 The Nigerian Health Insurance Authority Act 2022 now makes health insurance mandatory for all Nigerians. However, for many small businesses in the country, the question of how to provide health insurance for their employees is a major concern. With the cost of health care skyrocketing, many employers find themselves at a loss as to how they can afford such benefits without taking on significant risk and responsibilities. Now analysts say Health Maintenance Organization HMO offers a viable solution for this dilemma. On the show today, we'll be focusing on health plans for businesses and the role of the MHIA Act. Welcome to business in Sightseam plus TV Africa. I am Justin Akadomi. Our first stuff, the LEGO State Government says the proposed fourth mainland bridge will make room for expansion, curb gridlock and bring development to neighboring states. The Special Advisor on Works and Infrastructure to the Governor Arame de Adeoye said this others they hold this meeting with some boundary communities in Lagos and Ogun State. Details in this package. This meeting, which is the 15th edition, took place in a shared estate, Ogun State. It is in continuation of the Environmental and Social Impact Assessment EIA on areas where the proposed fourth mainland bridge transverses. The Special Advisor on Works and Infrastructure Arame de Adeoye, who was represented by the Project Director in the Ministry to Kumbo Ajanaku, told the stakeholders that government is committed to the state transportation master plan. He urged them to take ownership of the proposed project from commencement to completion. The Lagos Infrastructure Project consisted of five projects, the Atyosa-Leki Expressway, the Regional Road, the Coastal Road, the Southern Bypass and the Fifth One and the largest, the Lagos Fourth Mainland Bridge. Since 2001, the Lagos State Government has initiated the process for the delivery of these projects. Responding to questions from stakeholders, Adeoye highlighted the technical details of the alignment on the corridor and listed numerous benefits of the proposed bridge. As of today, we have an all-inclusive 120-meter right-of-way in cross-section, but there are some areas, like the toll areas, which is what engineer Afolabiola Duni explained, that at the toll areas, it will be expanded. Adebyola Oyeteji is the financial secretary in Sherry Community. Like other stakeholders, he is concerned about the environmental impacts of the project. With regards to Fourth Mainland Bridge, I didn't hear anything about speedway, rail system. Is that going to be part of it? And if it's not part of it, I appeal to the government. It's something we need to consider. For people to believe more on what the outlook, what we want to see, actually, that those geo-reference maps they've been able to do, they should translate to a 3D picture, where we see the drone view of what, from where we are starting points, the ending points, and all the axes. Afolabiola Duni is a project consultant. He assured that the people who are the ultimate end users will be carried along through a transparent process. Welcome back. Liga's government is blazing trills yet again. Moving on, Dr. Nita Ikweme is the founder of Wealth and Health Technologies, a Nigerian health tech startup, providing affordable health micro-insurance for common conditions across Africa. He is also an internal medicine physician, having acquired a bachelor's of medicine and surgery degree from the Trinity College Dublin in Ireland. His expertise in capacity in working at the nexus of health tech and fintech for emerging market has led to the notable recognition and awards for weller health technologies. Many thanks for joining us on Business Insights, Dr. Ikweme. Thank you so much. It's a huge pleasure to be here. It is our pleasure. Let's talk about the NHIA Act as it is right now. A whole lot of people have described it as a welcome development. We used to have the NSITF before now, but it's been replaced with the NHIA. Would you really say it has brought some sort of emsoco and goodwill for Nigerian workers? Absolutely. So the advent of the new NHIA, which replaces the NHIS, so the scheme has been replaced for an authority, means now that generally we have better access to great health insurance options. Prior to now, there wasn't really mandated health insurance across the board, but with this new act, it means that every Nigerian must have health insurance. The other advantage is that we are now able to get plans from state health insurance schemes that gives us better access at really affordable rates. It's a good thing that the federal government has actually made it mandatory for all Nigerian workers to actually be placed on some sort of insurance platform so that as much as possible we'd use them out of payment, out of pockets payment when it comes to providing health care in Nigeria. But then again, I would want to start by this way. We're talking about health insurance for businesses. Most employers might see it as an additional cost. Like for instance, I just have a small business and they have a capacity of about 10 workers working for me. Why should I even be choosing or getting health insurance for my employees? Yeah, that's a great question. So beyond the fact that it is mandated by the acts, there are actual productivity benefits for employers that provide health care packages for their staff. Imagine if you've got, you know, employees that are unwell and they have to worry about, you know, running from hospital to hospital, worry about the cost. In many instances actually, companies have to borrow their staff or give them advances on their salaries just so their staff can cater for those health care expenditures that are not planned for. And so in actual fact, it is not a cost. It is an investment in improving the productivity of the staff when companies provide health care benefits for the employees. So it's actually a win-win. The staff is happier. The company gets more productivity. And of course the government is able to ensure that everybody that is working has access to health care. So it's a win-win for all. Okay, let me just take it