Insurance, Health Insurance, NHIA & Public Schemes October 14 2026 | 30 mins read

State Health Insurance Schemes in Nigeria Explained: Lagos, Oyo, Anambra, FCT and More (2026)

Introduction

Nigeria now runs health insurance on two levels. The federal system, under the National Health Insurance Authority (NHIA), sets the country-wide rules. Alongside it, every state and the FCT is expected to operate its own State Social Health Insurance Scheme, funded partly by resident premiums, partly by government subsidy, and delivered through accredited hospitals and HMOs within that state.

This guide explains what those state schemes are, why they exist, how the biggest ones — Lagos, Oyo, Anambra and FCT-Abuja — currently work, and how to enrol in your own state’s scheme in 2026. If you have heard “health insurance is now compulsory in Nigeria” and are not sure what that means for you personally, this article is the place to start.

What a State Social Health Insurance Scheme actually is

A State Social Health Insurance Scheme is a health insurance programme created by a state government, run by a dedicated state agency, and open to residents of that state. It is separate from a private HMO and separate from the federal NHIA formal-sector scheme, although it operates under the same national legal framework.

Every state scheme has roughly the same building blocks:

A state agency that regulates the scheme, accredits providers and manages enrolment (for example, LASHMA in Lagos or OYSHIA in Oyo).
A benefits package, usually anchored on primary care, common secondary care, maternal health, essential drugs and emergencies at accredited hospitals.
A network of accredited providers, mostly public primary healthcare centres and mid-tier private hospitals within the state.
Contribution categories, typically formal sector (civil servants and organised private employers), informal sector (traders, artisans, self-employed), students, vulnerable groups (subsidised or free), and sometimes tertiary-institution students.
Vulnerable-group cover, funded through the Basic Health Care Provision Fund (BHCPF) and state equity funds so that the poorest residents can be enrolled without paying premiums themselves.

Most importantly, cover under a state scheme is tied to the state you live in. If you move from Lagos to Enugu, you enrol under Enugu’s scheme, not Lagos’. This is why state schemes matter even for people who already contribute to a federal scheme or a private HMO.

Why every state now has one: the NHIA Act 2022

Before 2022, participation in Nigeria’s health insurance system was mostly voluntary and largely limited to federal civil servants and formal-sector employees. That changed with the National Health Insurance Authority Act 2022, which replaced the old NHIS Act and introduced two important shifts.

First, health insurance is now compulsory for every Nigerian and every legal resident. Second, each state (and the FCT) is required to operate its own State Social Health Insurance Scheme through a state agency, and to enrol its residents through that agency. The NHIA is the national regulator; the state schemes are the operational vehicles for most Nigerians.

The 2022 Act also formalised how the vulnerable are covered. Contributions from formal-sector members, a share of the BHCPF, and state equity funds combine to subsidise cover for pregnant women, children under five, the elderly poor, persons with disabilities and other groups identified by each state. For a fuller explanation of the Act and what mandatory cover looks like at the federal level, see our pillar on the NHIA Act 2022 and what mandatory health insurance means for you, and the step-by-step National Health Insurance Authority (NHIA, formerly NHIS) in Nigeria: A 2026 Enrolment Guide for the federal route.

Lagos: ILERA EKO under LASHMA

The Lagos State Health Scheme was passed into law in May 2015 and is administered by the Lagos State Health Management Agency (LASHMA). Its consumer-facing name is ILERA EKO.

In July 2024, Governor Babajide Sanwo-Olu signed an Executive Order making Social Health Insurance mandatory for all residents of Lagos State, regardless of state of origin or nationality. Full enforcement of the order began in the third quarter of 2025. In practice, this means every person who lives, works or studies in Lagos is expected to be enrolled in ILERA EKO or in a comparable private plan.

LASHMA reports that more than 1.89 million lives were registered on the scheme by the end of August 2026, across a network of over 640 healthcare facilities. Enrolment channels include the LASHMA head office and divisional offices, LASHMA kiosks and community pharmacies across the state, the ILERA EKO web portal at lashma.com, and the self-registration USSD code *6700*006#. The scheme covers formal-sector workers, informal-sector residents, students and vulnerable groups on separate contribution categories.

Oyo: OYSHIA

Oyo State was one of the earliest movers on state-level health insurance. The Oyo State Health Insurance Agency (OYSHIA) administers the state’s scheme, marketed under the OYSHIA brand.

OYSHIA’s product menu is organised around individuals, families, pregnant women, students and businesses, with published premiums starting from ₦21,000 per year for the entry-level plan. Alongside the main scheme, OYSHIA runs a Community-Based Health Insurance Scheme (CBHIS) for rural communities, a UNICEF-supported programme for public primary school pupils, and a dedicated cover for tertiary students. Enrolment happens through the OYSHIA website at oyshia.oy.gov.ng, through agency offices, and through community outreach in participating LGAs.

