In Lagos, getting sick can quickly become expensive. A simple illness may mean consultation fees, drugs, laboratory tests and transport. A serious illness can mean admission, surgery or specialist care — and for a family paying everything from pocket, one medical emergency can wipe out months or even years of savings.

This is the reality Lagos State is trying to change with ILERA EKO, its social health insurance scheme. This is what ILERA EKO means for your pocket, your family and your next hospital visit. And LASHMA's message to residents is now clear: HEALTH INSURANCE IS MANDATORY FOR EVERYONE LIVING IN LAGOS STATE.

The policy is backed by the Lagos State Health Scheme Law, enacted in May 2015, and reinforced by the Executive Order signed by Governor Babajide Sanwo-Olu on July 16, 2024. LASHMA says it has commenced steps towards enforcement, while public education and sensitisation remain a major part of the process.

But beyond the law, there is a more practical question: What is actually in it for the average Lagos resident? The answer begins with one simple idea — you should not have to wait until you are sick before you start looking for money for treatment.

With health insurance, residents pay a premium into a pool and, in return, receive access to defined healthcare services when they need them. For the individual Lagosian, the current Standard Jaara plan costs ₦15,000 a year; while Jaara Plus costs ₦40,000 a year. There are also plans designed for seniors and Nigerians in the diaspora who want to provide healthcare cover for relatives in Lagos. Family and other categories have different premiums.

AND WHAT DOES THE MONEY COVER?

Depending on the plan, ILERA EKO provides access to consultations, specialist visits, hospital care, maternity and newborn services, physiotherapy, eye care, laboratory investigations, selected cancer treatment, renal dialysis, annual medical screening, telemedicine and other healthcare services within the limits of the chosen package.

For example, LASHMA's current plan information shows that the Standard Jaara package costs ₦15,000 per individual annually and includes up to four specialist visits and 15 hospital days per year. Jaara Plus costs ₦40,000, with eight specialist visits and up to 21 hospital days in a semi-private ward. The senior’s Plan is ₦60,000 and includes additional benefits such as physiotherapy and home-care nursing.

This is an important point for anyone considering enrolment: health insurance is not simply “pay money and everything is free.” Each plan has its own benefits, limits and conditions. So before choosing a plan, residents should check what is covered and understand the limits.

The next question is: WHERE WILL YOU RECEIVE THE CARE?

LASHMA says ILERA EKO now has more than 630 accredited healthcare providers across Lagos, including hospitals, clinics and other participating facilities. Its online provider directory allows residents to search for participating facilities by location and plan. That means the real test of the scheme is not just how many people register. It is what happens when an enrollee walks into a hospital.

• Does the hospital provide the service covered by the plan?
• Are the drugs and investigations within the package available?
• What happens when an enrollee has a complaint?
• And where does the resident go when there is a problem?

This is where LASHMA's grievance and support system becomes important. Residents can contact the agency through its 24-hour support channels for assistance, complaints and other enquiries.

Residents can also check the available plans, enroll online and find accredited healthcare providers through the official LASHMA website.

But what happens to the Lagos resident who cannot afford even ₦15,000?

This is one of the biggest questions surrounding mandatory health insurance.

Lagos has increased its equity fund for vulnerable residents from ₦1 billion to ₦3 billion, with one per cent of the state's Consolidated Revenue Fund dedicated to supporting health insurance coverage for vulnerable and indigent residents. LASHMA says residents who cannot afford the premium can be assessed for support through the equity mechanism.

There is also ILERA EKO EasyPay, a wallet-based payment option introduced to make premium payments easier, particularly for people in the informal sector who may find it difficult to pay the full amount at once.

And for emergencies, LASHMA has introduced LASHMA-AID — Assistance in Distress, designed to support emergency medical care, with the agency reporting that the intervention has helped save lives since becoming fully operational.

The idea behind making insurance mandatory is therefore bigger than simply enforcing a law. It is about getting enough people into the insurance pool so that healthcare costs can be shared, rather than leaving individual families to carry the full burden whenever illness comes.

The National Health Insurance Authority Act, 2022 provides the national legal framework for health insurance, while Lagos' own health scheme legislation provides the state-specific structure for its programme.

For Lagos, mandatory participation is being positioned as a route towards universal health coverage and protection from catastrophic healthcare spending. The figures show how far ILERA EKO has come.

LASHMA says the scheme has now crossed 1.5 million registered lives, with more than 630 healthcare providers in its network. But Lagos is a city of millions, meaning a large number of residents are still outside the insurance net. That is the gap the state now has to close. And closing that gap will require more than telling people that health insurance is compulsory.

People need to understand what they are paying for, where they can use it, the confidence that an accredited hospital will treat them properly and when something goes wrong, somebody will listen.

For the resident, however, the first step is simple. Don't wait until you are sick before you start thinking about health insurance. Visit lashma.com, compare the available ILERA EKO plans, check the accredited hospitals around you and choose the package that suits you.

Because when that unexpected hospital visit comes, having health insurance may mean the difference between getting care and asking, “Where will I find the money?”

ILERA EKO: “YOUR HEALTH TODAY, YOUR FINANCIAL PROTECTION TOMORROW”!