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NHIA Act 2022 Statutory Rules Engine

NHIA & State Health Insurance (SHIS) Co-Pay & Tariff Calculator

Instantly calculate patient out-of-pocket co-payments, insurance scheme reimbursements, and statutory compliance splits across all 36 States and the FCT.

1. Claim & Treatment Details

Select the accredited scheme regulating this patient encounter.
Total tariff or drug retail cost prior to insurance deduction.
Enter monthly capitation pre-payment if primary consultation is bundled.

2. Statutory Breakdown & Tariff Split

Encounter Gross Total: ₦25,000
Statutory Co-Pay Rate: 10%
Patient Out-of-Pocket Co-Pay: ₦2,500
Scheme / HMO Claim Amount: ₦22,500
Expected Provider Settlement: ₦25,000
Mandatory NHIA Section 13 Rule: Prescribed medications require a mandatory 10% patient cash co-payment at the pharmacy window. Do not waive or absorb this fee without statutory audit authorization.
Share Calculation to Medical / Billing Team
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Frequently Asked Questions

What is the mandatory drug co-payment percentage under the NHIA Act 2022 in Nigeria?

Under Section 13 guidelines of the National Health Insurance Authority (NHIA) Act 2022, enrollees are required to pay a 10% co-payment for prescribed medications listed on the NHIA essential medicines list at accredited health facilities. The health insurance scheme or HMO reimburses the remaining 90% upon electronic claim submission.

How does DokiTab EMR automate NHIA and State Health Insurance (SHIS) billing?

DokiTab features a built-in HMO & SHIS rules engine that automatically splits pharmacy and lab bills upon clinical order generation. The front-desk cashier collects the exact 10% patient out-of-pocket co-payment instantly, while the 90% insurance claim is packaged with pre-authorization codes and ICD-10 diagnostic entries for automated submission.

Can clinics use this calculator for State Health Insurance Schemes like LASHMA and FHIS?

Yes. This tool supports national NHIA tariffs as well as state-level schemes including Lagos State Health Scheme (LASHMA / Ilera Eko), FCT Health Insurance Scheme (FHIS Abuja), Oyo State Health Insurance (OYSHIA), Rivers State Contributory Health Protection Programme (RIVCHS), and private commercial HMO plans.