Anambra: ASHIA

The Anambra State Health Insurance Agency (ASHIA) runs the state’s scheme, with a mandate to provide mandatory health insurance for Anambra residents under a defined benefits package.

ASHIA is best known for its work in the informal sector. The agency has pushed the annual premium for informal-sector enrolees down to a headline figure of ₦12,000 a year, payable in smaller instalments through a mobile enrolment platform aimed at market traders and artisans. Enrolment can also be done directly on the ASHIA portal and through USSD and digital wallets. The provider network runs to over 500 hospitals within Anambra State, covering routine consultations, minor surgery, maternal care, diagnostics and referrals.

FCT-Abuja: FHIS

The FCT Health Insurance Scheme (FHIS) was established by FCT Executive Council resolution in 2006 to regulate social health insurance in the Federal Capital Territory, and now sits under the FCT Health Services and Environment Secretariat. It is the state-level equivalent scheme for people who live or work in Abuja and its area councils.

FHIS uses the same underlying model as the state schemes: a benefits package, a network of accredited providers, and premium categories for formal-sector employees, informal-sector residents, students and vulnerable groups, with the BHCPF supporting cover for people who cannot pay. Recent expansion efforts include a dedicated enrolment drive for FCT journalists, and, in May 2026, the first formal enrolment of FCT correctional-centre inmates into FHIS under the BHCPF. Enrolment information sits on fhis.abj.gov.ng.

Other state schemes worth knowing

Almost every state now has an operational scheme, though maturity and enrolment numbers vary widely. Well-known examples include:

Kaduna (Kaduna State Contributory Health Management Authority, KADCHMA), one of the earliest and most widely enrolled state schemes.
Kwara (Kwara State Health Insurance Agency, KWSHIA), which has run a large informal-sector programme for several years.
Enugu (Enugu State Agency for Universal Health Coverage, ENSAUHC), which merged its state scheme with its UHC drive.
Delta (Delta State Contributory Health Commission, DSCHC), covering formal and informal sectors.
Ogun, Ondo, Osun, Ekiti, Bauchi, Gombe, Nasarawa, Niger, Kano, Katsina, Sokoto, Kebbi, Cross River, Rivers, Akwa Ibom, Bayelsa, Edo, Abia, Imo and Ebonyi, each with its own state agency and enrolment channels.

Because names, premiums and benefit packages differ, the best starting point is always your own state agency’s website or nearest enrolment office. Do not rely on figures published for another state.

What a state scheme usually covers, and what it does not

Benefits packages vary by state and plan, but state schemes generally include general outpatient consultations, essential drugs on the state’s drug list, basic laboratory and diagnostic tests, antenatal and delivery services, immunisation, family planning and a defined list of minor and moderate surgeries. Emergency care within the accredited network is normally covered, and referrals from primary to secondary and tertiary providers are permitted under agency rules.

Common exclusions and limits

Cover is usually excluded or limited for cosmetic procedures, most fertility treatment, expensive chronic-disease drugs beyond a formulary, high-end dental and optical work, care outside the state scheme’s provider network without prior authorisation, and pre-existing conditions during a defined waiting period. Very high-cost cancer, cardiac and transplant care is often capped or handled through specialised programmes rather than the base plan.

Coverage, exclusions, waiting periods and premiums for each scheme are set by the relevant state agency and can change. Confirm them from your state agency’s current benefits package before enrolling.

Who is required to enrol, and what “mandatory” really means

Under the NHIA Act 2022, health insurance is compulsory for every Nigerian and legal resident. In most states, enforcement is still gradual, focused on formal-sector employers, government contractors, higher-education institutions and specific occupational groups. Lagos is currently the most advanced, with an Executive Order and an active enforcement team.

In practice, mandatory cover means one of three things applies to you:

1You are already covered

Through a federal NHIA arrangement, a state scheme or a private HMO, and you keep that cover active.

2Your employer is obliged to enrol you

Into an approved scheme and remit contributions, if you are in the formal sector.

3You are expected to self-enrol

Into your state’s scheme or into a private plan, if you are in the informal sector, self-employed or otherwise not enrolled through an employer.

Vulnerable groups (pregnant women, under-fives, elderly poor, persons with disabilities) can usually be enrolled without paying, through equity funds and BHCPF.

How to enrol in your state’s scheme

The process is broadly similar across states:

1Confirm the correct agency

LASHMA for Lagos, OYSHIA for Oyo, ASHIA for Anambra, FHIS for FCT, and so on.

