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Ghana - Apply for Private Health Insurance Scheme License

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ProcedureEdit

Apply In-Person:

  1. To Apply for Private Health Insurance Scheme License in Ghana, the applicants has to approach the Ghana National Health Insurance Authority contact link
  2. Applicant must obtain the required application form from this link or application form can be downloaded from this Link
  3. All information must have filled in the application form while when applicants submit to the application form.
  4. Applicant should attach all relevant documents in the application form.
  5. Documents that are needed for this procedure are mentioned under “Required Documents” section of this page.
  6. Payment of appropriate fees should be made and that can be found under the "Fees" section of this page.
  7. PHIS shall have Corporate Governance Manuals drafted in line with standards prescribed by the Board. These standards shall guide how PHIS are governed. PHIS shall subsequently submit those draft Corporate Governance Manuals to the Private Health Insurance Schemes’ Oversight Committee of the NHIA Board for review.
  8. PHIS shall promulgate their Governance Manuals within three (3) months of receipt of comments of the Committee.
  9. After the promulgation of the Manual, any subsequent review of Manuals shall be submitted to the Private Health Insurance Schemes’ Oversight Committee for consideration.
    Note: Where a PMHIS intends to use the services of a third party manager/administrator (independent body corporate), this must be indicated in the business plan and a copy of the agreement to regulate this relationship shall be submitted to the Authority. The third party administrator shall be licensed by the Authority as a PCHIS.
  10. A PMHIS cannot appoint a related party as a Third Party Administrator. A PCHIS shall NOT be managed by a Third Party Administrator. The Authority shall assess the relationship between a Third Party Administrator and the schemes/products they manage by requesting for details of the governing structures in addition to other relevant information.
  11. Proposed minimum premium/benefits package. These premiums/benefits package shall be actuarially determined and signed off by a qualified actuary with a profile, detailing years of experience. PHIS shall disclose the methodology and assumptions used in determining premiums. This must be described in such sufficient detail that another actuary qualified in the same practice area is able to evaluate it.
  12. Private Mutual Health Insurance Schemes:
    • A PMHIS is required to have a minimum capital requirement of One Million Ghana Cedis (GH¢1,000,000.00). This is subject to revision. The capital requirement refers to a paid-up initial subscription. A start-up PMHIS shall furnish the Authority with a business plan that describes the Proposed business and pro-forma statement of operations of the scheme for at least five (5) Years. This plan shall demonstrate satisfactorily, the scheme’s ability to remain solvent over the set period.
    • A PMHIS shall put twenty percent (20%) of the minimum capital required into a reserve fund. The Board may review the adequacy of the reserve in relation to the business of the PHIS as and when it deems necessary. A PMHIS in conjunction with the Authority shall create and operate an escrow account into which the reserve shall be deposited and managed.
    • In the event that a PMHIS suffers a substantial loss arising from liability to members or providers and the loss cannot reasonably be met from its available resources, the Board may, after ascertaining the nature of the claim, and on application made to it by the scheme, approve the withdrawal from the reserve of the scheme an amount of not more than twenty-five percent (25%). The withdrawn amount shall be replaced by the scheme not later than one hundred and eighty (180) days after the date of withdrawal, failing which the Board may invoke Section 60 of Act 852.
    • (2) The reserve fund is the asset of the PMHIS but except as provided above and shall be available to the scheme only in the event of the closure or winding up of the health insurance business for the discharge of the liabilities arising out of policies transacted by the insurer and remaining un-discharged at the time of the closure or winding up of the insurance business.
  13. In addition to the reserve fund/security deposit, PHIS must create and maintain a contingency fund to serve as a buffer in times of crises. This shall be 3% of net written premium set aside monthly. Withdrawal from this fund can only be made upon prior written approval from the Authority.
  14. An application for registration and licensing to operate PHIS shall be processed upon payment of a non-refundable amount.
  15. PHIS may be issued with a permit by the Board upon satisfaction of the requirements set out in Act 852 and as provided for in this guide.
  16. The processing time for this procedure takes 3 months.



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Required DocumentsEdit

An application for registration shall be submitted with the following:

  • Application Form Link
  • Two copies of:
    • The Constitution of PMHIS or
    • The Regulations of PCHIS
  • Certified true copy of the certificate of incorporation
  • Certified true copy of the certificate to commence business
  • A Business Plan which must contain at the minimum:
    • Detailed information on the Governing Body which shall be responsible for the direction of policies of the scheme and appointment of employees such as a Principal Officer/Managing Director (which may be an independent body corporate or a committee) and other officers who shall be responsible for the management of the scheme. In addition to directors, shareholders and senior management staff of PHIS must be “fit and proper”. Refer to Appendices 5, 6 and 7 for the requirements of the composition of boards, management and “Personal Questionnaire Forms”.
  • Any other relevant information that may be required.



Office Locations & ContactsEdit

National Health Insurance Authority
Address: AU, Ridge Residential Area, 36 SekouToure St, Accra, Ghana
HR83+9P Accra, Ghana
No. 36-6th Avenue, Opposite AU Suite, Ridge Residential Area, Accra.
Digital address: GA-029-3976
Fax number: +233 (0) 302 232325
Contact number: +233302216970/+233 (0) 302 238136/ 233255/ 216970/ 241690
Email id: [email protected]
Location link
Contact link

EligibilityEdit

  • A scheme does not qualify to apply to operate a private health insurance scheme unless it is registered and incorporated under the Companies Act, 1963 (Act 179) as a:
    • Limited liability company in the case of PCHIS or
    • Company limited by guarantee in the case of PMHIS
  • Where a commercial health insurance company is solely owned by non-Ghanaian, a minimum of 15% percent of the shares shall be owned by Ghanaians.



