Tuesday, July 23, 2024

Government Removes Buyback Option From NHIMA

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Minister of Labour and Social Security Brenda Tembatamba announced the removal of the buyback option under the National Health Insurance Scheme (NHIMA).

Ms Tambatamba says the buyback policy, which was introduced in 2020 and waived the waiting period that was required for members of the scheme to access services has been removed due to the high cost implications on NHIMA.

The Minister, who was delivering a Ministerial statement in Parliament, explained that whilst the introduction of the buyback policy was well intended, a large number of members from the informal sector opted to pay premiums only when sick and in urgent need of medical services, as some even required expensive medical procedures including cancer treatment, which in some cases cost as high as K8,000 per member.

“Despite the good intentions of the buyback programme, a large number of members from the informal sector only registered as members of the scheme when they were already sick. As a result, they would only pay the required average premium of K200 (which is K50 by 4 months) and then access all the services such as laboratory services, drugs and in some cases even very expensive services such as CT and MRI scans,” she noted.

She added that most of the members even stopped paying premiums once they received the medical service and only returned to pay the K200 premium arrears under the buyback option when they fall ill again.

Ms Tambatamba lamented that such practices are affecting the sustainability of NHIMA and feared that if continued, they may render NHIMA bankrupt as the trend proved that the number of claims so far exceeded the premiums received.

“The actuarial evaluation on scheme sustainability conducted, revealed that the surge in claims was mainly emanating from the buyback option clause which was prevalent in the informal sector. The actuarial study also revealed that if the same trajectory is maintained, the scheme will run bankrupt. The removal of this option is primarily to save the fund from bankruptcy and from grinding to a halt under our watch,” she said.

Ms Tambatamba disclosed that the new approach which will be implemented in this regard is aimed at encouraging the informal sector and the public at large to pre- register their membership and to ensure that members’ contributions are consistent to avoid a repeat of the situation.

She that the Ministry has to this effect embarked on a rigorous sensitisation campaign on the need to contribute consistently and pre-register in order to access the health insurance services.

The National Health Insurance Scheme (NHIMA) was established by Act no. 2 of 2018 as a compulsory scheme to provide reliable health care financing for all Zambian citizens and legal residents, in line with the government’s agenda of bringing services closer to the people and ensuring Universal Health Coverage (UHC) agenda.

The buyback option enabled new members to register and pay their premiums in retrospect as a buy back of four months and immediately access necessary healthcare services.

Similarly, old members whose payment fell into arrears would also settle the arrears and immediately access necessary healthcare services as long as the arrears were within the four months period.

6 COMMENTS

  1. When Chitalu Chilufya rushed the NHIMA we expressed our concerns and one of them was about the sustainability of the scheme. Our worry wasn’t about claims but the heavy management. Is it true that the Director alone is on K300,000 basic salary? The behavior of the informal sector reflects what’s going on in the nation. Payments for goods and services are inconsistent. Suppliers and contractors sometimes wait for months to be paid and even then buyers and accountants want a share of the same money. How does NHIMA expect them to be consistent?

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  2. We have a free education policy in Zambia while there exists a compulsory insurance premium on healthcacre. What’s the point of being educated for free and die the next day because I can’t pay for the compulsory healthcare? Every meaningful life is hinged on health and education. But better health makes it easy to learn. This policy contradictory incongruence must be corrected.

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  3. My goodness, @Ayatollah and @My Zambia, do write nonsense.
    When you guys don’t know what you are talking, just keep quiet.

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    • This @blackman is a frustrated tired soul, offering no insightful commentary. If what some people write here doesn’t impress you, please just pass or catch another bus. Full of cowardice by dropping your usual alias pseudonym. Take courage. Be inclusive. Bal-ly will surely fix it all for you.
      Government won’t payoff or take care of Zambians who don’t contribute to NHIMA. Meaning if you don’t pay for your premium, no service. Your young ones receive free education without free healthcare. Enjoy your life.

  4. Most culprits are in the private health facilities. The NHIMA accredited healthcare providers most times defraud government. They stock the fire by providing inflated amounts when claiming from nhima for services.

  5. This was a risky venture from the beginning
    A few to pay for the many is one point ??
    you would also be surprised if you checked their monthly wage bill and running costs compared to the contributions.
    Also as someone pointed out FRAUD by over inflated claims etc

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