NATIONAL HEALTH INSURANCE MANAGEMENT ......2 The following is the Detailed Benefit package of the...

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NATIONAL HEALTH INSURANCE MANAGEMENT AUTHORITY PRESS RELEASE

LUSAKA, FRIDAY, 3rd JANUARY 2020

RELEASE OF BENEFIT PACKAGE FOR THE NATIONAL HEALTH INSURANCE SCHEME The National Health Insurance Management Authority (NHIMA) is pleased to inform the public that the first ever Benefit Package for the National Health Insurance scheme (NHIS) has been completed and released to the public. The Benefit Package is a result of a participatory process that involved several stakeholders and experts including the Ministry of Health and other Government line Ministries, Academia, Professional bodies, Regulators, Private sector, informal sector, Cooperating partners, Civil Society, Trade Unions and members of the public to whom we offer our sincere gratitude on this significant milestone. This is another bold step in fulfilling our pledge towards Universal Health Coverage and ensuring that all eligible citizens and established residents will have access to affordable and quality healthcare under the National Health Insurance Scheme as outlined in the NHI Act No 2 of 2018. The requirement for a Benefits Package is provided under Part III of the NHI Act No. 2 of 2018 and Section 10 of the SI 63 of 2019. The Benefit Package essentially outlines the insured health services that members will be able to access at accredited public and private healthcare providers under the NHIS. It will also serve as a reference point and standardisation of claims that will be made by accredited healthcare providers for reimbursement from NHIMA for services utilized by members of the NHIS. The Benefit Package covers standard, high cost, premium and fast track services in accredited public health facilities. The covered services include Consultations, Registration, Hospitalisation, Intensive Care Unit (ICU), Minor and Major Surgery, Maternity and Neonatal care, Eye Care Services, Oral Health Services, Pharmaceuticals, Blood products and Physiotherapy

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The following is the Detailed Benefit package of the National Health Insurance Scheme offered to esteemed beneficiaries. Health care benefits in this package include but not limited to the following:- S/N Programme / Services Description

1 Outpatient Department (OPD) Registration and Consultation

This covers for costs related to Registration and Consultation of patients. Limited to 3 visits per health event unless condition is classified as Chronic

2 Pharmaceuticals and blood products

It covers for the costs of medicines prescribed in Generic names and medical consumables as per the National Essential Medicines List. It includes a medicine list recommended from time to time to meet members evolving needs. The benefit package provides for whole blood where indicated as part of the treatment protocol.

3 Investigations It provides for the costs of Investigations and Diagnosis tests as per the Investigation List in the benefits package.

4 Surgical Services It covers for the cost of Minor, Major, Orthopaedic, ENT and Diagnosis surgical procedures as per the listed interventions and tariffs. The surgical costs will cover for anaesthesia costs; disposables; medicines and medical consumables, dressing and other medical expendables used during the operation.

5 Maternal, New-born and Paediatric Services

It provides for cost of deliveries both normal and caesarean, obstetric and gynaecological interventions, New-born and paediatric services as listed in the package

6 Inpatient Care Services This covers for the costs of daily patient admission in private or ordinary ward, Intensive Care Unit, High Dependent Unit Services for the daily admission costs depending on the level of the facility and the agreed daily rates as per the tariff schemes, Investigations, Nursing care, Oxygen therapy, Medicines and Medical Consumables dispensed while the member is admitted.

7 Physiotherapy and rehabilitation services

This is provided to inpatients and outpatients where the facility has been accredited for these services.

8 Vision care and Spectacles The Fund also pays for visual corrective spectacles to the member once for every three years. Vision care services have been included in the package and include interventions for conditions such as Cataract, Glaucoma and trauma

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10 Dental and Oral health Services

It covers for inpatients and outpatients related to oral health as per the listed interventions and tariffs. This includes dental conservation surgeries (e.g. dental filling), gum diseases, dental extractions and root canal treatment

11 Cancer/Oncology services A limited number of investigations and interventions have been included for cervical, prostate, breast and Colon cancer.

12 Mental Health

It covers the cost of chronic conditions such as schizophrenia and affective disorders such as Mania and depression and other conditions as the NHIS will determine from time to time.

13 Medical / Orthopaedic Appliances and Prosthesis

It is provided for supportive orthopaedic and medical appliances that are determined by the NHIS from time to time.

14 Services that require Pre-Authorization approval

CT – Scan (with or without contrast), MRI, Dialysis services, CATHLAB services- angiogram, balloon & Stenting, Pacemaker placement, Orthopaedic Implants & Prosthesis, Spectacles, High Dependency Unit and ICU beyond stipulated period in the schedule

SCHEDULE 1. Second and Third Level Hospital – Providers to be paid using Diagnosis-Related Groups (DRG) Tariffs Each condition listed includes cover for Drugs, Investigations, medical consumables, Non-Clinical (catering, laundry and cleaning), Capital maintenance

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In patient Department (IPD)

Programme Condition

Communicable Uncomplicated Malaria

Complicated Malaria

Pneumocystis Carinii Pneumonia

Diarrhoeal diseases (non-bloody/bloody diarrhoea)

