FREQUENTLY ASKED QUESTIONS ON OSUN HEALTH INSURANCE SCHEME

Is the scheme voluntary or compulsory?

The scheme is mandatory and compulsory for all residents in the State.

In the case of Civil Servant, how much is being deducted and how much is the Government adding on monthly basis?

For Public Servants/Formal Sector, 1.5% is being deducted from their salary while the state government adds 3%, this serves as their premium until their retirement.

In the informal sector, how much does it cost an individual to enroll, and that of a family?

For the general Public or Informal Sector. The sum of ₦ 12, 066 is charged for an individual, while ₦ 57, 600 is charged for family of 6 (father, mother and four biological children or legally adopted under the age of 18) for one year.

When is the expiring date of OHIS CARDS? For the Public Servants (Formal sector)?

OHIS cards for civil servants expires on the date of their retirement, it is the same with their spouse. For their children, it is when they reach the age of 18.

When is the expiring date of OHIS Cards for informal sector (General Public)?

OHIS cards for Informal Sector expire after one year of registration.

How long does it take an enrollee to start receiving treatment, after registration?

For civil servant, accessing health care takes immediate effect. For the informal sector accessing health care starts after 45 of enrolment

Is it possible for an enrollee to change his/her Health Care Provider (Hospital) ?

Yes, it is possible after 6 months; the enrollee will visit OHIS Headquarters at Ogo-Oluwa to complete necessary forms on the process.

How many dependants are allowed for a principal enrollee, in the formal sector?

For civil servants, Principal enrollee is entitled to 5 dependants, spouse and 4 biological/legally adopted children.

Who are HMOs and TPAs? What are their roles in OHIS operations?

Health Management Organizations, TPAs Third Party Administrators. They are the OHIS representatives spread across the 9 Federal constituencies in the state. HMOs/TPAs handle cases on behalf of OHIS; they solve various problems encountered by OHIS enrollees. They perform publicity marketing and enrollment activities for the Agency. HMOs also perform Quality assurance claims management and pre-authorize of referrals from PCP to SCP.

If Primary Care Provider chosen by an enrollee cannot handle his health condition, as a result of complications,
will happen?

The PCP will refer the enrollee or his/her dependent to a higher healthcare facility, SCP. This is normally handled by the TPAs/HMOs through code generation.

Are enrollees expected to pay any money when accessing care?

Only the 10% of the cost of drugs administered during treatment will be paid.

Is it possible for an enrollee to change his/her Health Care Provider (Hospital) ?

Yes, it is possible after 6 months; the enrollee will visit OHIS Headquarters at Ogo-Oluwa to complete necessary forms on the process.

In the informal Sector if a man has more than one wife, what happens to others, since the scheme accommodates only one wife and four (4) biological or legally adopted children, not more than 18 years old?

Only one legally married wife is qualified to be his dependent and 4 biological children. Meanwhile, the man can enroll other wives on individual basis at the cost of ₦ 12, 066 for a year.

Is there any programme for students of the higher institutions, i.e? The tertiary institutions? Since majority of them are more Than 18 years and cannot enjoy free health under their parents?

Yes, This programme is known as TISHIP: The Tertiary Institutions Social Health Insurance Program.

If any enrollee travels and he/she is involved in any emergency, but has his OHIS Card with him, can such enrollee access care when he is outside Osun State and how?

Yes, such an enrollee will get in touch with HMO/TPA assigned and will give the necessary directives where the enrollee will be treated, and arrangement to settle the bill will be made by the HMO.

Does the scheme cover all ailments?

No, but all basic ailments are covered, note that ailments such as Cancer, etc. are not covered in the scheme. (Psychiatric cases).

What is the emergency number to call, in case one needs to know more information about OHIS?

