Health insurance is compulsory in Lagos twice over. The Lagos State Health Scheme Law 2015 requires every resident of Lagos State to be covered, and the federal National Health Insurance Authority Act 2022 made health insurance mandatory for everyone in Nigeria.
In practice, enforcement is light, and a great many Lagosians pay for care in cash. That works until it does not - a hospital admission paid out of pocket is how a family’s savings disappear.
Your three routes
| Route | Who it is for |
|---|---|
| Your employer’s plan | Most salaried workers. Usually through an HMO |
| Ilera Eko | The Lagos State scheme, which anyone resident can join |
| A private plan | Bought directly from an HMO, at the level you choose |
An HMO - a health maintenance organisation - is the company that administers a plan: it holds the list of hospitals you can use, approves treatment, and pays the hospital.
Ilera Eko
Ilera Eko is the Lagos State Health Scheme, run by the Lagos State Health Management Agency. It costs ₦8,500 a year for an individual and ₦40,000 for a family of six.
You enrol, pay, and choose a primary care provider - the clinic you go to first, which refers you on when you need a specialist or a hospital. You cannot walk into any hospital and be covered; the referral is the scheme.
It is cheap and it is narrow. It is a good floor for anybody without an employer’s plan, and it is not a substitute for a fuller plan if you can afford one.
An employer’s plan
If you are employed, check what you actually have. Ask HR, or the HMO directly, for:
- The plan level. Plans run from basic to premium, and the difference is which hospitals you can use and what is covered once you are inside.
- The hospital list. Find one near your home and one near your office.
- What needs approval. Many treatments need an authorisation code from the HMO before the hospital will proceed. Find out how to get one out of hours.
- Whether your family is covered, and how many dependants.
- What is excluded. Common exclusions are pre-existing conditions, some maternity costs, dental and optical care, and treatment abroad.
The wait before you are covered
Most plans have a waiting period between enrolment and being able to claim, during which you pay as you go. Ilera Eko quotes 30 days, and some HMO plans make you wait far longer for particular things, maternity among them.
Enrol in your first week, not your first illness.
What a visit costs without cover
Without insurance, a consultation at an ordinary private clinic runs from about ₦15,000, and at a well-known private hospital to ₦60,000 or more, before any test or drug. A malaria test is about ₦3,000 - you will take more of them than you expect.
In an emergency
Go to the nearest hospital first and sort out the insurance afterwards. Call the HMO’s emergency line as soon as you can; most will authorise emergency treatment at a hospital outside your list if you tell them promptly.