Bacterial meningitis

Non-Communicable Acute Asthma

Asthma Life Threatening

Diabetes ketoacidosis

Pulmonary Oedema

Heart failure

Hypertension

Infarctive Stroke (CVA)

Haemorrhagic Stroke (CVA)

Ischemic heart Disease

Diabetes Type 1

Diabetes Type 2

Internal Medicine Peptic Ulcer Disease (PUD)

Hepatitis B

Pneumonia

Arthritis

Sickle Cell Anaemia

Epilepsy

Pulmonary Embolism

STI (Ulcerative)

STI (Discharge)

Dialysis per session (includes heparin and consumables)

UTI

Reproductive & Maternal Health Normal labour

Caesarean section (Spinal)

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Pelvic Inflammatory Disease

Pelvic abscess

Ectopic pregnancy

Postpartum Haemorrhage

Episiotomy Repair

Deep vein thrombosis (DVT)

ANC Mng.Pre-eclampsia and eclampsia

Ruptured Uterus/Emergency Hysterectomy

APH (Abruptio)

APH (Placenta praevia)

Cervical cerclage

Urinary tract infections (UTI)

Bartholin Cyst/Abscess marsupialization

Fibroids

Paediatrics Congenital Heart Disease (CHD) and Acquired heart disease Rheumatic Heart disease

Heart Failure

Simple Diarrhoea (non-infectious diarrhoea)

Infectious Diarrhoea (Non-bloody or Bloody)

ARI (Pneumonia)

Severe Pneumonia

Malaria(uncomplicated)

Complicated Malaria

Prematurity

Epilepsy

Acute Otitis Media

Pharyngitis/ Tonsillitis

Sickle Cell Anaemia

Neonatal Jaundice

Asthma

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Neonatal Sepsis

Diabetes Mellitus

Cancer Biopsy or local excision of cervical lesion

Loop Electrosurgical Excision Procedure

Breast Biopsy

Prostate Biopsy

Eye / Vision Care Small Incisional Cataract Surgery

Glaucoma

Glaucoma-trabeculectomy with trabeculotomy-Children

Glaucoma-Goniotomy-children

Refractive Errors (Spectacles)

Corneal Conditions

Ocular Trauma

Foreign Body removal (corneal repair)

Eyelid mass/growth excision

Enucleation

Evisceration

Exenteration

Nasal Lacrimal Duct Obstruction- Surgery (External Dacryocystorhinostomy)

Paediatric Cataract (Paediatric Lens Aspiration + Intraocular Lens + Primamry Posterior Capsulotmy + Anterior Vitrectomy)

Paediatric Cataract Surgery (Paediatric Anterior Segment Reformation Surgery)

Laser Photocoagulation /trabeculoplasty

Strabismus

Examination Under Anaesthesia

Oral Health Dental Carries-Temporal Fillings

Dental Carries-Permanent Fillings

Root canal treatment

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Simple extraction

Surgical extraction

Apicectomy

Alveolar osteitis

Gingivitis

Fungal infections-oral candidiasis

Viral infections- (Herpes Simplex, Varicella Zoster, Oral Hairy leukoplakia)

Mouth ulcers

Fractures-Mandibular Fractures

Infection- Odontogenic and Non-Odontogenic-Abscesses

Gingival Hyperplasia

Dental Scaling -whole mouth (Must be medically indicated)

Frenulum Attachment

ENT Otitis Media-Uncomplicated

Foreign body ear /nose/throat

Acute Rhinosinusitis

Chronic Rhinosinusitis with and without polyposis

Adenotonsillitis

Laryngeal papilloma

Epistaxis (cauterization)

Mental Health (Tariffs cover 180 days treatment)

Acute Schizophrenia/Relapsed Schizophrenia/substance induced psychotic disorder

Affective disorders-severe mania/mania

Depression - moderate/severe

Minor Surgery under LA Male Circumcision

Foreign Body Removal

Biopsy

Excision

Debridement and Suturing (minor)

Lumpectomy

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Intercostal Drainage

Manipulation Under Anaesthesia + POP

Joint dislocation reduction

Sloughectomy

Incision and Drainage

Diagnosis Surgical Procedures Cystoscopy/Urethroscopy

Proctoscopy/Sigmoidoscopy

Colonoscopy with polypectomy

Colonoscopy

Endoscopy

Examination Under Anaesthesia

Major under GA Gastrostomy

Jejunostomy

hemorrhoidectomy

Hydrocelectomy

Amputation finger or toe

Extraperitoneal abscess drainage

Orchidectomy

Debridement and Suturing (major trauma)

Tracheostomy

Herniorrhaphy/plasty

Appendicectomy

Gastrectomy

Abdominal Perineal Resection

Laparotomy

Cholecystectomy

Thyroidectomy

Mastectomy

Parotidectomy

Colostomy

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Splenectomy

Colectomy

Pancreatectomy

Skin graft

Nephrectomy

Prostatectomy

Craniectomy

Orthopaedics ORIF Plate and screws

ORIF K-Nail

External Fixation

K wiring

Tendon Repair

Arthrotomy

Amputation

PMR Club foot

Ponseti Club foot

Intra Articular Injection

Sequestrectomy

Exercise therapy (120 min session) General Exercise

Pre & Post-natal

Pre & Post-Operative

Specialized Exercise Training

Keep fit/group exercise

Manipulative Therapy-reduction of joints, fractures and POP immobilization/splinting