one step further and try to understand them, the NHIA, you know, what it actually stipulates and entails. Does the act have a stipulated or different categories of maybe provisions for maybe small businesses, for maybe MNCs, or just how does it really work? Yeah, so that's a great question. So the NHIA is currently being the guidelines for its operationalization are actually being drawn up. So some specifics are not yet clear. But what we do know is that if you have staff of, I think it's around five people at least, you do have to provide them with a health plan. Now, each state has a state health insurance scheme. And each state will publish, you know, the costs for those schemes and the benefit package. Several states already have them. If you're in Lagos, there is a Lagos state health plan. If you're in Abuja, the FCT has a health plan as well. Those plans are actually not that expensive. You can get a plan for a single individual for somewhere around 20 to 25,000 Naira. There's other HMO plans as well that are actually fairly affordable. Ourselves at Welli Health, you know, we sell health plans that start at just 600 to 700 Naira a month. So it's not as exorbitant as people would like to think it is. It is very affordable. And once, you know, you sign on for them, the companies are able to onboard you and provide you with the benefits that is commensurate with the amount that you pay. All right. Well said, Dr. Ikwemi. Our suits stay on the small business that has just about in five to 10 employees, you know, in their employ. But what do they really need to know? There's NHIA fine established that, for instance, the company or the business is so small, they don't really have like an organized structure. They don't have like a human resources department. And what would you say, or what would you advise them to do? What is the step-by-step approach? I mean, they want to do what the law says, but they're not well structured. What should they be looking at really? Yeah. So again, good question. It's important, of course, as a small business, you do meet the requirements, you know, that the law has, that you're duly registered, you know, you'll pay your taxes, those types of basic requirements. I think it's important because it means that, you know, of course, you can also draw on benefits from the government. Now, when you have those things done, the next thing from a health insurance point of view would be, you know, one, you could approach your state health insurance scheme. It's easy to find it. So just go online and search for your state and put health insurance scheme. Lots of states have them now. If you're not able to do that, you can reach out to any health maintenance organization. They can provide you with a plan or they can actually also, you know, connect you with your state health insurance scheme. And if all that isn't successful, you can reach out to the actual, you know, authority, the NHIA, they have a website, they have phone numbers, and they've got state offices who can connect you directly to, you know, either health maintenance organizations or the state health insurance scheme. You can reach out to, you know, private entities like ourselves who manage your healthcare plans on behalf of states and HMOs online, you know, via, you know, the web, via a voice, etc. So there's a lot of opportunities that businesses can reach out to to find out about these plans and sign up. All right, so just how affordable. Let's talk about them, financial and cost them implication of all of this. It looks also laudable and very, you know, juicy as it were. But how affordable is it and what are the cost implications on the businesses. So as much as they want them, their, their staff to be well motivated and to be sure that their health is being taken care of, how do they ensure that at least they are still meeting their bottom line and they're not actually running at a loss, so to speak. Absolutely. And that conversation about cost cannot be heard outside of the benefits. And so if we look at just what you spend on the healthcare plans or the health insurance schemes alone, you know, one might seem or might feel discouraged. But if you look at it holistically and look at the productivity gains, look at the benefits, look at your staff satisfaction. When you look at those things, you realize actually it's a small price to pay that for a, if you were to give that extra healthcare payments directly to your staff, you will not get the same type of satisfaction if you use it instead on a healthcare benefit. Now, having said that, from the cost point of view, and plans that are just around 700 Naira a month, you know, plans like as provide you basic access. Did you say 700 Naira? How just how much did you say? Yes, you could start from around 700 Naira a month for a basic plan. And this extends up to, you know, more extensive plans that can go to hundreds of pounds of Naira. Okay, so, so, Dr. Ikbumi, let me just take it step by step. When you say 700 Naira plan, is it per employee or just at the ceiling of all together? Yeah, no, so per employee, per employee a month, it can start around that. So like I said, there are a variety of options, a variety of choices, it behoves the business owners and managers to investigate what the options are and look at what their budget can take and realize that actually there are plans that are very budget friendly and affordable. Okay, fine. In this discussion in passing, you mentioned the heat maintenance, health maintenance organization, the HMOs. So we've talked about the cost implication, we've talked about the benefits to employees now. We want to take it one step further as a business, you know, how do you choose to write HMO services for your business? Because there are an array of them spread across Nigeria and how would you as a business ensure that the right HMO is what you are going for? Absolutely, again, great question and a lot of people approach us with this question. I would say to consider three factors. One is the price, you know, are they offering plans and the price points that you can afford and that you like? Second is the benefits for