Health Insurance: FCTA Threatens Defaulting HMOs With Sanctions
The Federal Capital Territory Administration (FCTA) has warned Health Maintenance Organisations (HMOs) under the FCT Health Insurance Scheme (FHIS) that any entity found guilty of failing to promptly remit payments to healthcare providers will face sanctions.
The Senior Special Assistant to the FCT Minister on Public Communications and Social Media, Lere Olayinka, conveyed the caution in a statement on Tuesday.
This follows complaints by healthcare providers over non-remittance of funds by some HMOs, despite recent interventions by the FCTA to strengthen the scheme.
“Some HMOs have claimed that bank details of hospitals were unavailable as the reason for non-remittance. Such excuses are unacceptable to the government,” Olayinka said.
The FHIS is a social health insurance programme designed to provide financial protection and access to affordable, quality healthcare services for all residents of the Federal Capital Territory.
It offers free enrolment for FCTA staff, Area Council employees, and vulnerable groups, including pregnant women. Other residents can enrol by paying an annual premium of ₦22,500.
Wike had reportedly approved and disbursed about N4bn in outstanding payments for capitation and fee-for-service, covering 2022 to 2024. The payments were completed between 2023 and 2025.
Olayinka added that the administration has made significant progress in implementing reforms under the FHIS over the past year.
The reforms include:
- Clearing all outstanding capitation and fee-for-service payments up to 2024.
- Improved timeliness in payments to HMOs.
- Review and increase in capitation rates to healthcare providers.
- Free enrolment and access to services for vulnerable populations.
- Accreditation of 100 Primary Health Care (PHC) facilities across the FCT to expand access.
The FCTA urged HMOs and healthcare providers to uphold their responsibilities under the scheme.
While HMOs are required to promptly remit payments, healthcare providers are expected to deliver efficient and quality services to enrollees.
“The compliance of HMOs to prompt remittance, and the commitment of healthcare providers to quality service delivery, will be strictly monitored. Defaulters on either side will be sanctioned,” the statement read.
The FHIS, through the Basic Health Care Provision Fund (BHCPF), has prioritized care for vulnerable groups, especially pregnant women.
Enrollees at PHC Centres across the six Area Councils now benefit from:
• Free medical consultation and treatment
• Health education
• Routine antenatal medication
• Laboratory investigations
• Free delivery, including caesarean section and treatment for obstetric complications such as eclampsia
Secondary care, including referrals to the 14 general hospitals in the FCT, is also provided at no cost under the BHCPF.
The FHIS Benefit Package includes the Basic Minimum Package of Health Services (BMPHS), offering promotive, preventive, curative, and limited rehabilitative care.
The services cover:
• Primary preventive care and screenings
• Emergency services
• Dental, mental, eye, ENT (ear, nose, and throat) care
• Physiotherapy and surgeries
• Laboratory and radiological investigations, including ultrasound and x-rays
The FCTA reaffirmed its commitment to building a transparent and accountable healthcare system that serves all residents, especially the underserved.
The warning to HMOs is part of efforts to instill discipline and trust in the administration of health insurance in the territory.
“The goal is not just to fund healthcare but to ensure that the funds translate to real, accessible, and quality services for FCT residents,” Olayinka added.
Stakeholders and residents are encouraged to report irregularities and support the ongoing transformation of the health sector in the capital territory.
Health Insurance: FCTA Threatens Defaulting HMOs With Sanctions is first published on The Whistler Newspaper