ICU Accommodation fee per day (First 7 days after which revert to HDU tariff)

The set prices for the ICU services include Consultation and Registration fees; Admission fees, Resuscitation services, Investigations, Radiological investigations, Medicines, Medical Consumable, Nursing care and monitors services. The rate will cover for everything, no other charges will be accepted

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High Dependency Unit (HDU) Accommodation fee per day

The set prices for the HDU services includes charges for Resuscitation services given at Causality Department, Consultation and Registration fees, Admission fee, Nursing care, Ventilator and monitors services. Covers a Maximum of 5 days. Extensions beyond 5 days requires Pre-Authorization

Accommodation Premium/Private Wards fee per day

Per night up to standard Length of Treatment (LoT) and Maximum of 7 days per event. Cost includes accommodation, Nursing care, Oxygen therapy. Extension beyond 7 days requires Pre-Authorisation

OPD Registration & Consultation Initial Visit

Subsequent Visit (limited to 2 review visits for health event)

Chronic conditions after initial and two subsequent visits (e.g. Hypertension, Diabetes, Asthma, Arthritis, sickle cell, epilepsy etc)

Blood Products Unit whole Blood

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SCHEDULE 2. District Hospital Tariffs Standardised based on expected Capitated Utilisation per facility.

Type of Visit

Per Outpatient (OPD) Visit

Per Inpatient (IPD) Visit

SCHEDULE 3. Laboratory Services.

Type of Laboratory Test

Serology Immunology, virology

RPR test for syphilis

Rapid syphilis test

Rapid HIV Test - Determine

Rapid HIV Test - SD Bioline

Rapid HIV Test - Wantai

Rapid duo HIV /syphilis test - SD Bioline

Rapid Hepatitis C

Rapid Hepatitis B

Rheumatoid Factor

CD4,CD8 Count

HIV Viral load Analysis

HIV DNA PCR

Biochemistry, Tumour Markers, Hormones, Immunochemistry, Cardiac Makers

Magnesium

Calcium

Phosphorus

Cholesterol

Auto-Creatinine

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HDL cholesterol

LDL cholesterol

Glucose

Urea

Albumin

Total protein

Acid phosphatase

Uric acid

Triglycerides

Auto-BILIRUBIN D

Auto-BILIRUBIN T

Lipase

Pancreas-amylase

LDH liquid

CK NAC activated

GOT (ASAT

GPT (ALAT)

G-GT

Alkaline phosphatase

A-AMYLASE

Alkaline phosphatase

Ck mb

Iron tptz

Electrolytes

Blood Glucose using accucheck

Glycated HB

CSF Total Protein

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CSF Glucose

Total Protein - Pleural Tap '-Effusion, etc

C-reactive Protein

Brain natriuretic peptide (BNP)

ACTH test

AFP Test

Anti-HAV IgM

Anti-HAV

Anti-HBc

Anti-HBc IgM

Anti-HBe

Anti-HBs

Anti-HBs

Anti-HCV

Vitamin B12

Cancer Antigen (CA) 125

Cancer Antigen CA 15

Cancer Antigen CA 19-9

Cancer Antigen CA 72-4

Carcinoembryonic Antigen CEA

CK-MB STAT

CMV IgG

CMV IgM

Cortisol

DHEA-S

Digoxin

Estradiol

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Ferritin

Free HCG beta

Folate

Folate RBC

free PSA

Follicle-stimulating hormone

Free T3

Free T4

Triiodothyronine (T3)

Thyroxine (T4)

HBeAg

HBsAg

HCG

HCG+beta

Human Growth Hormone

IgE

Insulin

Myoglobin

Progesterone

Prolactin

proBNP

Total PSA

Rubella IgG

Rubella IgM

Troponin I

Troponin T

Toxo IgG

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Toxo IgM

Thyroid Stimulating Hormone

Serum Vitamin D

Serum Vitamin B12

Haematology, immunohematology

Full Blood Count FBC

Haemoglobin (HB)

Differential Count

Solubility Test (for Sickling)

HB Electrophoresis

Reticulocyte Count

Bleeding time

Clotting Time

Activated Partial Prothrombin Time

Prothrombin Time

INR

Antinuclear Factor

Bone Marrow Aspiration Procedure

Bone Marrow May-Grunwald stain

Bone Marrow special stains

Coagulation Factor Assays, each

Fibrinogen antigen test

Fibrinogen Degradation Products (FDP) Test

D-Dimer test

Grouping ABO (Blood)

Rhesus Factor

Cross-Matching

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Bacteriology

Culture & Sensitivity Urine

Culture & Sensitivity - Stool

Culture & Sensitivity-cerebral spinal

Culture & Sensitivity - Pus

Culture & Sensitivity - Blood

Culture & Sensitivity - sputum

Culture & Sensitivity HVS

Culture & Sensitivity Urethral swab

Culture & Sensitivity - other body fluids

Microbia identification (API 20e)

