Frequently Asked Questions

Can my siblings, children or parents be registered on my form?

Parents, siblings and other relatives are not to be registered on your form. The scheme covers only the principal staff, spouse and four (4) biological children for the formal sector. However, you can purchase regular individual plans for your siblings and parents from ASHIA directly. For the informal sector, premium payment covers each individual and not a spouse, child nor parent.

Can I register more than one wife or above four (4) children?

You are entitled to register just one wife and maximum of 4 biological children for the formal sector. However, you have the option of purchasing our regular plan and paying an additional premium for each additional spouse or dependant as many as you want.

My child is above 18 years, can I register him/her?

The age limit for the dependants on the scheme shall be 18 years or a maximum of 21 years, if still in a tertiary institution for the formal sector enrolees.

Can I register my family in separate hospitals different from mine?

Yes, each family member can choose a different hospital from the principal insured, especially if the members are residing in different locations.

Can I choose more than one (1) hospital?

No. Each enrollee is entitled to choose only one preferred provider. However, you would be referred to a secondary facility if there be need for it.

Can I get my membership ID card replaced if it is lost or stolen?

Yes. You should immediately notify ASHIA for loss or theft of the ID card. Replacement of the ID card would attract a token fee from the enrollee.

Can I attend a hospital without my membership ID card?

No.

What is the limit of my healthcare benefit?

There is no financial limit within the year for covered services.

If the medical bill incurred is high, does the health plan or my employers surcharge me?

No, you will not be required to pay any additional amount nor any deductions made for high medical bills regardless of the number of visits made to the provider except for the 10% statutory co-payment on drugs prescribed.

How do I register for the scheme?

To register unto the scheme, each enrolee must complete the enrolee family data form (online or hardcopy) and attach a recent passport photograph for each person to be enrolled.

Can I register for hospitals not listed in your network?

If your health provider of choice is not on the scheme, you may introduce them for possible inclusion in the provider list. This is subject to ASHIA discretion.

Who chooses the provider? The ASHIA or Enrolee?

The enrolee has the sole right to choose any preferred provider within our network.

Do I start accessing healthcare immediately after registration/change of healthcare provider?

No, there is a waiting period of 30 days after registration/change of healthcare provider. This period is for proper documentation.

Do I pay for Laboratory or Clinical investigations?

No.

Can I be refunded for payment of medical bills incurred?

Reimbursement of medical expenses incurred can only be settled in conditions of emergency, accidents, or prevailing circumstances in which the ASHIA has prior notice and authorization was given for such care.

Do I have to pay for drugs?

Yes, but 10% of the total amount.

If I am refused treatment in my hospital, what do I do?

In case of refusal of treatment, enrollees are encouraged to call our help line:08021810222 immediately for prompt intervention. However this is not envisaged.

Is there a limit to the number of times I can visit the hospital?

There is no limit to the number of times a member can visit the hospital for medical attention.

Does the scheme cover maternity care?

The scheme covers female Principal beneficiaries or the wife of a male beneficiary for antenatal care and child delivery (including C/S) for up to 4 live births and also for gynaecological care.

Does the scheme cover my newborn child or new spouse?

New born babies or new spouse are automatically included unto the scheme for civil servant family schemes, once the passports and other information are forwarded to ASHIA.

How do I get access to specialist care?

Access to specialist care is through referrals from the enrolee’s primary provider. Specialist consultation can be accessed in same hospital or referred elsewhere.

How do I access eye or dental care?

Referral letters from the primary providers’ or from ASHIA is necessary when accessing care from the dental and eye centres.

If I am not satisfied with my healthcare provider, what do I do?

Complaints generating from misunderstanding of the scheme by either the provider or member, should be communicated to the ASHIA help line for prompt attention and resolution.

Will I be refunded if I did not visit any healthcare provider in a year?

No, it remains in the pool so that it is used to subsidise for others.

In case of an accident/emergency, what do I do?

Ans 1: If you are within your service area, go to your health provider or call the ASHIA help line for directives.

Ans 2: If you are outside your primary station, you can go to any of the hospitals on our network of providers for treatment. In the unlikely event that you cannot locate one, kindly go to the nearest hospital but ensure that ASHIA is informed of this within 24 hours.

Is substitution of enrolees or patients allowed?

Health insurance is based on each individual life so substitution of registered members with others is not an option.

Do I need to come to the ASHIA office every time I need a referral?

Collection of referral letters to secondary care providers are not restricted to the ASHIA office, but should be collected from members’ primary care provider.

Does my medical history or record get to my employers’ knowledge?

Knowledge of the medical history of our enrolees is strictly restricted to the attending hospital(s) and the ASHIA medical personnel. However, if there are exemptions, such can only be done with the express approval of the said enrolee.

Is HIV/AIDS covered under the programme?

No. National Agency for the Control of AIDS (NACA) is handling the supply of anti-retroviral drugs.

Of what advantage is the programme to me?

Beneficiaries have easy access to health care without payment at the point of treatment.