₦15,000 a Year: What Lagos Residents Get Under Ilera Eko Health Insurance

Kehinde Adeleye

For many Lagos residents, a visit to the hospital can quickly become an unexpected financial burden, particularly when consultation, laboratory tests, medicines, admission and other medical services have to be paid for out of pocket.

The Lagos State Government is now renewing its call for residents to embrace health insurance, with Commissioner for Health, Professor Akin Abayomi, highlighting the benefits available under the state’s subsidised Ilera Eko health insurance plan.

So, what does a resident actually get for ₦15,000 a year?

What is Ilera Eko?

Ilera Eko is the Lagos State Government’s health insurance programme, administered by the Lagos State Health Management Agency (LASHMA).

The scheme is designed to help residents access healthcare while reducing the financial burden that comes with paying the full cost of treatment whenever illness occurs.

The state says health insurance is a key part of its drive towards Universal Health Coverage.

How much does it cost?

According to Professor Abayomi, the subsidised Ilera Eko plan costs ₦15,000 per person annually.

That is approximately ₦1,250 per month when the annual premium is broken down into 12 months.

The commissioner said the relatively low price is possible because of government subsidy and risk pooling. He put the unsubsidised cost at about ₦100,000 per person annually.

In other words, the ₦15,000 payment does not represent the full estimated cost of the healthcare coverage.

What does the plan cover?

According to the commissioner, the subsidised plan provides coverage for a range of healthcare services, including:

1. Doctors’ consultations

Residents can access medical consultations covered under their plan without having to bear the full cost privately.

2. Antenatal care

The plan includes antenatal services for pregnant women.

3. Childbirth care

Maternity and childbirth services are among the benefits highlighted by the commissioner.

4. Treatment for malaria and fever

Common illnesses such as malaria and fever are included in the package.

5. Hypertension management

Residents living with hypertension can receive covered management and treatment under the plan.

6. Diabetes management

The package also includes management of diabetes.

7. Laboratory tests

Covered laboratory investigations can be accessed under the scheme, subject to the terms and limits of the plan.

8. Simple surgeries

Certain simple surgical procedures are included in the benefit package.

9. Specialist consultations

The plan also provides access to specialist consultations where applicable.

10. Hospital admission

The commissioner said the plan covers up to 15 hospital days annually.

Does ₦15,000 cover every medical bill?

No.

This is an important point for residents considering enrolment.

Health insurance does not mean that every medical service a person may require will automatically be free.

Professor Abayomi explained that residents may still have to pay out of pocket for treatments that fall outside their insurance package or go beyond applicable annual limits.

Residents are therefore advised to understand the terms, benefits and limitations of their particular health insurance plan before seeking treatment.

Why is Lagos encouraging residents to enrol?

The government says the major objective is to reduce the financial pressure that medical emergencies can place on individuals and families.

Without insurance, a resident may have to pay separately for consultations, tests, medicines, admission and other services.

With insurance, the financial risk is pooled among members of the scheme, with government subsidy helping to reduce the amount residents pay for the coverage.

The state’s wider social health protection system also includes support for indigent residents. Lagos says Ilera Eko can be provided free to indigent patients through the equity fund, while hospital-based social welfare funds are available to assist patients who require emergency care but cannot afford it.

Is health insurance mandatory in Lagos?

The Lagos Government says the 2024 Executive Order domesticating the National Health Insurance Authority Act 2022 made health insurance mandatory for residents of the state. The state has also previously documented the Lagos State Health Scheme as mandating residents to obtain health insurance.

The latest reminder from the Commissioner for Health therefore comes as part of the state’s continuing push to increase health insurance coverage.

Where can residents enrol?

Non-corporate residents interested in Ilera Eko can visit:

– Any LASHMA office

– The health insurance desk at any Lagos State general hospital

– A 24-hour primary healthcare centre

Residents are encouraged to ask questions about the benefits and limits of their chosen plan before enrolling.

What should residents remember?

The biggest lesson from the government’s latest message is that having health insurance is not the same as having unlimited free healthcare.

The value of Ilera Eko lies in having specified healthcare costs covered under an insurance arrangement, rather than having to shoulder the entire cost of every covered service when the need arises.

For ₦15,000 annually, the subsidised Ilera Eko package highlighted by the government provides access to consultations, maternity care, treatment for common illnesses, management of certain chronic conditions, laboratory tests, simple surgeries, specialist consultations and up to 15 days of hospital admission.

But residents should always confirm the specific benefits, limits and exclusions applicable to their plan.

For Lagos residents, the message from the government is clear: understand your health insurance, know what it covers and make use of the protection available before a medical emergency occurs.