NHIA (formerly NHIS) vs Private HMO Plans in Nigeria: Which Should You Choose?
NHIA vs private HMO plans are not opposites.
Use one plan, the other, or both.
The right mix depends on your income, your family, and the hospitals you want to use.
Many Nigerians still say “NHIS”, but since the NHIA Act was signed on 19 May 2022 the scheme has been run by the National Health Insurance Authority (NHIA). NHIA also accredits the Health Maintenance Organisations (HMOs) that sell private plans.
This guide compares NHIA public schemes with private HMO plans on cost, cover, hospital access, waiting periods and family cover. It ends with a short guide to which option suits which household.
What NHIS means today: NHIA and its public schemes
NHIS no longer exists as a separate body; NHIA took over its role under the Act signed on 19 May 2022 (NHIA FAQ). The Act makes health insurance mandatory for all Nigerians and legal residents, and requires every state to set up its own health insurance agency (I CIR).
The public side is made up of several programmes:
- Formal Sector Social Health Insurance Programme (FSSHIP): for employees in the public and organised private sector.
- Group, Individual and Family Social Health Insurance Programme (GIFSHIP): for groups, individuals and families, including people outside formal employment.
- Tertiary Institutions Social Health Insurance Programme (TISHIP): for students in tertiary institutions.
- State health insurance schemes: run by each state agency for residents of that state.
- Vulnerable Group Fund (VLF): pays or subsidises premiums for people who cannot afford them. NHIA reported about 1.8 million people covered through the fund in 2024 (NAN).
Under these programmes you are enrolled with an HMO and treated at NHIA-accredited facilities only (NHIA FAQ). The HMO may be the same company that sells private plans. What differs is the scheme it is delivering and the rules that apply.
NHIA vs private HMO plan: side-by-side comparison
The core difference is who sets the rules and the price: NHIA programmes follow national rules and set contributions, while private plans follow each HMO’s own tiers and premiums.
| Factor | Public NHIA scheme | Private HMO plan |
|---|---|---|
| Regulator | NHIA | NHIA accredits the HMO |
| Who pays | Employer and employee (FSSHIP: 10% + 5% of basic salary); state or Vulnerable Group Fund for vulnerable persons | You or your employer, at the premium the HMO sets |
| Price basis | Contribution set by the programme | Premium set by the HMO, by tier, network and number of dependants |
| Benefit package | Set by NHIA, with exclusions and partial exclusions | Set by the plan tier; read each benefit schedule |
| Hospitals | NHIA-accredited facilities only | The HMO’s own network; check the list for your city |
| Family cover | Spouse and four biological children under 18; extra dependants at additional cost | Per-person premiums or a family plan, depending on the HMO |
| Best for | A regulated baseline at a lower cost | More choice of plan, hospital and add-ons |
This is a general comparison. Benefits, limits and waiting periods differ by programme and plan, so confirm them with the HMO or NHIA before you enrol.
Cost: contributions vs premiums
In the formal sector, NHIA cover costs 15% of basic salary: your employer pays 10% and you pay 5% (NHIA FAQ). That payment replaces your medical allowance, and an employer may choose to pay the full 15% so you pay nothing (NHIA programme page).
If you are outside formal employment, your contribution depends on the programme or state scheme you join, and enrolment goes through an accredited HMO or your state agency. Vulnerable persons are covered without paying premiums, funded through the Basic Health Care Provision Fund and other sources (I CIR).
Private plans are priced as premiums. Each HMO sets its own, and the price moves with the plan tier, the hospital network and the number of dependants you add. To compare fairly:
- Get quotes from at least three NHIA-accredited HMOs.
- Ask each one to split the quote into base premium, riders (such as maternity or dental) and administration fees.
- Compare the hospital list and benefit limits, not only the price.
Coverage, hospital access and waiting periods
NHIA cover is a defined benefit package used at accredited facilities, while private plans vary by tier and network.
- NHIA programmes: treatment is cashless at NHIA-accredited facilities, and you cannot select a provider outside the NHIA list. NHIA does not cover every ailment: some conditions are excluded or partly excluded, and some services carry limits. Kidney dialysis, for example, is limited to six sessions a year (NHIA FAQ).
