In April 2018, the government of Zambia passed a National Health Insurance Act, 2018 (the “Act”), which aims to provide mandatory universal access to healthcare for all citizens and residents age 18 and older. The commencement orders of the new law are still pending.
The government of Zambia currently provides the population with free, government-funded, basic healthcare limited to primary healthcare services. High government health expenditures and capacity constraints pushed the government of Zambia to pass the Act in order to diversify funding sources and incorporate private sector support.
As of today, the national health insurance regulatory authority (the “Authority”), which is in charge of implementing the new National Health Insurance (NHI) plan, is being established. On 17 March 2019, the health minister appointed the Authority management board. It is still unclear when the Authority will be fully established.
Once the NHI system is implemented, employers will be required to register their employees with the Authority within 30 days of the start date of the employment contract. The health minister recently announced that a contribution of 1% of gross pay shall be paid by both employees and employers.
Once fully established, the Authority will develop healthcare benefits packages and prescribe payment mechanisms available to members. Following negotiation with accredited public and private health care providers, the Authority will establish and update a uniform national standard fees schedule of insured health care services. Essential health care services will be fully covered by the NHI plan to avoid out-of-pocket payments.
Employers should monitor the implementation timeline of the Act, ensure accurate and timely registration with the NHI and review contribution allocations with their payroll provider.