proof of pregnancy such as current antenatal card, a signed note from a doctor or midwife, pregnancy test result endorsed by a doctor or midwife or other prescriber or an ultrasound scan report. (ii) A SSNIT contributor should be active in the SSNIT database presented to NHIA by SSNIT. (iii) A SSNIT pensioner should show his/her SSNIT number. or will be registered without paying premium. (iv) You will then be registered without paying premium. The following people in the exempt categories do not pay processing fee: (v) Pregnant women (vi) Indigents (vii) Categories of differently-abled persons determined by the Minister responsible for Social Welfare (viii) Persons with mental disorder (ix) SSNIT contributors (x) SSNIT pensioners (xi) Persons above seventy years of age (the elderly) (xii) Other categories prescribed by the Minister The following members are exempted from the waiting period: Above 70 years Pregnant Women Children under 5 years

  The members will be required to renew their membership every year

Health care benefits

  The NHIA has a pre-defined benefit package of about 95% of the most common diseases seen at health care facilities in Ghana. The services covered include general out-patient and in-patient care, reproductive and maternal care (normal and caesarean delivery), eye, dental and emergency care. A list of essential drugs pre-qualified by the NHIA is also covered. However, expensive procedures such as dialysis for chronic renal failure, treatments for cancer (other than cervical and breast cancers), organ transplants and cosmetic surgery are not covered. Treatment for HIV/AIDS (Human Immuno-deficiency Virus/Acquired Immune Deficiency Syndrome), immunization and family planning services are also not covered under the scheme but provided for under other government vertical programs.

  On-demand provision

 Indirectly and to health providers (The National Health Insurance Authority (NHIA) engages healthcare providers to offer services to insured members through a process called credentialing. The credentialing process is to ensure that healthcare providers are in a position to provide basic quality health services to insured members in Ghana in accordance with the Benefit Packages within the National Health Insurance Scheme and/or Private Health Insurance Scheme.)

Children, elderly, Indigent people, pregnant women and LEAP beneficiaries.

The National Health Insurance Authority (NHIA) was established under the National Health Insurance Act 2003, Act 650. Act 852 has replaced ACT 650 in october 2012

Smart office Workplace implemented formed part of the NHIA’s (5D Strategy) including  eMemo and eCorrespondence Management Systems (The National Health Insurance Authority (NHIA) Membership and Regional Operations (MRO) and Management Information Systems (MIS) Directorates on October 16, 2023, began a nationwide training of some selected staff of the National Health Insurance Scheme (NHIS))