Lagos Health Agency Clarifies ILERA EKO Policy Adjustments, Assures Emergency Care Remains Unaffected
The Lagos State Health Management Agency (LASHMA) has clarified recent policy adjustments under the Lagos State Social Health Insurance Scheme, ILERA EKO, assuring residents that emergency services, including emergency caesarean sections and urgent surgeries, remain unaffected by the new waiting period.
The Permanent Secretary of LASHMA, Dr. Emmanuella Zamba, explained that no benefits had been removed from the scheme. Instead, certain terms and conditions were reviewed to prevent abuse, enhance sustainability, and improve health outcomes.
Dr. Zamba noted that the adjustments were introduced to protect families from catastrophic medical costs, improve maternal health outcomes, and preserve the financial sustainability of the scheme. She reaffirmed the state government’s commitment to maintaining affordable and accessible healthcare for all residents.
According to her, the specific areas affected include maternity services—whether vaginal or caesarean delivery—elective surgeries, and a one-month waiting period before activation for new enrollees, beginning January 1, 2026. These changes, she said, are designed to promote early enrolment, continuous participation, and responsible use of ILERA EKO services.
Under the revised guidelines, pregnant women must be enrolled for at least five months and present proof of antenatal attendance before accessing delivery services. A four-month waiting period also applies to elective, non-emergency surgeries. However, antenatal care remains fully covered with no waiting period, ensuring continuous medical support for pregnant women.
Dr. Zamba added that enrollees who have not met the waiting-period criteria can still access required services by paying an affordable, negotiated tariff under the ILERA EKO scheme. She encouraged residents to report cases of overbilling through the agency’s 24/7 customer service lines or WhatsApp channels.
The Permanent Secretary explained that the adjustments were prompted by adverse selection, a growing trend where individuals register only when they need high-cost services, such as deliveries or surgeries, and exit immediately afterward. “This behaviour undermines the risk-pooling principle that sustains every insurance system,” she said.
She emphasized that the revised policy applies only to the general public category, while the vulnerable population (funded through the Lagos State Equity Fund) and public servants under the formal sector plan remain unaffected, as they maintain structured and continuous premium payments.
Dr. Zamba disclosed that the new directives took effect in the second quarter of 2025, following formal notifications to hospitals and enrollees via emails, text messages, WhatsApp broadcasts, and ILERA EKO radio programmes.
She noted that the policy changes were also discussed at the agency’s Q3 Media Parley held on October 22, 2025, where she reiterated that the adjustments were necessary to preserve the scheme’s integrity and advance Universal Health Coverage (UHC) in Lagos State.
