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The short answer
NHIA cover pays for treatment in its benefit package at accredited facilities, funded by contributions; a medical loan pays for anything, but you repay it with interest. NHIA publishes its own contribution rules and benefit packages, and says its cover has exclusions and partial exclusions. The sensible order is to use insurance first and borrow only for the gap it does not cover.
When a hospital bill arrives, two questions matter: what will insurance pay, and how will you cover the rest? In Nigeria the National Health Insurance Authority (NHIA, formerly NHIS) runs the national scheme, through HMOs and state schemes. A loan is the fallback. This guide explains what NHIA says about its cover and when borrowing is worth it.
What NHIA cover is
NHIA describes its benefits as cashless treatment at NHIA-accredited facilities. Its FAQ (checked Oct 2026) sets out the main points:
- Formal sector programme: for employees in the public and organised private sector.
- Students: tertiary students can be covered under the tertiary institutions programme (TISHIP).
- Dependants: the contributor, a spouse and four biological children under 18. Additional dependants can be registered as extra dependants.
- Contributions: the FAQ says the employer pays 10% of basic salary and the employee 5%, and in the same answer gives 3.25% for the employer and 1.75% for the employee on a consolidated salary. It does not reconcile the two; ask your HR or HMO which applies to you.
- Exclusions: NHIA says it does not cover all ailments; "there are exclusions and partial exclusions". Some items have limits; kidney dialysis, for example, is "limited to six sessions yearly".
- Drugs: prescribed drugs are sourced through providers; HIV/AIDS drugs are handled by NACA.
NHIA publishes the full benefit package and premiums for its other programmes on its site. Because these change, check the current package before relying on cover for a specific procedure. Enrolment is linked from the NHIA site at enrollment.nhiaonline.com.
What a medical loan is
There is rarely a special "medical loan" product. In practice it is a salary advance, personal loan, MFB loan, cooperative loan or app loan, used for a hospital bill. It pays for anything the hospital charges, at any hospital, but you repay the full amount with interest and fees. See hospital bill loans for the lenders.
Side by side
| NHIA cover | Medical loan | |
|---|---|---|
| What it pays for | Treatments in the benefit package | Anything, up to the loan amount |
| Where | NHIA-accredited facilities | Any hospital |
| Cost | Monthly contributions, whether or not you are ill | Interest and fees, only when you borrow |
| Speed at the hospital | Depends on HMO authorisation | Depends on lender approval |
| Limits | Exclusions, partial exclusions and caps | Your income and credit history |
| Family | Spouse and four children under 18 included | You borrow for each person separately |
Worked example: using both
Example only. An employee earns a basic salary of ₦200,000 a month. On the FAQ’s first formula, the employee’s 5% is ₦10,000 a month and the employer’s 10% is ₦20,000. A family member needs a ₦400,000 procedure. The HMO confirms that ₦250,000 of it falls within the package and ₦150,000 is excluded.
The family borrows the ₦150,000 gap at GTBank’s published QuickCredit rate of 2.95% a month over three months (as at Oct 2026): three instalments of about ₦52,979, about ₦158,936 in total, plus a 1% insurance fee of ₦1,500. The cost of borrowing is about ₦10,436. Borrowing the full ₦400,000 would have cost several times that.
When a loan makes sense
- The treatment is excluded or only partly covered.
- You need a hospital that is not accredited for your plan, for a good clinical reason.
- The HMO’s authorisation is delayed and treatment cannot wait; ask whether costs can be reimbursed later.
- You are not enrolled at all. Enrolling after the event will not cover the current bill, but it can protect against the next one.
If you are not formally employed
NHIA’s FAQ concentrates on the formal sector programme, but it lists other programmes, including a private plan and programmes for vulnerable groups, and many states run their own health insurance schemes. Self-employed people, traders and artisans can ask their state scheme or an NHIA-accredited HMO about individual or family plans. The premium is a known monthly or yearly cost; a loan taken after an illness is an unknown cost at the worst possible time. For a household without any cover, even a basic plan can reduce how much you would ever need to borrow.
What to check first
- Call your HMO with the diagnosis and procedure name and ask what is covered, at which hospital, and whether any co-payment applies.
- Get the hospital’s itemised estimate and mark which items insurance will pay.
- Borrow only for the gap, for the longest tenor you can afford.
- If cover is refused unfairly, NHIA says complaints can go to NHIA offices, HMOs or its call centre; its listed email is info@nhia.gov.ng.
For ongoing prescriptions, see monthly medication costs.
Where Pryme fits
Pharmacies are a Spaces sector. If Solid Allianze MFB has offered you a Loans on Spaces limit, you can use it at Spaces pharmacies after reading and accepting the agreement; see Loans on Spaces. A Flexible Savings Box can hold a small health fund for co-payments.
Questions people ask
Does NHIA cover surgery?
Some surgical procedures are in the benefit package and others are excluded or partly excluded. Ask your HMO about the specific procedure and hospital before treatment.
How much do workers pay for NHIA?
NHIA’s FAQ says employers pay 10% of basic salary and employees 5%, and also gives 3.25% and 1.75% on a consolidated salary. Ask your HR which basis your employer uses.
Can NHIA cover my children?
Yes. The contributor’s spouse and four biological children under 18 are covered; extra dependants can be registered.
Should I take a loan or wait for my HMO?
Ask the HMO first. If the item is excluded or authorisation cannot come in time, borrow only for the uncovered part.
Sources
- National Health Insurance Authority: FAQ · accessed Oct 2026
- GTBank: QuickCredit · accessed Oct 2026
This article is general information, not financial, legal or tax advice. Products described are provided under the terms on this site and are subject to regulation and eligibility.