the price points that you're comfortable with is the benefit package, what you would like and what your staff would want to key into. And then thirdly is the quality of the service. So when you're being sold to when you experience a service, how do you feel? How are you taken? So a combination of these three really can help you to then decide what is the best option. And remember that if you don't like a service, you can actually switch because of the competition on the market and the many providers that are out there, you can test and if you're not happy, you can switch after some time. So I would say to people be, you know, comfortable and confident with shopping around and ensuring that you stick with a service that you can afford, that has the right benefit package and that you actually enjoy using. I also want to stay with the health maintenance organization and because I don't know how proven it, if it's been proven really, because most times we hear that drugs from HMOs or health insurance, you know, packages are usually substandard, they're not actually qualitative. How true is this? So that is not true at all, I would say that straight. It isn't true at all. So we work with, you know, a lot of health maintenance organizations to manage their drug benefit schemes. And I can tell you that we go through a process of vetting and ensuring that the medications that are given in those schemes are the right medications. Now there is a thing in the pharmaceutical space where you have two types of medications. You have what are called branded medications and you have what are called generic medications. So sometimes people misunderstand that branded medications which are usually more expensive are medications that are made by usually foreign pharmaceutical organizations that are imported in. Sometimes people feel like those are more efficacious and more effective. Whereas there are generic medications, these are medications that are made locally by, you know, repeatable organizations that have been quantified and certified by NAFDAQ, they do provide the same type of benefit. Now the price point might be different, the branding might be different, but they actually are just as efficacious. So sometimes people can misunderstand that, you know, this difference is related to quality. It actually isn't, it's because of the source of the medication and the companies that make them. They are underlying beneath all of that the same medication and NAFDAQ would not have proved it if it isn't. All right, Tab, it's still business insight and plus TV Africa which will have Dr. Naito Ikbeme with us talking about the NHIA and of course what businesses need to know. We'll take a very quick break and we'll be right back with more to join us again. Welcome back to business insight and plus TV Africa. Dr. Naito Ikbeme is our guest. We're looking at health insurance scheme and of course how businesses, small, medium and of course large ones can benefit from the NHIA. Thanks for staying with us Dr. Ikbeme. Good thing you've clarified, you know, the air concerning the issue of substandard product or drugs, you know, which most people, you know, attributes to being on HMOs. But then again, there are also other complaints. Sometimes members of staff say that the packages that they are placed under cannot actually cover the bulk of their needs or their main needs as it were. Some, you know, because of the situations that we have in the country, young people are actually hypertensive lately and some people actually diabetic. But when you go to some of these hospitals, they tell you that your HMO plan does not cover drugs for, you know, high blood pressure and all of that. How do we reconcile all of this? Yeah, that's true and that is a concern. And so remember when I spoke about the things we look at when you're picking a plan, those are some of the things to consider. So when you look at the price, the next is the benefit package. Now, usually if you've gone with something really affordable, you know, at a low price, the benefit package usually isn't that much. And so what you really want to start out with is ask yourself, what are the benefits that I want, whether it's for an individual or company, what are the benefits we want? And when you decide those benefits, you can then go shop around with the HMOs and see what is the best price you can get for those benefits. Now, if you want your high potential cover, diabetes cover, those plans are out there. You just have to pay the premium for those plans. The challenge I think is that mismatch between people selecting plans that do not include the benefits that they want. And of course, when they arrive at the clinic or the hospital, you know, the hospital cannot provide you with a benefit that you haven't selected or paid for. So I think the advice here is to be careful in the types of plans you're selecting to ensure that they have the benefit that you do want. If you want maternity, if you want, you know, diabetes, if you want hypertension care, then ensure that you select that in the plan at the start. Okay, so what would you really advise for small businesses? Sorry, I'm staying on small businesses because we try to encourage them start off some a whole lot on this show. You know, what kind of plans, what kind of package should they be looking at? Because most times employees might want their next of kin or their family members to be covered in their insurance plan. So what do you really suggest? What advice can you give really? Yeah, so I'd say it depends on your budget. Of course, you know, as a small business, your budget is tight, so look at what your budget, what is in your budget. And then that might be the guy that you would need then to go figure out what benefits you want based on that budget. Now you might want to start with just the existing staff that you have, if you add on next of kin or family members, that might be a bit more expensive. So maybe start with the, you know, the people that you have employed with the basic plan, if that's all you can afford. And let's see how that does. If you're doing quite well, the, you have high satisfaction, you