This is to inform all accredited Health Maintenance Organizations (HMOs) with the National Health Insurance Scheme (NHIS) that, in furtherance to its letter of April 26, 2017, requesting for submission of relevant documents attached thereto, for sighting and verification, in line with the provisions of the NHIS Act, CAP N42 LFN, 2004 and the Operational Guidelines, 2012.
In view of the above, you are hereby reminded to submit the documents listed below as the first level of the reaccreditation process, on or before June 16, 2017:
- Letter of HMO’s non-indebtedness from all healthcare facilities that the HMO is in contract with, as signed by the Chief Medical Director (at reaccreditation and quarterly thereafter).
- A list of organizations managed by the HMO under Private Health Insurance (PHI).
- Contact details of the organizations listed above.
- Total number of lives managed by the HMO’s under the PHI.
- Details of the benefit package and all health plan under the HMO’s PHI.
- Evidence of quarterly remittance of 1% contribution from PHI to NH IS since last accreditation.
- Advance Payment Guarantee from any NHIS-accredited insurance company as is ongoing before disbursement for Capitation and FFS.
- A copy of HMO’s letter authorizing its operational bank(s) to forward a three (3) months statement of account of the HMO to NHIS covering April-June, 2017.
- A letter granting NHIS access to information on the HMO’s operational accounts with NHIS accredited banks.
- Academic Qualification of Principal Officers (CVs and Original Credentials be made available or sighting).
- Current tax clearance of the Company.
- Current tax clearance of Directors.
- Sworn Affidavit of good character in respect of the directors from a High Court Justice.
- Evidence of audited account of company.
- Evidence of payment ofAnnual Returns with CAC.
- Evidence of compliance with PENCOM ACT by clearance certificate or remittance of RSA of staff.
- Indemnity Insurance certificate to the value of the paid-up share capital.
- QualityAssurance tools used by the HMO
Your organisations may wish to contact the Standards and Quality Assurance Department for inquiries on the re-accreditation requirements, process and procedure before the expiration of the timeline stated above.
TAKE NOTICE that, HMOs, who fail to submit the prescribed re-accreditation documents attached to the letter in reference, shall be excluded from participating in the exercise and ultimately exited from the Scheme.
Dated this…… day of…… 2017.
Dr. Victor C. Amadi
For: Executive Secretary/CEO