OHIS emergency No is 0700022556447 the call centre will attend to your call in the language you prefer (English, Yoruba and Pidgin)

Does OHIS exist on Internet such as: Twitter, facebook, Whatsapp, website etc? If yes, let us know the contacts

Yes OHIS Social media address are: a) Facebook: Osunhealthinsurancescheme b) Twitter: @Osunhis c) Website: www.oshia.ng d) Email: info@oshia.ng

How can an enrollee get a new OHIS card, if the first one issued is damaged or lost by mistake?

The enrollee will come to OHIS Headquarters, with a sworn affidavit fill a form requesting for a new OHIS card, stating the reasons, or what happened to the first card. He will be requested to pay a token.

Can an enrollee receive treatment outside the station or state.

Yes, for cases of emergency midwived by the HMO/TPAs

What plan does the scheme have for retirees?

Individual informal sector plan.

Can an enrollee access care without carrying the OHIS Card?

Yes, for cases of emergency.

Does the scheme accommodate overseas treatment

No.

How many times can enrollee attend hospital in a year?

As many times as needed within the provision of the benefit package.

If for a whole year as a principal enrollee, I do not visit the facility I choose to access healthcare, am I entitled to collect a percentage of my premium either formal or informal sector?

The scheme is based on the principle of Social solidarity, where the healthy pays for the sick, and the rich pays for the poor. The Agency pays the Health care provider on monthly basis, on each of the enrollee, whether they access care or not. Anyone who does not visit The facility of his choice throughout the year is not entitled to any returns.

If both husband and wife are civil servants in the scheme who is the children's custodian?

In this case, the wife is given the authority to choose the facility for the children. Children cannot be beneficiaries of both the husband and wife to avoid double capitation payment.

What efforts are made by the Agency (OSHIA) to monitor/supervise the HCPs, to make sure they do the right things expected of them on OHIS enrollees?

There is a department in charge of monitoring the HCPs in OSHIA, Standard & Quality Assurance (SQA). Visitation are done frequently to ensure that the HCPs comply with the rules and regulations embedded in the OHIS benefit packages.

Does your scheme include surgical procedures?

Yes, (e.g Hernioraphy, Appendicytomy, Ceasarian Section etc)

What is Equity fund, who pays the fund and what is it meant for?

This is a contribution from Federal, State and Local Government meant to take care of the vulnerable in the society.

ÌBÉÈRÈ TÍ ÀWON ARÁÀLÚ SAABA MÁA Ń BÈÈRÈ NÍPA ÀJO TÓ WÀ FÚN ÈTÒ ADÓJÚTÒFÒ ÌLERA NÍ ÌPÍNLE OSUNIFAARA

Ofin idojutofo nidi eto ilera tipinle Osun ni a sagbekale re lodun 2018 lujuna ati pese eto ilera to muyanlori fun awon olugbe ipinle Osun eleyii ti inawo re ko ni i gun won lapa laifi ti bi won se je lawujo se rara.

Se dandan ni eto yii ni abi fun eni to ba wu?

Eto yii je dandan fun gbogbo olugbe ipinle Osun.

Elo ni won n yo ninu owo-osu awon osise ijoba fun eto yii ati pe elo nijoba n fi kun un fun won losoosu?

Fun awon osise ijoba, ida kan ataabo ninu ogorun (1.5%) ni won n yo ninu owo osu won, ijoba si n ba won fi idameta ninu ogorun (3%) kun un titi di asiko ifeyinti won.

Elo ni awon ti ki se osise ijoba atidile won yoo san lati fi darapo mo eto yii?

Fun gbogbo awon araalu ti won ko sise ijoba, enikansoso yoo san egberun mejila o le die naira (₦ 12,066), idile to ba je eleni mefa, iyen, baba, iya, awon omo won tabi awon omoti won gba to merin ti ojo ori won ko ti i pe odun mejidinlogun (18) yoo san egberun matadinlogota o le egbeta naira (₦ 57,600) fun odidiodun kan.

Gbedeke igba wo lo wa lorii kaadi eto yii fun awon osise ijoba?