Microscopy sputum

Microscopy - Pus

Microscopy Urine

Microscopy - Stool

Microscopy CSF

Microscopy- other body fluids

Gram Stains - All specimens

Urea breath test

Cryptococcal Antigen Latex - CSF/serum

Chlamydia Test

Sputum Gene Xpert

Parasitology

Occult Blood

Blood parasites

Malaria Blood slide

Malaria RDT

Toxoplasma antibodies - serum

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Pregnancy Test (Urine)

Urinalysis 10 parameter

Urinalysis Glucose and Protein

Histology, Cytology and Immunohistochemistry

Single block from a specimen

Hematoxylin and eosin single slide staining

Ziel Neelsen stain for a single slide

Masson trichrome stained slide

Periodic Acid Schiff Stain

Alcian Blue Stain

Grocott-Methenamine Silver Stain

Immunohistochemistry stain single slide

Histology Large Surgical Specimen (6-10 blocks) e.g. uterus with fallopian tubes and ovaries, mastectomy

Histology Medium sized surgical specimen (3-5 blocks) e.g. prostatectomies

Histology small surgical specimen (1-2 blocks) e.g. skin ellipse

Histology small biopsies (1-2 blocks) e.g. Trucut Biopsies/ needle biopsies

Liver biopsy histology (H & E) to include special stains (masson trichrome, silver, PAS)

Renal biopsy histology (H & E) to include special stains (masson trichrome, silver, PAS)

Cervical Papanicolaou smear

Fine Needle Aspirate

Fluid cytology (1 PAP and 1 Giemsa)

Arterial Blood gas

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SCHEDULE 4. Radiology / Imaging.

Type of Imaging

Plain film X-Ray (Analog or Digital)

Skull

Neck

Chest

Abdomen

Limb

Joint

Spine (per region)

Intraoral Xray

Any other region

Ultrasound

Ultrasound scan

Doppler

ECHO

US guided interventions(e.g. biopsy, aspiration etc)

Contrast studies: (Digital OR Analogue)

Ba swallow

Ba meal

Ba meal follow through

Small bowel enema(SBE)

Ba enema

IVU

Cystogram

Urethrogram

MCUG

HSG

Sinogram

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Type of Imaging

Fistulogram

Mammogram:(Analog or Digital) - Diagnosis

- Screening

Computed Tomography Per region without contrast

Per region with contrast

MRI: Per region without contrast

Per region with contrast

Cathlab

Diagnosis Coronary angiogram

Coronary Ballooning & Stenting

Pacemaker Placement

Nuclear Medicine

Bone scan

Thyroid scan

Renal scintigraphy

Cardiac scintigraphy

Brain scan

Q/V scan

Inflammatory/infection

Liver scan

Venogram

Gastrointestinal (scan)

Gastrointestinal (reflux)

Salivary glands

Milk Scan

I 131 therapy

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SCHEDULE 5. Prosthetics.

TYPE OF PROSTHETIC

Prosthetics- Lower Limbs

Hip Prosthesis Polypropylene

Modular (Laminated)

Transfemoral Prosthesis

polypropylene

Modular without Silicon liner (Laminated)

Modular with silicon (Laminated)

Transtibial Prosthesis

polypropylene

Modular with silicon (laminated)

Modular without Silicon liner (Laminated)

Knee Disarticulation

polypropylene

Modular Without silicon (Laminated)

Modular with silicon (Laminated)

Symes Prosthesis polypropylene

Modular

Ortho prosthesis Polypropylene

Modular

Partial Foot Prosthesis Laminated/Polypropylene

Orthotics – Spine

Cervical Collar Adult

Child

Lumbar Brace Adult

Child

Thoracolumbar Brace Adult

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TYPE OF PROSTHETIC

Child

Cervical-Thoracal - lumbar sacral orthosis

Adult

Child

Medical and Orthopedic Appliances

Axillary Crutch (Each)

Hearing Aid (Pair)

Neck Collar with shin support

Knee Braces

Lumbar Belt and Trunk Corset

Drop foot splint

Elbow crutch (each)

Triangular arm sling

Kneecap

Knee support

Ankle /Wrist support

Denture per tooth

Orthodontic appliance fixing per jaw ( procedure and material)

Varicose stocking – full

Varicose stocking -below knee

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SCHEDULE 6. Orthopaedic Implants (Requires Pre-Authorization)

TYPE OF ORTHOPEDIC IMPLANTS

ORIF plate and Screw

Pedicle Screws + plugs

Rods

cervical plates + screws

peek Cage spacer

10 hole and below plate

11 hole and above plate

Per screw

ORIF K Nail Ordinary

interlocking

External fixation

Rush pin

Ortho fix/set

Ex fix/set for Tibia

K wiring per wire

malleable wires

HIP replacement

Thompson

Austin Moore

total cemented

Total uncemented

Knee Replacement

Bone Cement

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SCHEDULE 7. Drugs.

