The Federal Capital Territory Administration (FCTA) says it will sanction any Health Maintenance Organisations under the FCT Health Insurance Scheme (FHIS) that fail to remit payments to healthcare providers promptly.

Lere Olayinka, Senior Special Assistant to the FCT Minister on Public Communications and Social Media, gave the warning in a statement in Abuja on Tuesday.

Mr Olayinka explained that the FHIS was a social health insurance programme, offering financial protection through access to quality, affordable, and equitable healthcare services for all FCT residents.

He added that staff of the FCTA and area councils, including vulnerable persons and pregnant women, were being enroled for free, while other members of the public could enrol upon payment of N22,500 as a premium per annum.

Mr Olayinka added that about N4 billion outstanding payments for capitation and fee for service from 2022 to 2024 was approved by the FCT Minister, Nyesom Wike, and paid between 2024 and 2025.

According to him, this is to improve the quality of healthcare services provided to the FHIS enrollees.

He said one of the benefit packages of the FHIS was the Basic Minimum Package of Health Care Services (BMPHS), ranging from promotive, preventive, curative, and some rehabilitative care services.

Mr Olayinka said other services included primary preventive care, screening, primary emergency services, and secondary-level care such as dental, mental, eye, ear, nose, and throat care; physiotherapy; surgeries; laboratory investigations; and radiological investigations such as ultrasound scans and x-rays.

The spokesman, however, said complaints have been received from some healthcare providers concerning non-remittance of their payments by some of the HMOs.

According to him, the HMOs blamed the non-payment on the nonavailability of bank details of the affected hospitals.

“This excuse is not acceptable to the FCT Administration government,” he said.

He said that henceforth, the compliance of the HMOs to the prompt remittance of payments to healthcare providers and the commitment of the healthcare providers to the FHIS enrollees would be closely monitored.

On implementation of the FHIS in the last year, Mr Olayinka said outstanding payment for capitations and fees for service from 2022 to the end of 2024 had been paid.

He identified other successes as improved timeliness in the payment of capitation to HMOs, upward review of capitation to healthcare providers, and free enrolment of vulnerable persons, especially pregnant women, children under five years, and indigent residents.

“Others include accreditation visits to 100 Primary Health Care (PHC) facilities to expand the number of PHCs providing FHIS services and, in the long run, improve access to healthcare services in communities.

“Also, all pregnant women who enrolled through the Basic Health Care Provision Fund (BHCPF) PHCs across the six area councils in the FCT will continue to enjoy free health education, medical consultation, and treatment.

“Other services include routine antenatal drugs, laboratory investigations, and delivery.

“Referral for secondary care, including caesarean section, blood transfusion, and treatment of other obstetric complications such as eclampsia in all the 14 general hospitals in the FCT, is also provided at no cost to the patient through the BHCPF,” Mr Olayinka said.

(NAN)