Ojo ti osise ijoba ba feyinti ni kaadi eto adojutofo ilera re ko ti wulo mo, bee lo si ri fun iyawo tabi oko re naa. Fun awon omo won, ojo ti won ba pe omo odun mejidinlogun tabi ti awon obi won ba fehin ti ni kaadi won ko sise mo.

Awon ti won ko sise osu wa nko? Gbedeke wo lo wa fun kaadi awon ti ki se osise ijoba?

Leyin odun kan ti won ti gba kaadi ni ko ti wulo mo.

Igba wo ni eni to ba foruko sile fun eto yii yoo bere si i janfaani itoju to peye?

Leyin ojo marunlelogoji (45 days) teeyan ba ti foruko sile ni won le bere gbigba itoju.

Se anfaani wa fun eni to foruko sile lati paaro ileewosan to fee ma a lo?

Beeni, o se e se leyin osu mefa, iru eni bee yoo sabewo si olu ile ise OHIS to wa ni Ogo-Oluwa ni Osogbo lati se awon eto to ye lori igbese to feegbe.

Eeyan melo lo le janfaani eto yii lati ipase osise ijoba to ba foruko sile?

Eeyan marun. Iyawo tabi oko re pelu merin ninu awon omobibi inu e tabi awon to gba to.

Awon wo ni HMOs ati TPAs? Ki ni ojuse won ninu ajo OHIS?

Awon HMO: Health Maintenance Organization ati awon TPA: Third Party Administration je asoju ileese wa kaakiri ekun (Constituencies) meseesan to wa nipinle Osun. Won n yanju isoro-kisoro ti awon to foruko sile fun eto wa ba n dojuko. Won maa n setaniji kaakiri fun awon araalu nipa eto wa. Won maa n ran awon ti won ba leto si owo idojutofo lowo lati seto re, bee ni won si n gba awon ti won nilo itoju nileewosan niyanju lati lo sibe nipase imoran awon ilewosan alaboode atawon ile iwosan agba.

Ti ile iwosan alaboode ti eni to forukosile mu ko ba le yanju oro ilera re, ki lo ma a sele?

Iru dokita alaboode bee yoo mu oro eni naa to ile iwosan agba lo, awon TPA ati awon HMO ni won maa sise aarin naa.

Se eni to ba ti foruko siletun maa san owo kankan nigbakuugba to ba ti lo fun itoju?

Idamewaa ninu ogorun owo oogun (drugs) ti won ba lo fun un nileewosan nikan ni yoo san.

Eni ti o ba ni ju iyawo kan lo, ki ni yoo sele si awon iyawo to seku nigba to je pe iyawo kan soso atawon omo merin ti ojo-ori won ko ti i pe odun mejidinlogun ni won lanfaani si eto yii?

Iyawo kan soso to ba fe pelu ofin ati omo merin ti won je omo bibi inu re tabi to gba to nikan ni won letoo si anfaani yii. Sugbon, iru okunrin bee le foruko awon iyawo yooku sile nipa sisan egberun mejila naira o le die (₦ 12,066) fun enikookan won lodun.

Nje eto kankan wa fun awon akekoile-eko giga niwon igba to je pe pupo won ti le lomo odun mejidinlogun, ti won ko si le janfaani yii labe awon obi won?

Beeni. Eto yii ni a pe ni The Tertiary Institutions Social Health Insurance Programme (TISHIP).

Ti eni to foruko sile yii ba lo si irinajo, ti isele ojiji sele nibe, to si ni kaadi ajo adojutofo tipinle Osun lowo, se iru enibe le ri itoju gba nipinle miran ati pe bawo lo se fee se e?

Beeni. Iru eni bee yoo pe asoju wa to maa n lo, iyen HMO/TPA, asoju yii ni yoo to o sona lori ibi ti yoo ti lo gba itoju, ajo wa yoo si seto sisan owo itoju naa nipase asoju wa.

Se itoju gbogbo aisan ati arun ni eto yii wulo fun?

Rara o, sugbon anfaani re wa fun itoju awon aisan to je gboogi. A gbodo mo pe ko wulo fun awan arun bii jejere ati bee bee lo.

