---
title: "NHIA & State HMO Co-Pay Calculator Nigeria — DokiTab"
description: "Free interactive NHIA and State Health Insurance (SHIS) co-pay and tariff calculator for Nigerian hospitals. Calculate 10% drug co-pays and capitation balances."
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Statutory Healthcare Financial Assessment (NHIA Act 2022 Section 13)

Generated:

Engine: Accredited NHIA/SHIS Engine

# NHIA & State Health Insurance (SHIS) Co-Pay & Tariff Calculator

Instantly calculate patient out-of-pocket co-payments, insurance scheme reimbursements, and statutory compliance splits across all 36 States and the FCT.

## 1. Claim & Treatment Details

## 2. Statutory Breakdown & Tariff Split

- ✓ **Stop HMO rejection penalties:** Enforce real-time tariff rules & pre-auth checks before claim submission.
- ✓ **Automate copay math at the cashier point:** 10% statutory drug split calculated instantly without cashier queues.
- ✓ **Zero manual spreadsheet errors:** Clean electronic claims formatted for NHIA and private HMO reconciliation.

## Frequently Asked Questions

### What is the mandatory drug co-payment percentage under the NHIA Act 2022 in Nigeria?

Under Section 13 guidelines of the National Health Insurance Authority (NHIA) Act 2022, enrollees are required to pay a 10% co-payment for prescribed medications listed on the NHIA essential medicines list at accredited health facilities. The health insurance scheme or HMO reimburses the remaining 90% upon electronic claim submission.

### How does DokiTab EMR automate NHIA and State Health Insurance (SHIS) billing?

DokiTab features a built-in HMO & SHIS rules engine that automatically splits pharmacy and lab bills upon clinical order generation. The front-desk cashier collects the exact 10% patient out-of-pocket co-payment instantly, while the 90% insurance claim is packaged with pre-authorization codes and ICD-10 diagnostic entries for automated submission.

### Can clinics use this calculator for State Health Insurance Schemes like LASHMA and FHIS?

Yes. This tool supports national NHIA tariffs as well as state-level schemes including Lagos State Health Scheme (LASHMA / Ilera Eko), FCT Health Insurance Scheme (FHIS Abuja), Oyo State Health Insurance (OYSHIA), Rivers State Contributory Health Protection Programme (RIVCHS), and private commercial HMO plans.

### Free 15-Minute Billing & HMO Tariff Audit

Identify revenue leakages, unbundle claims safely, and stop HMO clawbacks with a Dokitab health billing consultant.

🔒 **NDPA 2023 Compliant:** Your facility financial data remains strictly confidential. Zero spam.

## Schema.org Drug & Clinical Formulary Entities

### NHIA Essential Medicines Formulary Drug (10% Statutory Co-Pay)
- **INN / Generic Name:** Artemether-Lumefantrine, Amoxicillin-Clavulanate, Metformin, Amlodipine, Lisinopril, Oral Rehydration Salts

## Frequently Asked Questions (Schema.org FAQPage)

### Q: What is the mandatory drug co-payment percentage under the NHIA Act 2022 in Nigeria?
Under Section 13 guidelines of the National Health Insurance Authority (NHIA) Act 2022, enrollees are required to pay a 10% co-payment for prescribed medications listed on the NHIA essential medicines list at accredited health facilities, while the scheme or HMO covers the remaining 90%.

### Q: How does DokiTab EMR automate NHIA and State Health Insurance (SHIS) billing?
DokiTab features a built-in HMO & SHIS rules engine that automatically splits pharmacy and lab bills upon clinical order generation. The front-desk cashier collects the exact 10% patient out-of-pocket co-payment instantly, while the 90% insurance claim is packaged with pre-authorization codes and ICD-10 diagnostic entries for automated submission.

### Q: Can clinics use this calculator for State Health Insurance Schemes like LASHMA and FHIS?
Yes. This tool supports national NHIA tariffs as well as state-level schemes including Lagos State Health Scheme (LASHMA / Ilera Eko), FCT Health Insurance Scheme (FHIS Abuja), Oyo State Health Insurance (OYSHIA), Rivers State Contributory Health Protection Programme (RIVCHS), and private commercial HMO plans.