FORMAL SECTOR


The Formal Sector Contributory Healthcare Program is designed for employees who have structured salary. This includes:

Individual, Family and Group contributory scheme

Organized private sector (OPS) for organizations with a minimum of five (5) staff

Uniformed service men e.g. Civilian Task Force, Borno State Road Management Agency and others

Retirees

All elected and political appointees of the state and local government

Tertiary Institution Students Contributory Health Program

Contributions

The employees in the public service of the state and local government shall contribute 3.5% of their monthly basic salary.

For the organized private sector, the employer pays 10%, while the employee pays 5% representing 15% of the employee’s monthly basic salary. In a situation where the contribution is less than what is required, the Agency is to determine a minimum take off balance. However, the employer/employee may decide to pay the entire contribution.

For Uniformed Service Men, contribution is monthly contribution of 3.5% of their monthly earnings.

For Retirees, a contribution rate is monthly contribution of 3.5% of basic salary.

Waiting Period

There shall be a processing/waiting period of ninety (90) days before an enrollee can access healthcare services for formal and informal programs.

Scope of Coverage
  1. The registration covers the Principal, spouse and 4 biological children below the age of 18 years.
  2. The Principal can register up to 6 additional dependents upon payment of N9,000/person/annum. The dependents may be wife (s), parent (s) or children below the age of 18 years. Subject to review by the agency
  3. A valid means of identification (Voter registration card, National ID card, International Passport or Driver’s license) for the principal must be presented at the point of registration for authentication.
  4. Birth Certificates of biological children must be presented at the point of registration for authentication.
  5. The enrollees should note that multiple registration and that of an ineligible dependent /spouse is a criminal offence punishable by law.
Benefit Package
The benefit package shall reflect preventive, promotive and curative components of health care delivery. It shall aim at minimum primary and secondary curative care, taking into cognizance the prevailing local morbidity and mortality profile, including pre and post-natal care and normal delivery.

Covered Procedures

Primary Level Care
Disease prevention and health promotions
Management of simple infections/infestations
Primary surgery
Primary eye care
Primary paediatrics
HIV/AIDS/Sexually Transmitted Diseases
Family Planning Services Basic Packages
Maternal, Neonatal and Child Health (MNCH) Services
Emergency Care
Basic laboratory investigations (Malaria Parasite using Rapid diagnostic test, Urinalysis, urine and stool microscopies, Packed Cell Volume (PCV), Random Blood Sugar /Fasting Blood Sugar (RBS/FBS), Pregnancy test
Other conditions that may be listed by the agency from time to time.)
Secondary Level Care
Pediatrics
Internal medicine
Gynecological intervention
Surgeries
Dental care
Ophthalmology
Ear, Nose & Throat (ENT)
Physiotherapy
Laboratory Services
Laboratory investigations at secondary level of care: (All investigations (a-g) at primary level
Genotype
Urea/electrolyte/creatinine
Bilirubin (total and conjugated)
Microscopy/Culture/Sensitivity-Urine
Blood
stool
Sputum
Wound
Urethral
Ear
Eye
Throat
Aspirate
Cerebrospinal
Fluid
Endocervical
Swab
High Vaginal Swab
pap smear
Occult blood in stool
Gram stain
Blood groupings/cross matching
Hepatitis B surface antigen
Hepatitis C virus antibody screening
Screening for HIV/AIDs
FBC and ESR
Blood transfusion services including blood bag
Lipid profile
Liver function test
2-hour postprandial blood sugar
Thyroid function test
Hemoglobin A1C
Cardiac markers
Serum Uric acid
Radiology
X-ray of chest
Abdomen
Skull & Extremities
Dental X-rays and other plain X-rays
Abdominopelvic USS
Obstetric and gynecological USS
Small parts e.g. thyroid
scrotal sac
Doppler USS
Psychiatry

Diagnosis and counseling as well as treatment