Wike clears N4bn health insurance debt, vows sanctions for HMOs delaying payments

Nyesom Wike, minister of the Federal Capital Territory (FCT), has cleared a backlog of N4 billion in unpaid health insurance claims under the FCT Health Insurance Scheme (FHIS), unlocking access to improved healthcare for vulnerable residents.

The payments, covering capitation and fee-for-service claims from 2022 to 2024, were fully disbursed between last year and this year.

This was disclosed in a statement on Tuesday by Lere Olayinka, senior special assistant to the FCT minister on public communications and social media.

According to the statement, the intervention is part of broader efforts by the Federal Capital Territory Administration (FCTA) to strengthen healthcare financing, remove bottlenecks, and restore trust among healthcare providers participating in the scheme.

The FHIS provides financial protection and access to quality care for FCT residents. It offers free enrolment for FCTA staff, area council workers, and vulnerable groups, including pregnant women and indigent persons.

As part of its push for accountability, the FCTA also issued a warning to Health Maintenance Organisations (HMOs) under the scheme, threatening sanctions against any that delay payments to healthcare providers.

“However, complaints have been received from some healthcare providers concerning non-remittance of their payments by some HMOs, under the excuse that bank details of the hospitals were not available—an excuse not acceptable to the government,” the statement said.

“Therefore, compliance of the HMOs to the prompt remittance of payments to healthcare providers, as well as commitment of the healthcare providers to the discharge of their duties to the FHIS enrollees, will be monitored with a view to sanctioning defaulters appropriately.”

The FCTA said the FHIS benefit package includes the Basic Minimum Package of Health Care Services (BMPHS), ranging from promotive, preventive, and curative to rehabilitative care.

These services include primary preventive care, screening, emergency services, dental, mental, eye, and ENT care, physiotherapy, surgeries, and laboratory and radiological investigations such as ultrasound and X-rays.

The statement also listed key milestones recorded over the past year.

“On implementation of the FHIS in the last year, there have been payments of all outstanding capitations and fees for service backdated to the year 2022 by the end of 2024,” the statement read.

“Improved timeliness in the payment of capitation to HMOs; review and increment of the capitation to healthcare providers for improved service delivery to enrollees; free enrolment of vulnerable persons, especially pregnant women and those under five, the poor, and indigents, who have started enjoying healthcare services; and accreditation visits to 100 Primary Health Care (PHC) facilities to expand the number of PHC facilities in FCT and improve access to healthcare services in the communities.”

The FCTA also reiterated its commitment to maternal and child health under the Basic Health Care Provision Fund (BHCPF).

“Also, all pregnant women who enrolled through the Basic Health Care Provision Fund (BHCPF) Primary Health Care (PHC) Centres across the six Area Councils in the FCT will continue to enjoy free health education, medical consultation and treatment, routine antenatal drugs, laboratory investigations, and delivery,” the statement read.

“Referral for secondary care, including caesarean section, blood transfusion, and treatment of other obstetric complications such as eclampsia, at all 14 general hospitals in the FCT is also provided at no cost to the patient through the BHCPF.”