- Private HMO plans: the benefit schedule sets the annual limit, the hospital list and add-ons such as dental, optical or maternity. A higher tier usually means more benefits and a wider network, but read the schedule rather than assume.
- Waiting periods and pre-authorisation: these differ by plan. Ask the HMO in writing about maternity, pre-existing conditions and elective procedures, and whether planned admissions and specialist visits need pre-authorisation.
If something goes wrong, you can lodge a complaint with NHIA offices, your HMO or the NHIA call centre (NHIA FAQ).
Family cover, changing jobs and using both
NHIA formal sector cover includes you, your spouse and up to four biological children under 18. More family members can be registered as extra dependants (NHIA FAQ).
A child above 18 is not covered by your contribution. Students in tertiary institutions can join TISHIP, and other adult children can register under GIFSHIP (NHIA FAQ).
Private plans handle families in one of two ways: a premium per person, or a family plan at one price. Compare both for your household, especially if one member needs a higher tier.
If you change jobs or move state: cover that comes through your employer depends on that employment, and a state scheme serves residents of that state. A plan you buy yourself belongs to you, but check that the HMO’s network covers the city you are moving to.
Can you use both? Yes, you can hold NHIA cover and a private plan at the same time. Tell each HMO about the other cover and ask how claims are coordinated, so the same bill is not submitted twice.
Which option suits your household?
Name the specific gap first, then add a private plan only to close it. This table is a decision framework, not a rule; confirm terms with your HMO or NHIA.
| Your situation | Start with | Consider a private plan when |
|---|---|---|
| Employee in the public or organised private sector | Your employer’s scheme (NHIA formal sector or a group plan) | Your package limits a service you use, or you want a hospital outside the NHIA list |
| Self-employed or informal worker | Your state scheme, or GIFSHIP through an accredited HMO | Your budget allows wider hospital access and extra benefits |
| Family with young children | NHIA or state cover as the baseline | You want a wider hospital list for admissions and referrals |
| Tertiary student | TISHIP or GIFSHIP | You need hospitals or benefits outside the programme |
| Pregnant woman, child under five or low-income household | Ask your state agency about Vulnerable Group Fund cover | Your basic cover is secure and your budget allows it |
| Older parent or relative with ongoing care | NHIA or state cover, if eligible | A higher-tier or senior plan fits; check pre-existing condition terms first |
Frequently asked questions
Is NHIS the same as NHIA?
No. NHIA replaced the old NHIS as the national body under the Act signed on 19 May 2022. The public programmes people still call “NHIS” now run under NHIA.
Are private HMO plans regulated by NHIA?
Yes. NHIA accredits HMOs, including those that sell private plans. Confirm an HMO’s current accreditation with NHIA before you pay.
Can I use NHIA cover and a private plan together?
Yes, you can hold both. Tell each HMO about the other cover and ask how claims are coordinated.
Are private HMO plans more expensive than NHIA cover?
They are priced differently, so compare real quotes. Formal sector NHIA cover costs 15% of basic salary, shared between employer and employee. A private plan is a premium that depends on its tier, network and dependants.
How many family members does NHIA cover?
The contributor, one spouse and four biological children under 18. Other family members can be registered as extra dependants.
Does the NHIA Act force me to buy health insurance?
The Act makes health insurance mandatory for all Nigerians and legal residents. How enforcement reaches individuals depends on NHIA and state implementation, so enrol in the programme that fits your situation rather than wait.
Conclusion
NHIA and private HMO plans solve different problems. NHIA gives a regulated baseline at a set contribution, and a private plan buys more choice of hospitals and benefits at a premium. Check the specific gap in your cover, compare quotes from NHIA-accredited HMOs, and confirm waiting periods and exclusions in writing before you pay.
Compare NHIA-accredited HMO plans
This article gives general information and is not medical or financial advice. Benefits, limits and waiting periods vary by plan and can change; confirm current terms with the HMO, your employer or NHIA before enrolling.
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