have a bit more room, then the next time you go to renew, you can actually increase it. I think that there is scope to start small and kind of go up as you get better, you get more profitable and you get more experience and understanding of the plans. Also, as you build a relationship with an HMO, there is more room there to negotiate certain things. So if you start off with a 10 cost 10 employees, maybe you can expand to 50 employees. And if you have a good record with the HMO, they're usually, you know, open and happy to negotiate some certain prices, costs and benefits. So what I would say is, you know, look at your budget, start low, and then go up slowly over time as you grow and progress. But don't put it off because it is now mandated and there is a lot of gains being made from providing health benefits to your employees. All right. Before we go, I have just about two more questions, you know, to, to ask you, Dr. Ikbeme, we've looked at the, we looked at the demand side right now since we started this conversation. Let's talk about the supply side that some HMOs themselves, what would you say? How are they really thriving? Are they challenged by issues in the sector or what exactly is going on with them? And we'll talk about healthcare development in Nigeria. Yes. So with the HMO sector, there's a lot of changes and improvements going on. You know, the NHIE actually just got passed recently. And that is still being, you know, the guidelines for that is still being figured out and, you know, deliberated on operationalized. So there's a lot of, you know, changes, a lot of flux happening. It's clear that the industry is coming of age, it's growing. And we have a lot of really, really great companies that are innovating and doing excellent things around technology, quality of care, and more. And I'm very confident on, you know, what the sector can do, especially with the new act, to cover more people, to provide even better services and actually to provide services that are really affordable as the net increases. So as the more people coming to pay for insurance, what happens actually is the cost goes down. The challenge at the moment is the insurance companies, the HMOs, don't have a big enough pool. And so they can sometimes struggle to really negotiate the best types of prices. But if you imagine there's, you know, 50% of the population going via the insurance, the HMOs, then they can actually, you know, use that economies of scale, use that negotiating power to improve the cost of care across the board for everybody. Because currently 70% of us are paying like a pocket that's over $7 billion every year. If we could organize that better, there's a lot of efficiencies to be hard. All right, on the final notes now, Dr. Ikbeme, let's just get your candid opinion concerning the NHIA. I know it is relatively new, but would you really say that there are loopholes or lacuny that should be really looked into? I think as with everything, the proof of the pudding is in eating. We are in the process of actually operationalizing this new act. And I'm really confident we have the right mix in place. You know, we have the right will. We have the right people as well. And so I'm really optimistic that as we start to put this into practice and implement it, that things will go well. Now there are always challenges, especially at the early days. But that's natural enough. I think that a lot of us in the industry are really keen to see health insurance uptake improve. And I also know that Nigerians are now more interested in their health care. The recent pandemic has taught us that without health care, we have nothing. And so I think we're really in a good place broadly. And as we implement in the right way, learn and improve, we're really going to go to great places. I predict that in the next five to 10 years, we'll have about 50% of the population covered, which will be quite phenomenal if we can get there. All right. Many thanks, Dr. Naito Ikbime. Thanks for sharing all of these useful insights and thoughts with us on business insights. Thank you so much, Dr. Naito Ikbime. It is indeed a pleasure, Dr. Naito Ikbime is a founder of a World Health Technology and he manages a health tech startup. I'll leave you with reaction from Nigerians on the CBN's cash withdrawal limit. That's the size of the show for this week. I am Justin Akadoni. Many thanks for watching and see you again next time. Bye for now. I want to make a transaction in the business that will earn me more profits. And at that very moment, I need something. I need a capital more than the desire, this whatever policy that I've made. So it's not a very good idea. Where do you want me to get your other fund to actualize my profits? It can happen because as you make someone go to the hospital and has a bill of 40,000, 35,000 to pay, it can happen. There is no way this can happen. How can we draw 30,000 in a day and pay the bill? How, when you have a maximum of 20,000 to withdraw, someone has a surgery that has to take a surgery and has to pay 1.5 million and has to pay for that 1.5 million, has to deposit maybe 500 or a million on the spot. How can it do it? They should review the policy. You mean we can only withdraw 20,000 per day? Okay, what about people that are doing that in the market? You want to go and buy stuff now? Okay, you want to buy stuff for your baby? Let me say for example now, someone that just delivered or about to deliver, definitely you want to withdraw more on ATM. She now said that the response she gave me is that they would not do transfer. So I was not like, okay, so we will now sit down inside the market and be expecting transfer to come in. And don't you know that sometimes network is not always okay. So meaning that I want to buy stuff, 20,000, I have to transfer so how many people am I going to do that to? If I have 500,000, can someone give me, I wanted to do a job and I need to transfer some money to my colleagues, maybe they just want to follow me to work. Like yesterday night, I did some 250,000 and this morning, another 150,000. Transfusion? How many times I had 20,000 in me? No, it's not me since.