NHIS Coverage

Our healthcare financing service covers what is not paid for by the National Health Insurance Scheme (NIHIS), complimenting it. Presently, about 95% of common ailments in Ghana are covered by the NHIS while the remaining 5% not covered by the Scheme are driven down the path of medical and financial difficulties. 

The government recently approved the treatment of the four commonest childhood cancers namely Acute Lymphoblastic Leukaemia, Burkitt Lymphoma, Retinoblastoma, and Wilms Tumor to be added to the NHIS benefit package and is in the process of adding the treatment of sickle cell with Hydroxyurea on the NHIS medicine list.

The National Health Insurance Scheme (NHIS) has been in operation since 2006 under the Insurance Act, 2006 (Act 724). The NHIS publishes every benefit that a member of the scheme is entitled to, in its Membership Handbook - but many fail to educate themselves on what condition is covered and what's excluded.

It's important to note that, it is not every healthcare facility that accepts NHIS (even if the service you're seeking is covered by it), as it's not compulsory for healthcare facilities to onboard with the NHIA to accept NHIS mode of payment.

We highlight a few of what the NHIS covers below....

 

1. OUT-PATIENT DEPARTMENT (OPD) GENERAL & SPECIALIST SERVICES

Consultations including reviews. Conditions treated at outpatient setting include the following:

• Malaria, acute respiratory tract infection, diarrhoea diseases, skin disease and ulcers, hypertension, acute eye infection, rheumatism, anaemia, intestinal worms disorders, acute ear infection, typhoid fever, dental caries, diabetes mellitus, Sexually Transmitted Infections (STIs), asthma and others.

• Investigations, including laboratory test, x-rays and ultrasound scans.

• Symptomatic treatment for opportunistic infections due to HIV/ AIDS.

• Out-patient/day surgical operations, including hernia repairs, incision and drainage of abscesses, and excision of lumps and haemorrhoidectomy.

• Out-patient physiotherapy.

• Medication, namely, prescription medicines on the National Health Insurance Scheme Medicines List, traditional medicines approved by the Food and Drugs Authority and certified by the Minister of Health to be on NHIS Medicine List.

• Any other services approved by the Minister of Health

 

 

IN-PATIENT DEPARTMENT (IPD) GENERAL & SPECIALIST SERVICES

• Investigations including laboratory test, x-rays and ultrasound scans for in-patient care.

• Cervical and breast cancer diagnosis and treatment.

• Diagnosis and complications from other cancers, e.g. anaemia or obstruction.

• Surgical operations, including appendicectomy (removal of the appendix).

• In-patient physiotherapy.

• Accommodation in General Ward

• Feeding (where available).

• Medication, namely, prescription medicines on the National Insurance Scheme Medicines List, traditional medicines approved by the Food and Drugs Authority and prescribed by accredited medical and traditional medicines practitioners.

• Processing and provision for blood (grouping and matching).

 

Oral Health Services including: 

• Pain relief, which includes incision and excision.

• Drainage, tooth extraction and temporary relief.

• Dental restoration, which includes simple amalgam.

• Fillings and temporary dressing

 

 

Eye Care Services including:

• Refraction

• Visual fields test

• Scan

• Keratometry (measuring the curvature of the anterior surface of cornea).

• Cataract removal

• Glaucoma

• Eye lid surgery

 

 

Maternity Care including:

• Ante-natal care

• Deliveries, namely, normal and assisted, including forceps delivery and Caesarean Section.

• Postnatal care

• Emergencies

 

 

Medical Emergencies:

All emergencies are covered. These crisis health situations that demand urgent intervention and include:

• Medical emergencies and surgical emergencies, including the need for brain surgery or heart surgery due to accidents.

• Paediatric emergencies

• Obstetric and Gynaecological emergencies including Caesarean sections

• Road Traffic Accidents

• Industrial and workplace accidents.

 

 

NOTABLE EXCLUSIONS

To know the full NHIS Coverage, kindly refer to their handbook. Mental Health, Parkinson's Disease are some of the diseases and/or ailments that are not covered by the NHIS.

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