PRESENTATION ON DHML
ENROLLEES/HEALTHCARE
PROVIDERS ENLIGHTENMENT
By
Arogundade Adekemi
INTRODUCTION
What is INSURANCE
What is HEALTH INSURANCE
National Health Insurance Scheme (NHIS)
This is a social health insurance programme established under
Act 35 of 1999 by the Federal Government of Nigeria to
complement sources of financing healthcare and to improve
access to health care for all Nigerians.
SCOPE
This presentation will cover the following;
The main objectives of NHIS
Brief History of DHML
Source of funding
Operations of the scheme
Services covered by the scheme
Services excluded from the scheme
Conclusion
Question & Answers
Objectives of NHIS
 To ensure that every Nigerian has access to good health care services.
 To protect families from the financial hardship of huge medical bills.
 To limit the rise in the cost of health care services.
 To ensure equitable distribution of health care cost among different income groups.
 To improve and harness private sector participation in the provision of health care
services.
 To ensure adequate distribution of health facilities within the federation and equitable
patronage of all levels of health care.
 To ensure the availability of funds to the health sector for improved services.
DEFENCE HEALTH MAINTENANCE
LIMITED (DHML)
 The Defence Health Maintenance Limited is a corporate
entity owned by the Ministry of Defence and the
Nigerian Armed Forces as a health maintenance
organization (HMO).
 It was incorporated by corporate affairs commission
(CAC) on the 21st October,2005;accredited by the NHIS
on the 27th of June,2006 and commenced operations in
Nov,2006.
Board of Directors
 Honourable Minister of state for Defence (chairman)
 Permanent secretary of MOD
 The Chief of Defence staff (CDS)
 Chief of Army staff (COAS)
 Chief of Naval staff (CNS)
 Chief of Air staff(CAS)
 Managing director-DHML as the secretary to the board.
Technical Committee

Head of Health Services-MOD
 Director of Medical Admin & Logistics- DHQ
 Corps Commander Medical-NA
 Director of Medical services Nigerian Navy
 Director of Medical services Nigerian Air force
 MD-DHML.
DHML
(Contd)
DHML currently has six (6) zonal offices ;
North-East
North-West
North-Central
South-West
South-East
South-South
DHML
(Contd)
DHML is among the 76 HMOs accredited
by NHIS. It currently operates about 155
Military primary healthcare providers and
about 157 secondary/tertiary HCP ; of
these 33 are Military health care facilities
while 124 are civilian healthcare facilities
spread across the Country .
OBJECTIVES
VISION
MISSION
FUNDING
The Federal Government of Nigeria pays the full Premium for all
its Uniformed Officers, these include members of the Nigerian
Armed Forces, the Nigerian Police, Nigerian Customs service,
Immigration, Prisons and Civil Defence Corps Personnel and in
addition the Retired Military Personnel.
“No deduction is made from the salaries of the above mentioned or
from the pension of the retired military personnel“.
DHML is funded like any other HMO by NHIS only. It does not
receive subvention from the Ministry of Defence or from the
Services.
OPERATIONS OF THE SCHEME
 Each employee wishing to participate in the scheme
registers with NHIS and is assigned a registration
number.
 NHIS then issues an ID card to the enrollee and his
eligible dependants which includes the spouse and
4 biological children below 18 years. The primary
care provider (PCP) takes care of all the primary
health care needs of the enrollee based on NHIS
benefit package.
OPERATIONS OF THE SCHEME
(contd)
 The PCP could refer the enrollee to a secondary or
tertiary healthcare provider accredited by the NHIS
subject to the approval of the HMO.
 The HMO pays the PCPs a pre-agreed global
capitation of N750 monthly.
 All claims for specialist treatment are presented to
the HMO for verification and re-imbursement at a
pre-agreed fee-for-service tariff as prescribed by
the NHIS.
BENEFIT PACKAGE
All enrollees of the NHIS are entitled to the following
benefits:
 Out-patient care, including necessary consumables
as in NHIS standard treatment guidelines and
referral protocol.
 Prescribed generic drugs, pharmaceutical care and
diagnostic tests as contained in the National
Essential Drug and diagnostic test lists.
 Routine maternity care for ALL pregnancies (four
(4)
live
births)
for
every
insured
contributor/couple in the formal sector.
 Preventive care, including immunization as it
applies
to
the
National
Programme
on
Immunization, health education, Child welfare
services , ante-natal , post-natal care and family
planning education.
BENEFIT PACKAGE (contd)
 Consultation
with
specialist
such
as
Physicians,
Pediatricians, Obstetricians & Gynecologists, General
surgeons, Orthopedic surgeons, Ear Nose and Throat (ENT)
surgeons, Ophthalmologists etc.
 Hospital care in a standard ward for a stay limited to a
cumulative 21 days per year following referral.
 Eye examination and care with low priced spectacles ,a
range of prostheses limited to artificial limbs produced in
Nigeria.
 Preventive /Promotive oral care and pain relief including
consultation and dental health education.
 In cases of emergency the enrollee shall visit his PHCP or
the nearest NHIS accredited health care facility. The facility
is to offer emergency care where applicable before referral
if necessary and notification of HMO must be within 48 hrs.
EXCLUSIONS
TOTAL EXCLUSIONS
 Operational Injuries.
 Occupational/industrial injuries. These are covered under the workman
compensation Act.
 Injuries resulting from conflicts, social unrest, riots, wars and natural
disasters e.g earthquakes flood or land slide.
 Epidemics.
 Family planning commodities including condoms.
 Injuries arising from extreme sports e.g car racing, polo, boxing,
wrestling etc.
 Drug abuse/addiction
 Domiciliary visits
EXCLUSIONS (contd)
 Surgeries such as: Organ Transplant, cosmetic
surgeries, open- heart surgeries, laminectomy and
neurosurgery (except Borehole) etc
 Ophthalmology- Provision of contact lens
 Internal Medicine-Anti-tuberculosis drug, ARV’s.
 ENT-Hearing aids and associated appliances
Paediatrics-Congenital abnormalities involving
major/extensive surgical repairs, e.g. TOF,ASD,VSD,
separation of Siamese twins, omphalocoele, Hirschsprung
disease etc.
Obstetrics & Gynaecology – Infertility Management.
EXCLUSIONS (contd)
Dental Care- Dentures, Crowns, Bridges, Bleaching and
Implants.
Terminal illnesses including all cancers.
Pathology-Post-mortem examination
PARTIAL EXCLUSIONS
For the life saving emergency treatment requiring high
technology investigations, the HMO would pay 10% of the
cost
and
the
other
90%
paid
for
by
the
contributor/employer, e.g. CT Scan, MRI
CONCLUSION
Thank you for listening..