FeesEdit

  • Registration fees for Private Mutual Health Insurance Scheme -5,000 GHS
  • Private Commercial Health Insurance Scheme -7,500


NOTE:
  • The Board may review these fees as and when appropriate.
  • These fees, once paid are non - refundable.


ValidityEdit

  • Licences issued will be valid for a period of 2 years.



Documents to UseEdit


Sample DocumentsEdit

Please attach sample completed documents that would help other people.



Processing TimeEdit

  • The processing time for this procedure takes 3 months.



Related VideosEdit

Videos explaining the procedure or to fill the applications.
Attach videos using the following tag <&video type='website'>video ID|width|height<&/video&> from external websites.
Please remove the '&' inside the tags during implementation.
Website = allocine, blip, dailymotion, facebook, gametrailers, googlevideo, html5, metacafe, myspace, revver,
sevenload, viddler, vimeo, youku, youtube
width = 560, height = 340, Video ID = Can be obtained from the URL of webpage where the video is displayed.
e.gIn the following url 'http://www.youtube.com/watch?v=Y0US7oR_t3M' Video ID is 'Y0US7oR_t3M'.



InstructionsEdit

Please provide other instructions related to the certificate/documents.
E.g. the state office holds birth records since January 1908.


Required InformationEdit

  • Name of Scheme
  • Name of Individual
  • Personal data
    • Sur name
    • First name
    • Last name
    • Postal address
    • Telephone number
    • Fax number
    • Email id
    • Nationality
    • Date of birth
    • Residential address (street, house number, suburb etc.)
    • Age and sex
    • Qualification
    • Any change of nationality Date changed
    • Current residential address
    • Any other residential address (es) in the previous ten years (with dates)
    • Capacity in which you are completing this form, e.g. as a current or prospective director, shareholder or principal officer or any combination of these.
    • Date of Appointment
    • Status of Directorship e.g. Non-Executive, Executive and Independent
    • State your full title and describe the particular duties and responsibilities attaching to the position(s) which you hold or will hold.
  • Experience
    • Period of employment (month and year)
    • From address, To address
    • Name of employer
    • Address of employer
    • Nature of employer’s business
    • Position(s) and responsibilities held
    • Reason for leaving
    • Nature of employer’s business
    • Position(s) and responsibilities held
  • Details of Qualifications and Training
    • Other Business Interests
    • Principal activities
    • Date or period of directorship
    • Name of business
    • % of shares owned or controlled
    • Past or current
  • Other Relevant Information
  • Particulars of directors details
  • Particulars of management team details
  • Details of particulars of auditor
  • Name of principal officer/manager
  • Declaration



Need for the DocumentEdit

  • Private health insurance is designed to cover policyholders for certain hospital and medical expenses that aren't covered under the public health system, Medicare, or where the patient chooses to be treated privately.



Information which might helpEdit

  • The National Health Insurance Authority (NHIA) is mandated by National Health Insurance Act, 2012 (Act 852) to regulate Private Health Insurance Schemes (PHIS) in Ghana. In performing its regulatory functions the Authority registers, licenses and supervises the operations of PHIS in Ghana.


Private Mutual Health Insurance Schemes (PMHIS)

  • A PMHIS refers to a health insurance scheme operated exclusively for the benefit of its members. Any identifiable group of persons in Ghana may form and operate a PMHIS. For example, membership may be community-based, occupation-based, faith-based or an association. PMHIS shall have individuals (natural persons) as their members and NOT corporate organizations. Under no circumstance shall an employer impose membership of PMHIS on employees.


Private Commercial Health Insurance Scheme (PCHIS)

  • A PCHIS is required to have initial capital requirement of Five Million and Five Hundred Thousand Ghana Cedis (GH¢5,500,000.00). This is subject to revision. The capital requirement refers to paid-up capital.
  • Note: At least sixty percent (60%) of a scheme’s minimum capital requirement shall be in cash or near cash and forty percent (40%) may be in fixed assets.
  • A PCHIS shall deposit with the Bank of Ghana (BoG) a sum of Five Hundred and Fifty Thousand Ghana Cedis (GH¢550,000.00) representing 10% of the initial capital required. The security referred to above shall be maintained throughout the period that the business of private commercial health insurance is carried on. The Board may review the level of the security deposit as and when it deems necessary.
  • Where a PCHIS suffers a substantial loss arising from liability to members or providers and the loss cannot reasonably be met from its available resources, the Board may, after ascertaining the nature of the claim, and on application made to it by the scheme, approve the withdrawal from the security deposit of the scheme an amount of not more than ten percent (10%). The withdrawn amount shall be replaced by the scheme not later than ninety (90) days after the date of withdrawal, failing which the Board may invoke Section 60 of Act 852.
  • The security deposit is the asset of the PCHIS, except as provided above and shall be available to the scheme only in the event of the closure or winding up of the health insurance business for the discharge of the liabilities arising out of policies transacted by the insurer and remaining un-discharged at the time of the closure or winding up of the insurance business.



Other uses of the Document/CertificateEdit

Please explain what are other uses of obtaining this document/certificate.
e.g. Birth Certificate can be used as proof of identity.



External LinksEdit


OthersEdit

More information which might help people.



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