PRODUCT DESCRIPTION STRENGTH DOSAGE FORM

Basic Unit LEVEL OF ACCESS

MEDICINES FOR INFECTIONS



1.0 ANTIBIOTICS

PENICILLINS

Ampicillin (sodium salt) 500mg injection Each Vial I - IV

Amoxycillin (trihydrate) 250mg Capsule Tablet HP - IV

Amoxycillin (trihydrate) 100ml 125mg/5ml suspension Bottle HP - IV

Amoxycillin(trihydrate) Combined with Clavulanate 500mg/125 mg capsule capsule I - IV

Amoxycillin(trihydrate) Combined with Clavulanate 125/31 mg suspension Bottle I - IV

Amoxycillin + Clavulenic acid 625mg Tablet Tablet I - IV

Benzathine Benzylpenicillin(sodium) 2.4 mega injection Each Vial HP- IV

Benzyl Penicillin Sodium 5mega injection Each Vial HC - IV

Phenoxymethyl Penicillin (as potassium salt) 100ml 125mg/ml suspension Each Bottle HC - IV

Phenoxymethy Penicillin (as potassium salt) 250mg tablet Each Tablet HC - IV

Procaine Penicillin 3MU injection Each Vial I - IV

Cloxacillin 250mg capsule Each Tablet HP - IV

Cloxacillin(sodium) 500mg injection Each Vial II - IV

Cloxacillin 125mg/5ml suspension Each Bottle I - IV

CEPHALOSPORINS

Cefotaxime Sodium 1g injection Each Vial II - IV

Ceftriaxone (sodium) 250mg injection Each Vial II - IV

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Ceftriaxone Sodium 1g injection Each Vial I - IV

Cephalexin 100ml 125mg/5ml suspension Each Bottle I - IV

Cephalexin 250mg tablet Each Tablet I - IV

Cefuroxime 100ml 125mg/5ml suspension Each Bottle II - IV

Cefuroxime 250mg tablet Each Bottle II - IV

Cefixime 200mg tablet Each Bottle II - IV

Cefixime 30ml 100mg/5ml suspension Each Bottle II - IV

Imipenem 1gm Injection Each Vial III - IV

CHLORAMPHENICOL

Chloramphenicol (sodium succinate), 100ml 125mg/5ml suspension Each Bottle II - IV

Chloramphenicol 250mg capsule Each Tablet II - IV

Chloramphenicol Sodium Succinate 1g injection Each Vial II - IV

Vancomycin hydrochloride 1g injection Each Vial IV

Vancomycin hydrochloride 500mg injection Each Vial IV

QUINOLONES

Ciprofloxacin (hydrochloride) 250mg tablet Each tablet HC - IV

Nalidixic Acid,100ml 300mg/5ml suspension Each Bottle I - IV

Nalidixic Acid 500mg tablet Each Tablet I - IV

Ofloxacin 200mg tablet Each Tablet I - IV

TETRACYCLINES

Doxycycline(hyclate) 100mg tablet Each Tablet All

AMINOGLYCOSIDES

Gentamycin Sulphate 40mg/ml injection Each Ampoule I - IV

Kanamycin 1g injection Each Vial I - IV

AMOEBICIDES

Metronidazole, 100ml 5mg/ml injection Each Bottle I - IV

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Metronidazole benzoate, 100ml 125mg/5ml suspension Each Bottle I - IV

Metronidazole 200mg tablet Each Tablet HP - IV

Tinidazole 500mg tablet Each Tablet II - IV

Metronidazole oral gel, 30g tube Oral Gel Each tube of Oral gel

I - IV

SULPHONAMIDES

Co-Trimoxazole, 100ml 240mg/5ml suspension Each Bottle HC - IV

Co-Trimoxazole 480mg tablet Each Tablet HC - IV

Cotrimoxazole 96mg/ml I.V injection Each Ampoule III- IV

NITRO-FURAN DRUGS

Nitrofurantoin 50mg 50mg tablet Each Tablet I - IV

MACROLIDES

Azithromycin Tablet 250mg tablet Each tablet II - IV

Azithromycin Oral, 30ml 200mg/5ml suspension Each Bottle II - IV

Clarithromycin 250mg tablet Each Tablets II - IV

Erythromycin Ethyl Succinate 100ml 125mg/5ml suspension Each Bottle I - IV

Erythromycin Stearate 250mg tablet Each Tablet I - IV

ANTIFUNGALS

Fluconazole 200mg Tablet Each Tablet III - IV

Miconazole, 30g Tube Oral Gel Each tube of Oral gel

III - IV

Miconazole Nitrate 2% 30g Tube Cream Each tube of cream

I - IV

Griseofulvin 125mg Tablet Each Tablet HP - IV

Clotrimazole Pessaries 500mg Pessaries Each pessary HP - IV

Nystatin Oral Susp, 30ml Btl 100,000iu/Ml Suspension Each Bottle HP - IV

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Amphotericin B, 50mg/vial injection Each Vial II - IV

