Following widespread discussions on social media about changes to the ILERA-EKO Health Insurance Scheme, the Lagos State Health Management Agency (LASHMA) has assured residents that the scheme remains affordable, robust, and accessible to all.
The agency clarified that no benefit has been removed from the health insurance package.
Instead, certain provisions were refined to prevent abuse, enhance sustainability, and improve healthcare outcomes for residents.
Permanent Secretary, Dr. Emmanuella Zamba, made this known while reacting to public concerns on the recent policy adjustments, noting that the review was necessary to protect the integrity of the state’s social health insurance system.
“The adjustments we made are meant to protect families from catastrophic medical costs, improve maternal health outcomes, and safeguard the sustainability of the scheme,” she explained.
According to Dr. Zamba, the review affects three major areas, maternity services, elective surgeries, and waiting periods for new enrollees, which will take effect from January 1, 2026.
Under the revised guidelines, pregnant women must be enrolled for at least five months and show proof of antenatal attendance before accessing delivery services, whether vaginal or caesarean.
A four-month waiting period now applies to elective (non-emergency) surgeries, while antenatal care remains fully covered with no waiting period.
Dr. Zamba explained that the new rules were introduced to discourage “adverse selection,” a trend where individuals register shortly before undergoing expensive procedures such as childbirth or surgery and then exit immediately after treatment.
“Some residents enroll just to access maternity or surgical care without contributing their full premiums. This undermines the risk-pooling principle that keeps every insurance scheme sustainable,” she said.
Citing actuarial data, she disclosed that maternity services account for about 61 per cent of total claims, with caesarean sections representing 79 per cent of maternity costs, about 48 per cent of overall claims.
Almost half of the beneficiaries (49.4 per cent) accessed benefits within the first month of registration, and 75 per cent within three months, indicating high levels of short-term enrolment.
“These high-cost interventions are being treated as pay-as-you-go services by some members of the public,” she noted, adding that the new policy was designed to promote fairness for consistent contributors.
Dr. Zamba clarified that the adjustments apply only to the general public plan.
Vulnerable residents covered under the Lagos State Equity Fund and public servants in the formal sector plan are not affected, as their premiums are continuous and structured.
She added that the new policies took effect in the second quarter of 2025, following official notifications to hospitals and enrollees through emails, text messages, WhatsApp, and ILERA-EKO radio programmes.
The policies were also discussed during the agency’s Q3 Media Parley on October 22, 2025.
To protect low-income families and emergency cases, LASHMA stressed that emergency services, including urgent surgeries and emergency caesarean sections, remain exempt from any waiting period.
“No patient has been denied emergency care under ILERA-EKO. Those yet to meet the waiting-period criteria can still access care by paying affordable, negotiated tariffs.” Dr. Zamba said.
She urged residents to complete their premium payments early, especially those on the Pay Small-Small plan, to ensure uninterrupted access to care.
“Health insurance thrives on collective responsibility. When people only join when they are sick, the system becomes unsustainable,” she warned.
Reiterating that health insurance in Lagos is mandatory by law, Dr. Zamba appealed to residents, particularly the young and healthy, to enroll and stay active on ILERA-EKO.
“By staying enrolled, Lagos residents are not only protecting themselves but also contributing to a healthier, stronger state,” she concluded.