The National Health Insurance Authority (NHIA) has introduced a strict new regulation requiring Health Maintenance Organizations (HMOs) to process and approve treatment authorization requests within one hour of receipt from healthcare providers. The policy, effective since April 1, addresses systemic delays in Nigeria’s health insurance system that have long compromised timely medical care.
Emmanuel Ononokpono, NHIA’s Acting Director of Media and Public Relations, confirmed the development, stating the measure was adopted in February following stakeholder consultations and aligns with provisions of the NHIA Act 2022. Under the framework, healthcare facilities may proceed with treatment if HMOs fail to respond within the stipulated window, provided they immediately notify the regulatory body for service verification.
Emergency cases are exempt from prior authorization requirements, though providers must secure approval codes within 48 hours of treatment commencement. The NHIA has urged enrollees experiencing care delays due to HMO inefficiencies to report such incidents directly to the authority for resolution. This policy shift represents the latest in ongoing reforms to optimize Nigeria’s health insurance operations and ensure prompt service delivery to beneficiaries.