ANTI-VIRALS

Acyclovir 200mg tablet Each Tablet HP - IV

Acyclovir, Tab 400mg 400mg tablet Each Tablet HP - IV

Ganciclovir Powder for Inj 500mg injection Each Vial II - IV

2.0. DRUGS USED FOR PAIN AND INFLAMATION


UNIT PACK LEVEL OF ACCESS

ANTI-PYRETICS-NON-STEROIDAL ANTI INFLAMMATORY

Acetylsalicylic Acid 300mg Tablet Each Tablet HP - IV

Diclofenac sodium 50mg Tablet Each tablet HC - IV

Diclofenac sodium 75mg/3ml Injection Each Ampoule HC - IV

Ibuprofen 200mg Tablet Each Bottle HP - IV

Ibuprofen 100mg/5ml syrup Each Bottle HP - IV

Paracetamol 500mg Tablet Each Tablet HP - IV

Paracetamol 100mg Tablet Each Tablet HP - IV

Paracetamol 120mg suppositories Each suppository

HP - IV

Aceclofenac +Paracetamol 100mg+500mg tablets Each Tablet HC - IV

ANTI-GOUT

Allopurinol 100mg Tablet Each Tablet II - IV

NARCOTIC ANALGESICS

Morphine Sulphate 30mg Tablet Each Tablet II - IV

Morphine sulphate 10mg Tablet Each Tablet II - IV

Morphine Sulphate 10mg/ml Injection Each Ampoule II - IV

Morphine Sulphate, 5g Powder Each Bottle II - IV

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Morphine Sulphate 5mg/5ml syrup Each Bottle II - IV

Pethidine 100mg/2ml Injection Each Ampoule I - IV

Pethidine 50mg/ml Injection Each Ampoule I - IV

Tramadol 50mg Tablet Each tablet II - IV

Fentanyl 12.5mcg Transdermal Patch

Each Patch II - IV

Fentanyl 25mcg Transdermal Patch

Each Patch II - IV


Each Patch II - IV


Each Patch II - IV

Paracetamol + Codeine Phosphate 500mg+30mg Tablet Each Tablet II - IV

3.0 DRUGS ACTING ON THE GASTROINTESTINAL SYSTEM

ANTI DIARRHOEAL

Loperamide 2mg Tablet Each Tablet I - IV

Oral Rehydration Salt 27.9g sachet Each Sachet HP - IV

Zinc Sulphate 10mg Tablet Each Tablet HP - IV

ANTI ACIDS

Omeprazole 20mg 20mg Capsule Each tablet II - IV

LAXATIVES

Bisacodyl 5mg Tablet Each Tablet II - IV

Lactulose 3.1-3.7g/5ml Solution Each Bottle II - IV

ANTI SPASMODICS

Hyoscine Butyl Bromide 10mg Tablet Each tablet I - IV

Hyoscine Butyl Bromide 20mg/ml Injection Each Ampoule I - IV

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ANTI EMETICS

Metoclopramide 10mg Tablet Each Tablet I - IV

Metoclopramide 10mg/2ml Injection Each ampoule I - IV

Ondansetron (as hydrochloride) 2mg/2ml Injection Each ampoule II - IV

Ondansetron (as hydrochloride) 2mg/ml,30mls Solution Each bottle of 30 ml

II - IV

Ondansetron (as hydrochloride) 4mg Tablet Each Tablet II - IV

Ondansetron Mouth dissolving 8mg Tablet Each tablet III - IV

4.0 DRUGS USED IN THE TREATMENT OF DIABETES

ANTIDIABETIC

Insulin, long acting, biphasic, 10ml vial 100IU Injection Each Vial II - IV

Insulin, intermediate and long acting, (30/70), 10ml vial 100IU Injection Each Vial II - IV

Insulin, short acting, soluble, 10ml vial 100IU Injection Each Vial II - IV

Glibenclamide 5mg Tablet Each Tablet HC - IV

Gliclazide 80mg Tablet Each tablet II - IV

Glimepiride 2mg Tablet Each Tablet II - IV

Glimepiride/Metformin 2mg/500mg Tablet Each Tablet II - IV

Metformin B.P 500mg Tablet Each Tablet HC - IV

Glucagon Hydrochloride with lactose, PWD for Reconstitution

1mg/unit Injection Each Vial II - IV

5.0 DRUGS USED IN THROMBOEMBOLIC DISORDERS ANTICOAGULANTS

Heparin Sodium, Usp 5ml 5000iu/ml Inj Each Vial II - IV

Warfarin Sodium, 5mg Tablet Each tablet II - IV

Acetylsalicylic acid 75mg Tablet Each Tablets I - IV

Enoxaparin Sodium Syringe (Pre-Fill) 40mg/0.4ml Inj Each Ampoule II - IV

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6.0 DRUGS ACTING ON THE CARDIOVASCULAR SYSTEM CARDIOVASCULAR

Digoxin,2ml Amp 0.25mg/ml Injection Each Ampoule II - IV

Digoxin 0.25mg Tablet Each Tablet II - IV

Hydrochlorothiazide 25mg Tablet Each Tablet II - IV

Frusemide, 2ml Amp 10mg/ml Injection Each ampoule I - IV

Frusemide 40mg Tablet Each tablet I - IV

Amiloride + Hydrochlorothiazide 5mg/50mg Tablet Each tablet HC - IV

Atenolol 50mg Tablet Each tablet I - IV

Glyceryl Trinitrate 500mcg 500mcg Tablet Each tablet II - IV

Isosorbide Dinitrate 20mg 20mg Tablet Each tablet II - IV

Isosorbide Mononitrate 10mg Tablet Each tablet II - IV

Nifedipine Retard 20mg Tablet Each tablet HC - IV

Nifedipine Retard 20mg Tablet Each tablet HC - IV

Nifedipine, Sublingual 10mg Tablet Each tablet II - IV

Spironolactone 25mg Tablet Each tablet I - IV

Propranolol Hydrochloride 40mg Tablet Each tablet I - IV

Carvedilol 6.25mg Tablet Each tablet II - IV

Hydralazine, 1ml Amp 25mg/ml Injection Each Ampoule II - IV

Hydralazine 25mg Tablet Each Tablets II - IV

Enalapril 10mg Tablet Each Tablets HC - IV

Losartan Potassium 50mg Tablet Each tablet II - IV

Verapamil 20mg Tablet Each tablet II - IV

Amlodipine 5mg Tablet Each tablet II - IV

Simvastatin 20mg Tablet Each tablet II - IV

Telmisartan 40mg Tablet Each tablet II - IV

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Methyldopa, film coated 250mg Tablet Each tablet HC - IV

