Universal health insurance bill comes with tight rules

A new study has revealed that 73 percent of Tanzanians can comfortably subscribe to universal health insurance cover, with each person contributing Sh65,000 annually to access services at
health facilities across the country

What you need to know:

  • The Bill also introduces the Tanzania Insurance Regulatory Authority (Tira) as the overall regulator mandated to oversee insurance schemes and quality of provided healthcare services.

Dar es Salaam. The government yesterday tabled the Universal Health Insurance (UHI) Bill 2022 in Parliament providing compulsory conditions for people to have registered in insurance schemes in order to secure several social services.

The Bill also introduces the Tanzania Insurance Regulatory Authority (Tira) as the overall regulator mandated to oversee insurance schemes and quality of provided healthcare services.

It imposes hefty penalties of up to Sh100 million to an individual who contravenes the Act or a maximum jail term of not less than 12 months.

According to Section 32 (a)(h) of the Bill, it will be compulsory for citizens to have health insurance whenever seeking driving license, motor vehicles insurance and admitting children for advanced secondary education or colleges.

Other services that will also be issued after producing evidence of being enrolled in health insurance schemes are provision of travel document (passport), Taxpayers Identification Number (TIN), business license, visa, simcard registration and provision of national identification card (ID).

“Authorities will ensure that registration and permit provision to applicants will conform to a condition of membership confirmation in the health insurance scheme,” reads part of the section.

But, Section 7(i) introduces the Tanzania Insurance Regulatory Authority (Tira) as the sole regulation body mandated to regulate insurance activities in the country.

“For the purpose of ensuring efficiency in executing the UHI system, the authority will have three obligations: registration of health insurance schemes, monitoring the quality of services provided by contracted services providers and ensuring health insurances provide basic benefits bundles as provided by the act,” reads the bill in part.

The regulator will also have the responsibility to ensure that provided services correlates with contributions made, issue payment guidelines to service providers and guidelines that will assure there is efficient operation in supervision of health insurance schemes.

Furthermore, the Bill says the regulator will be responsible for ensuring that health insurance schemes have enough liquidity and cash as provided by procedures and maintain a database of contracted healthcare service providers.

The regulator will also be obliged to inspect health insurance schemes, provide guidelines on members’ registration, requesting or summoning information whenever necessary and implementation of any other issue for the better execution of the act.

According to the bill, providing false information and failure to provide requested documents without good reasons contravenes with sections of the act and that once convicted, a member or beneficiary will be liable to a Sh200,000 fine or not more than Sh1 million, serve a jail sentence of not less than 12 months or both.

“For the offense committed by a health insurance scheme or contracted healthcare service provider, they will be liable to a fine of not less than Sh5 million and not exceeding Sh100 million,” reads another part of the bill.

A person contravening the act commits an offense and when confirmed that there was no specific punishment provided by the act, the said person will be liable to a fine of Sh50 million, not less than a year jail sentence or both, reads Section 36 of the bill.

In order to provide basic benefits bundle, employers in the public and private sector will be required to remit six percent of employees’ salary, through which employers will contribute half or more with the remaining amount to be continued by an employee.

The responsible minister will unveil the amount that will be contributed by people from the informal sector as will be highlighted in the regulation according to the fund’s actuarial assessment in provision of basic benefits bundle, after consultation with the finance minister, reads the document which was made public yesterday.

Regarding procedures stipulated by the law, employers in the public and private sector will be required to register employees in the health insurance scheme 30 days after commencing employment contract.

Furthermore, the bill says, the minister will collaborate with responsible authorities using guidelines to formulate procedures that will be used to recognize people lacking financial ability to pay for health insurances.

“The minister responsible for finance in collaboration with the health minister will unveil specific sources for funding health insurances to such people,” the document said.

Speaking to The Citizen’s sister newspaper Mwananchi, the Association of Private Health Facilities in Tanzania (APHFTA) chairman, Dr Egina Makwabe commended the government saying the introduction of a dispute resolution mechanism and regulatory body will provide more justice to beneficiaries.

A health expert, Elisha Osati, commended the government for recognition of private health insurance schemes while calling for the formulation of better regulations.