…clarifies policy settings
The Lagos State Health Management Agency (LASHMA) has reaffirmed its commitment to providing affordable and accessible healthcare to all residents through the Lagos State Social Health Insurance Scheme, ILERA EKO, ensuring that no benefits have been removed from its package.
The Agency clarified that only certain terms and conditions have been refined to prevent misuse, strengthen sustainability, and improve health outcomes across the state.
According to LASHMA Permanent Secretary Dr Emmanuella Zamba, the review was carried out to ensure accountability and protect members from catastrophic medical costs. “We have not eliminated or reduced any of the benefits of ILERA EKO. The adjustments are designed to safeguard the integrity of the Plan, improve maternal health outcomes and ensure continued access to quality health care,” he said.
Zamba explained that the adjustments cover maternity services (vaginal births and cesarean sections), elective surgeries and a one-month waiting period before activation for new members starting January 1, 2026.
Under the revised guidelines, pregnant women must be enrolled for at least five months and show proof of prenatal care before accessing delivery services.
A four-month waiting period now applies to non-emergency elective surgeries and prenatal care remains fully covered with no waiting period to encourage early and ongoing maternal care.
These measures, he said, aim to promote early registration, continued participation and responsible use of the scheme.
Zamba noted that the policy review was prompted by increasing cases of adverse selection, where people register only when they are about to access expensive medical services.
“Some residents join the scheme shortly before delivery or surgery and leave after treatment. This undermines the risk-sharing insurance principle that keeps the system sustainable,” he explained.
Citing actuarial data, it revealed that maternity services account for 61% of total claims, and cesarean sections account for 79% of maternity costs, nearly 48% of total claims. Furthermore, almost 75% of beneficiaries accessed benefits within the first three months of enrollment, confirming the trend of opportunistic enrollment.
“Some enrollees treated these high-cost services as pay-as-you-go options. The new policy ensures equity and long-term access for all continuing payers,” he said.
Zamba clarified that the policy changes affect only the general public category, not the vulnerable population (covered by the Lagos State Equity Fund) nor public servants enrolled in the formal sector scheme, whose premiums are constantly remitted.
In addition, he assured that emergency services, including emergency cesarean sections and urgent surgeries, will not be affected.
“No patients have been denied emergency care under ILERA EKO. Those who do not meet the waiting period criteria can still access care at ILERA EKO’s negotiated rates, and overbilling can be reported through our 24/7 customer service channels,” it added.
The new guidelines came into effect in the second quarter of 2025 after extensive notifications to hospitals and affiliates through emails, text messages, WhatsApp broadcasts and ILERA EKO radio programs. The Agency also briefed the media during its third quarter Media Parley on October 22, 2025.
Zamba encouraged residents, especially those using the Pay Small-Small plan, to complete premium payments at least two months before their expected delivery or surgery dates.
“Health insurance thrives on collective responsibility. When people only sign up when they are sick, the system becomes unsustainable,” he warned.
Reiterating that health insurance in Lagos is mandatory by law, he urged all residents to remain enrolled. “ILERA EKO is based on shared risk and solidarity. By staying active, Lagosians protect themselves and contribute to a healthier and stronger State,” Zamba concluded.
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