Dobutamine 250mg/20ml Injection Each Ampoule II - IV

Dopamine 40mg/ml Injection Each Ampoule II - IV

Lisinopril 5mg Tablet Each Tablet II - IV

Captopril 25mg Tablet Each Tablet II - IV

Losartan + Hydrochlorothiazide 50mg/12.5mg Tablet Each tablet II - IV

Bisoprolol fumarate 2.5mg/ml tablet each tablet II - IV

Tadalafil tablets 20mg Tablet each tablet II - IV

labetalol hydrochloride 50mg tablet each tablet II - IV

doxazosin 2mg Tablet each tablet II - IV

Alteplase 2mg (1.16 million units)

vial each vial II - IV

Streptokinase 250 000 units vial each vial II - IV

tranexamic acid 100mg/ml injection each injection of 5ml

II - IV

Urokinase 10000 units injection each injection II - IV

Etamsylate 500mg tablet each tablet II - IV

Clopidogrel 75mg tablets each tablet II - IV

Diazoxide injection 15mg/ml injection each ampoule of 20ml

II - IV

mannitol injection 10% injection each infusion,250ml

II - IV

Amiodarone HCL 100mg Tablet Each Tablet III - IV

7.0 DRUGS ACTING ON THE HAEMAPOETIC SYSTEM HAEMATINICS

Ferrous Sulphate 200 mg Tablet Each Tablet HP - IV

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Folic Acid 5 mg Tablet Each Tablet HP - IV

Folic Acid 0.4mg Tablet Each Tablet HP - IV

Heparin Sodium, in 5ml 25000iu Injection Each ampoule II - IV

Heparin Sodium in 5ml 5000iu Injection Each Vial II-IV

Erythropoietin, 0.5ml Prefilled Syringes 4000iu Injection Each prefilled syringe

III - IV

Erythropoietin, 0.5ml Prefilled Syringes 2000iu Injection Each prefilled syringe

III - IV

Iron Sucrose (venofer) 100mg/5ml Injection Each Vial III - IV

8.0 DRUGS USED TO TREAT HELMINTIC INFESTATIONS ANTITHELMITICS

Mebendazole 500mg Tablet Each tablet HP - IV

Mebendazole 100mg Tablet Each Tablets HP - IV

Albendazole 400mg Tablet Each tablet HP - IV

Pyrantel Pamoate 125mg Tablet Each tablet HP - IV

Praziquantel 600mg Tablet Each tablet HP - IV

9.0 DRUG ACTING ON THE CENTRAL NERVOUS SYSTEM

ANTIPSYCHOTIC MEDICATIONS

Fluphenazine Decanoate, 1ml 25mg/ml Injection Each ampoule I - IV

Haloperidol, 1ml 5mg/ml Injection Each ampoule I - IV

Haloperidol 5mg Tablet Each tablet I - IV

Trifluoperazine 5mg Tablet Each tablet I - IV

Chlorpromazine Hcl 1ml 25mg/ml Injection Each Ampoule I - IV

Chlorpromazine Hcl, Tab 100mg 100mg Tablet Each tablet I - IV

Risperidone 1ml 25mg/ml Injection Each Ampoule II - IV

Risperidone 2mg Tablet Each Tablet II - IV

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Quetiapine 25mg Tablet Each Tablet II - IV

Quetiapine 100mg Tablet Each Tablet II - IV

Clozapine 50mg Tablet Each Tablet III - IV

Flupentixol Decanoate 1ml 100mg/ml Injection Each Ampoule II - IV

Zuclopenthixol Decanoate 1ml 200mg/ml Injection Each Ampoule II - IV

MOOD STABILIZERS AND ANTI-EPILEPTIC MEDICATIONS

Phenobarbitone Sodium 1ml 200mg/ml Injection Each Ampoule I - IV

Phenobarbitone 30mg Tablet Each Tablet I - IV

Phenytoin Sodium 100mg Tablet Each Tablet II - IV

Sodium Valproate 200mg Tablet Each Tablet II - IV

Divalproex (Sodium Valp + Valproic Acid) 500mg Tablet Each Tablet II - IV

Sodium Valproate 200mg/5ml Susp Each bottle of 5 ml

II - IV

Carbamazepine 200mg Tablet Each Tablet I - IV

Lithium Carbonate 300mg Tablet Each Tablet IV

ANXIOLYTICS AND HYPNOTIC

Diazepam 2ml 5mg/ml Inj Each Ampoule HP - IV

Diazepam 5mg Tablet Each tablet I - IV

Alprazolam 0.25mcg Tablet Each tablet III - IV

Lorazepam 2mg/ml Injection Each Ampoule III - IV

Lorazepam 2mg Tablet Each tablet III - IV

Nitrazepam 5mg Tablet Each Tablet III - IV

Midazolam 5mg/ml Injection Each Ampoules

III - IV

ANTIDEPRESSANTS

Fluoxetine 20mg Tablet Each Tablet I-IV

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Imipramine 25mg Tablet Each Tablet I-IV