Ti eeyan ba nilo imo kikun sii nipa eto adojutofo yii, nomba ero ibanisoro wo la le pe?

Nomba ero ibanisoro OHIS niyii: 0700022556447. Oju ipe yii yoo dahun gbogbo ibeere yin ni ede ti e ba fe (English, Yoruba ati Pidgin).

Se oro nipa ajo yii wa lori awon ero ayelujara bii Tuita, feesibuuku, wasaapu, websaiti ati bee bee lo? To ba je bee, e je ka mo nipa won.

Beeni. Adiresi wa lori ero ayelujara niwon yii: a Facebook: Osunhealthinsurancescheme b Twitter: @Ohisng d) Website: www.osunhis.com e) Email: info@osunhis.com

Ti eni to ti foruko sile ba so kaadi re nu tabi to baje, bawo lo se le ri tuntun gba?

Eni bee yoo wa si olu ileese wa pelu iwe ibura lati ile-ejo, yoo gba foomu ninu eyi ti yoo ti so idi to fi nilo kaadi tuntun tabi ohun to sele si kaadi ti n lo tele. Yio san owo tasere.

Se eni to foruko sile le gbatoju nipinlemiran?

Beeni. Ohun ti eni to foruko sile naa nilo lati se ni ko pe oju ero ibanisoro wa (0700022556447), asoju wa yoo si se gbogbo eto to ye fun un.

Eto wo ni ajo yin ni fun awon osise feyinti?

Eto BHCPF wa fun awon ti won ko sise ijoba atawon osise feyinti ti ko si agbara fun.

Se eni to foruko sile le gba itoju lai mu kaadi re lowo?

Beeni, fun isele ojiji.

Se eto yii faaye sile fun itiju loke-okun?

Rara.

Eemelo ni eni to foruko sile le lo sileewosan laarin odun kan?

Gbogbo asiko ti won ba nilo itoju nibamu pelu alakale eto ti won se pelu wa.

Gege bii osise ijoba tabi onise adani, ti n ko ba lo sileewosan fun odidi odun kan lati gbatoju, se mo le ri ida owo ti mo san gba pada?

A gbe eto yii kale fun ifowowewo lawujo wa ni, nibi ti awon ti ara won da pe yoo ti sanwo fun awon alaisan, ti awon olowo yoo ti sanwo fun talaka. Osoosu la n sanwo fun awon osise wa lori enikookan to foruko sile, yala, won gbatoju tabi won ko gbatoju. Enikeni ti ko ba lo sileewosan lo gbatoju laarin odun kan ko letoo si owo kankan.

Ti oko atiyawo ba je osise ijoba, abe oruko taa ni awon omoyoo wa?

Ni iru nnkan bayii, iyawo lanfaani lati ko awon omo sabe. Ko se e se fun awon omo lati wa labe oko atiyawo, ki inawo ma ba a di ona meji fun ajo wa.

Bawo le se n samojuto awon asoju yin ti won wa kaakiri lati ri i daju pe won n se awon nnkan to bojumu fun awon araalu?

Eka kan wa to je pe ojuse tiwon ni lati maa samojuto awon asoju wa. Won maa n sabewo si won loorekoore lati ri i pe won n tele ofin ati ase ileese wa gege bo se wa ninu alakaleofin ise wa.

Se anfaani ise-abe wa ninu eto yin?

Beeni. Anfaani wa fun ise-abe fun awon alaboyun, ipake ati bee bee lo.

Ki ni itumo owo ajumosan (Equity Fund), taa lo n sanwo naa ati pe ki lo wa fun?

O je owo ti ijoba apapo, ijoba ipinle ati ijoba ibile maa n san lati fi pese itoju fun awon to ku die ka a to fun lawujo. Idameji ninu ida ogorun (2%) owo to n wole labenu fun joba ipinle ati ijoba ibile pelu owo tijoba apapo ya soto fun eto ilera, eyi tii se Basic Healthcare Provision Fund (BHCPF) ni owo naa.