FAQs

Answers to frequently asked questions.

The objective of the National Health Insurance Management Authority (NHIMA) are as follows:

  • To protect families from the financial hardship of huge medical bills.
  • ensure that every Zambian has access to good health care services
  • To limit the rise in the cost of health care services.
  • To ensure equitable distribution of health care costs among different income groups.
  • To maintain high standards of health care delivery services within the Scheme.
  • To ensure efficiency in health care services.
  • To improve and harness private sector participation in the provision of health care services.
  • To ensure equitable distribution of health facilities between rural and urban communities.
  • To ensure appropriate patronage of all levels of health care.
  • To ensure the availability of funds to the health sector for improved services.
  • NHI is a risk mitigation mechanism by which the insured is protected against financial catastrophe resulting from medical expenses.

(NHIS) aims at complementing efforts towards Universal Health Coverage by:                                                                                                                                                                                                                                  

 

  • Introducing innovative financing solutions for health care,
  • Providing quality affordable and sustainable health care,
  • Expanding provision of insured health services to all citizens and established residents,
  • Reduction of catastrophic and impoverishing health expenditure.
  • Compulsory contributions at a household level,
  • Pooling of risk, both good and bad, to protect all who are in the pool at their point of need thereby promoting equity,
  • Contributions are pooled, financial protection is not equal to the contributions.

Members will need the for lowing for registration:

  • Copy of the NRC
  • Contact number
  • Email address
  • Physical address
  • Spouse – attestation letter in the absence of the marriage certificate,
  • Copy of the National ID for the spouse,
  • Other dependants below the age of 18 – Birth certificate or attestation letter in the absence of birth certificate, and
  • Copy of National ID for children between 16 and 18.

 

  • Once a member is registered with NHIMA, the Membership ID and login credentials will be sent to their mobile number provided. However, if the member does not receive the credentials, details may be obtained through our call centre on the toll free line 8000 or write to info@nhima.co.zm
  • The waiting period after registration is four (4) months. Fully paid members can only access NHIMA services 4 months after registration. However, there is no waiting period for members aged 65 and
  • The member must be registered as a principal and make contributions separately as a principal membe
  • Members shall maintain their NHIS number and the account can be moved to the new employer.

Below are the services covered under scheme:

  • Medical Care
  • Major and Minor Surgery
  • Paediatric Maternity and Neonatal
  • Eye Care Services
  • Oral health
  • Selected Services cancer services
  • Pharmaceutical Drugs and Supplies Orthopedic Implants
  • Investigations including labs and Radiology
  • PhysiotherapyMental Health services.
  • Members are entitled to receive fast track services Upon admission are put in NHIMA dedicated wards or high-cost wards where space is available
  • Yes, Penalties will be levied at 10% of outstanding monthly TOTAL contribution subject to the maximum amount of K60,000.00, to compensate against lost investment gains, inflation, and breach of compliance penalty charge.
  • Premiums are due for remittance by the 10th of each month.
  • Formal sector – 1% of your declared income from the employee and 1% employer contribution from the basic salary of the employee.
  • Informal sector – As per eNHIMA income assessment tool for the informal sector
  • Member must pay contributions for the missing months.
  • The account should first be moved to the informal sector and you will be required to perform the income assessment for computation of premiums.
  • If the prescribed drug is covered under NHIMA, a member can collect the prescribed drugs from any of NHIMA accredited facility. The prescription must be stamped and claim number indicated.
  • Register members – This relates to registration of Employers, Employees and Beneficiaries,
  • Contributions – This relates to collection of contributions from the Employers, Employees and the Self Employed,
  • Benefit Package – design, pricing of tariffs, provider payment models and benefits & claim rules.
  • Accreditation of facilities – This relates to the engagement and contracting of health care providers based on established standards.
  • Operational Information System – Procurement, set up and launch of NHI Management System,
  • Communication – Roll out of robust communication messages on NHI,
  • Implementation Structures – This defines the Governance, staffing, operation and funding model.
  • Yes, all Zambians and established residents above the age of 18 with an income is required to register with NHIMA.

Members can be registered in the following ways:

 

  • If a member is in employment, registration is done by the employer within 30 days from the commencement date of the contract of employment,
  • Informal sector – registration is done online line through www.enhima.co.zm or by visiting any nearest NHIMA offices,
  • Senior citizens aged 65 and above – Registration is done online line through www.enhima.co.zm or by visiting a nearest NHIMA office without any contribution.
  • Retirees – registration is by their Pension Managers
  • The poor and vulnerable are identified and registered through the Ministry Community Development and Social welfare.
  • Domestic workers – they register in their own right as principal members.
  • 6 beneficiaries can be registered by the principal member e., your spouse and 5 children or dependents below the age of 18.

Members can be registered in any of the following ways:

  • Registration can be done online through enhima.co.zm if the member has login credentials. However, members without login credentials may contact our toll-free call centre line of 8000 or,
  • Through the nhima offices or facilities
  • Yes, members can register non-biological children if the member has proof of relationship or attestation form.
  • A member can register a newly born baby if the member has proof birth with full names of the baby indicated and relationship or attestation form.
  • Members will continue with the same NHIMA number.
  • Under section 13 of the NHI Act 2018, an employer shall register an employee with the Authority within thirty days of the commencement date of the contract of employment.
  • Membership of the deceased member to the Scheme shall cease on the death of a member. However, registered family members are entitled to continued benefits for a period of four (4) months following the death of the member.
  • Bypass is not its not covered as it is a Ministry of Health (MoH) Penalty surcharged when one doesn’t follow the referral system. It’s a once off payment made to MoH facilites and subsequent visits do not pay as they have a file number at that facility from initial visit. Facilities waiver by pass fee in cases of emergency and for those 65yrs and above (elderly) Members are encouraged to adhere to the referral system.
  • NHIMA has accredited more than 350 private and Public facilities throughout the country.
  • If the employer does not remit premiums to NHIMA, then members are considered not registered.
  • Returns should be filed in through the e-payments portal enhima.nhima.co.zm.
  • NHIMA does not refund members for any drugs not provided by the hospital. Members given prescriptions must collect their drugs at the nearest accredited pharmacy
  • In the absence of medical cards, members can present their National registration Cards or passports at any of NHIMA accredited facilities.
  • Members can visit any of our provincial offices for biometrics harvesting for the member cards between 08:00 hrs to 17:00hrs
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A national health insurance scheme established for all Zambians and established citizens 

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