By Bilkis Abdulraheem Lawal
The Lagos State Health Management Agency (LASHMA) has reaffirmed that the ILERA EKO Health Insurance Scheme remains robust, affordable, and accessible to all residents, despite recent policy adjustments aimed at strengthening sustainability and preventing misuse.
Permanent Secretary of LASHMA, Dr. Emmanuella Zamba, clarified that the Agency has not removed or reduced any benefits from the ILERA EKO package but has reviewed some terms to improve accountability, safeguard the scheme from abuse, and enhance maternal and surgical outcomes.
“The adjustments we made are meant to protect families from catastrophic medical costs, improve maternal health outcomes, and preserve the sustainability of the scheme,” Dr. Zamba explained.
The reviewed areas include maternity services (vaginal and caesarean deliveries), elective surgeries, and a one-month waiting period before activation for new enrollees starting January 1, 2026. Pregnant women must now be enrolled for at least five months and present proof of antenatal attendance before accessing delivery services. Antenatal care, however, remains fully covered without any waiting period to ensure continuous maternal support.
She revealed that maternity claims constitute 61% of total scheme expenditures, with caesarean sections accounting for nearly half of all claims, prompting the review. “Many people only register when they need surgery or delivery and exit afterward. This pattern undermines the principle of risk pooling that sustains any insurance system,” she said.
According to Dr. Zamba, the new measures target adverse selection, where residents join the scheme only to access high-cost care, by encouraging early enrolment and consistent participation. Importantly, the new rules apply only to the general public category, while the vulnerable population and public servants covered under the State Equity Fund and formal sector plans remain unaffected.
To protect patients, emergency care, including urgent surgeries and caesarean sections, remains fully covered, with no waiting period. Those who do not meet the criteria can still access services at affordable negotiated ILERA EKO rates. She also urged residents to report any overbilling via the Agency’s 24/7 customer service or WhatsApp lines.
Dr. Zamba encouraged Lagosians to complete premium payments early, especially those on the “Pay Small-Small” plan, to ensure uninterrupted access to care. “Health insurance thrives on collective responsibility. When people only join when they are sick, the system becomes unsustainable,” she said.
Reaffirming that health insurance is mandatory in Lagos State, Dr. Zamba called on residents, particularly the young and healthy, to stay enrolled under ILERA EKO. “By remaining active, residents are protecting themselves and contributing to a stronger, healthier Lagos,” she concluded.
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