2Pick a plan category

That matches your situation: formal sector, informal sector, family, student, senior, or vulnerable.

3Gather your documents

A valid ID, National Identification Number (NIN), proof of residence in the state, and passport photographs. Some states now require NIN for every dependant.

4Register

Through the agency’s website, USSD code, enrolment office, community pharmacy or approved kiosk.

5Choose an accredited primary provider

Usually a hospital or PHC close to where you live or work. This is the facility you will use for routine care.

6Pay the premium

For your category (annual or instalment). For vulnerable groups, this step is handled by the agency’s equity fund or BHCPF.

7Wait through any qualifying period

Typically 30 to 90 days, before non-emergency services become available.

8Renew annually

Ideally before your current cover expires, to keep access continuous.

For federal NHIA members, portal registration, status checks, login and e-ID collection are covered separately in our walkthrough of how to use the NHIA (formerly NHIS) self-service portal.

State scheme vs private HMO: quick orientation

State schemes and private HMO plans are complementary rather than competing products. State schemes are designed to guarantee a floor of essential care at a subsidised price, especially for the informal sector, vulnerable groups and civil servants. Private HMO plans usually offer wider provider networks (including higher-tier hospitals), broader benefits, faster pre-authorisation and more flexible add-ons, at a higher premium.

Many Lagos and Abuja residents in the formal sector now hold both: a state scheme membership because it is mandatory, and a private HMO plan for wider hospital access. For the full side-by-side on cost, coverage, network, waiting periods, dependants and portability, see our comparison of NHIA (formerly NHIS) versus private HMO plans.

Compare private Health Insurance plans

See how private HMO cover, premiums and networks stack up next to your state scheme.

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For most households, the practical question is not “state scheme or private HMO”; it is “which of these do I need first, and when?”

If you are on a modest income and do not yet have any cover, your state scheme is almost always the first move. Premiums are lower, subsidies exist for vulnerable groups, and enrolment is now expected by law. Your priority is to confirm the scheme name in your state, verify the current premium and benefits package from the agency’s own website, and pick an accredited hospital you can actually reach.

If you are salaried in Lagos or Abuja, or your job involves regular travel between states, you may want a private HMO plan on top of any state or federal cover, especially for access to larger private hospitals and faster claims. Do not drop your state scheme to fund a private plan; keep the state scheme active and treat the private HMO as an upgrade.

Frequently Asked Questions

Is health insurance really mandatory in Nigeria now?

Yes. Under the National Health Insurance Authority Act 2022, health insurance is compulsory for every Nigerian and every legal resident. Enforcement varies by state, and Lagos is currently the most advanced, but the underlying legal position is the same nationwide.

Do I have to use my state’s scheme, or can I use a private HMO instead?

You must have some form of approved cover. In most states, holding an equivalent private HMO plan satisfies the requirement, but this is easier to confirm in states with active enforcement (like Lagos). Where the state is still building enrolment, the safest route is to enrol in the state scheme and optionally add a private HMO on top.

What if I live in one state and work in another?

You enrol in the state where you spend most of your time and use healthcare, typically where you live. If you split time between states, check the enrolment rules of both agencies. Your private HMO (if any) usually covers you across states through its national network.

Are pre-existing conditions covered under state schemes?

Cover for pre-existing conditions depends on the specific scheme and plan. Many state schemes apply a waiting period before non-emergency care for pre-existing conditions is available, and some conditions remain excluded or capped. Confirm the current rule with your state agency before you rely on it.

How much do state schemes cost?

Premiums vary significantly by state and category. As benchmarks, Anambra’s ASHIA advertises informal-sector cover from around ₦12,000 per year, while Oyo’s OYSHIA lists individual plans from around ₦21,000 per year. Lagos, FCT and other states publish their own current rates on their agency websites. Vulnerable groups are typically enrolled without paying.

Where do I check whether my employer has enrolled me?

Ask your HR department for your enrolment reference and the name of the accredited provider assigned to you, then confirm on your state agency’s portal (for federal schemes, the NHIA portal). Do not assume that a deduction on your payslip means active cover; always confirm the enrolment.

Terms and conditions apply. Please verify all details with the relevant state health insurance agency, NHIA or HMO before enrolling. This article provides general information and is not medical advice.

Insurance, Health Insurance, NHIA & Public Schemes

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Noella Lepdung

Noëlla Lepdung is a writer who makes magic with all sorts of content, helping businesses find their voice and meet their ambitions with cutting-edge but human-first advertising. Her portfolio features brands such as Budweiser, The Coca-Cola Company, Nivea, Leadway Group, Honeywell Foods, Monieworx, Kimberly-Clark, and WAMCO.