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By Doris Obinna
Lagos State Health Management Agency (LASHMA) has reaffirmed its commitment to sustaining affordable and accessible healthcare for all residents under the Lagos State Social Health Insurance Scheme, ILERA EKO, while clarifying that no benefit has been removed from the scheme’s package.
The agency explained that recent adjustments were introduced to safeguard the scheme from abuse, ensure long-term sustainability, and improve health outcomes for residents.
Permanent Secretary, LASHMA, Dr. Emmanuella Zamba, said the agency has not reduced any of the benefits available to ILERA EKO enrollees but has refined certain provisions to strengthen accountability and promote responsible use of healthcare services. She said the changes aim to protect families from catastrophic medical expenses and enhance the scheme’s ability to deliver quality healthcare over the long term.
Zamba explained that the specific areas reviewed include maternity services both vaginal and caesarean deliveries-elective surgeries, and the introduction of a one-month waiting period for new enrollees beginning January 1, 2026. “Under the new policy, pregnant women must be enrolled for at least five months and provide proof of antenatal attendance before accessing delivery services, while elective non-emergency surgeries now carry a four-month waiting period. Antenatal care, however, remains fully covered with no waiting period to encourage early and consistent maternal care.
She said the policy adjustments were necessary to address the growing problem of adverse selection, where some individuals register only when they are about to use high-cost benefits such as delivery or surgery and then exit immediately after treatment. “Some residents enroll shortly before accessing maternity or surgical care and exit after treatment. This behaviour undermines the risk-pooling principle that sustains every insurance system,” she noted.
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Zamba cited actuarial data showing that maternity services account for about 61 per cent of total claims, with caesarean sections representing 79 per cent of maternity costs, equivalent to nearly half of overall claims. She added that nearly half of enrollees who accessed benefits did so within their first month of registration, confirming a pattern of misuse that threatens the scheme’s sustainability.
She clarified that the new measures apply only to the general public category, while vulnerable residents funded through the Lagos State Equity Fund and public servants under the formal sector plan remain unaffected due to their structured premium payments.
The revised policies took effect in the second quarter of 2025 following formal notifications to hospitals and enrollees through multiple communication channels, including emails, text messages, and ILERA EKO radio programmes.
She said the policy was also discussed at LASHMA’s third-quarter media parley held on October 22, 2025, where she emphasized that the reforms were crucial to maintaining the integrity of the scheme and advancing universal health coverage in Lagos State.
She assured residents that emergency care, including emergency caesarean sections and urgent surgeries, remains exempt from the waiting period. “No patient has been denied emergency care under ILERA EKO,” she said, adding that those not yet eligible under the waiting period can still access care through affordable, negotiated tariffs. She also urged residents to report any cases of overbilling through the agency’s 24-hour customer service lines or WhatsApp platforms.
Zamba encouraged enrollees, particularly those on the Pay Small-Small plan, to complete their premium payments at least two months before expected delivery or surgery dates to ensure seamless access to care. She reiterated that health insurance in Lagos State is mandatory by law and appealed to all residents, especially the young and healthy, to remain active under the scheme.