Amitriptyline Hydrochloride 25mg Tablet Each Tablet I - IV

Escitalopram Oxalate 10mg Tablet Each Tablet IV

10 DRUGS ACTING ON THE EYE

EYE PREPARATIONS

Gentamycin Sulphate, 5ml 0.003 ear drops Each bottle of 5 ml

HP - IV

Acyclovir Eye 4.5gm 0.03 eye ointment Each tube of eye ointment

I - IV

Amethocaine 0. 5ml 0.01 eye drops Each bottle of 5 ml

I - IV

Atropine Sulphate, 5ml Eye Drops 0.01 eye drops Each bottle of 5 ml

I - IV

Betamethasone 0.001 eye drops Each bottle of 5 ml

I - IV

Betamethasone 0.001 eye/ ear drops

Each bottle of 5 ml

I - IV

Betaxolol 0.5% Drops 0.005 eye drops Each bottle of 5 ml

III - IV

Brinzolamide 10mg/ml eye drops Each bottle of 5 ml

III - IV

Brimonidine +Timolol 5ml 0.2% +0.5% eye drops Each bottle of 5 ml

III - IV

Chloramphenicol ,10ml 0.5% 10ml eye/ear drops

Each bottle of 5 ml

HP - IV

Chloramphenicol ,5ml 0.005 eye/ear drops

Each bottle of 5 ml

HP - IV

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Ciprofloxacin Hcl Usp, 5ml 0.003 eye drops Each bottle of 5 ml

I - IV

Dexamethasone, 5ml 0.001 eye drops Each bottle of 5 ml

I - IV

Dexamethasone / Gentamycin Sulphate, 5ml 0.1%/0.3% eye drops Each bottle of 5 ml

III - IV

Dexamethasone / Neomycin Sulphate, 5ml 0.1%/0.35% eye drops Each bottle of 5 ml

III - IV

Dorzolamide 0.02 eye drops Each bottle of 5 ml

III - IV

Econazole 5g 0.02 eye ointment Each tube of eye ointment

II - IV

Fluorometholone, 5ml 0.001 eye drops Each bottle of 5 ml

III - IV

Gentamycin + Hydrocortisone, 5ml 0.03 eye/ear drops

Each bottle of 5 ml

II - IV

Gentamycin Sulphate Eye/Ear Drops, 5ml 0.003 eye/ear drops

Each bottle of 5 ml

HP - IV

Hydrocortisone, 5g 0.01 eye ointment Each tube of eye ointment

II - IV

Hydrocortisone 5ml 0.01 eye drops Each bottle of 5 ml

II - IV

Hydroxyethlcellulose +sodium chloride 0.5ml 0.44%+0.35% eye drops Each bottle of 5 ml

II - IV

Hypromellose Eye Drops 0.003 eye drops Each bottle of 5 ml

III - IV

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Latanoprost 50mcg/ml eye drops Each bottle of 5 ml

III - IV

Lignocaine ,0.5ml Drop 0.04 eye drops Each bottle of 5 ml

III - IV

Pilocarpine Nitrate Eye Drops, 5ml 0.5%. eye drops Each bottle of 5 ml

II - IV

Prednisolone Acetate, 5ml 0.01 eye drops Each bottle of 5 ml

III - IV

Sodium Cromoglycate, 5ml 0.02 eye drops Each bottle of 5 ml

I - IV

Tetracaine HCL 0.5% eye drops Each bottle of 5 ml

III - IV

Tetracycline Eye Ointment 0.03 eye ointment Each tube of eye ointment

HP - IV

Timolol Drop 0.005 eye drops Each bottle of 5 ml

III - IV

Travoprost 40mcg/ml eye drops Each bottle of 5 ml

III - IV

Tropicamide 0.005 eye drops Each bottle of 5 ml

III - IV

11. DRUGS ACTING ON THE SKIN

LOCAL APPLICATIONS

Acyclovir, Topical 5g Tube 0.03 Cream Each tube of cream

II - IV

Acyclovir, Tropical Solid 10g Tube 0.05 Cream Each tube of cream

II - IV

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Benzocaine (Anaesthestic+Analgestic) Oral Spray 0.2 Spray Each bottle of spray

II - IV

Benzyl Benzoate Lotion, 1 litre 25%/litre Lotion Each bottle of Lotion

HP - IV

Betamethasone Valerate 30g 0.001 Cream Each tube of cream

II - IV

Calamine Lotion, 1 Litre Btl Lotion Each bottle of Lotion

HP - IV

Clotrimazole Vaginal Tablet 500mg Pessary Each pessary HP - IV

Clotrimazole, 20g Tube 0.01 Cream Each tube of cream

HP - IV

Hydrocortisone Cream15g Tube 0.01 Cream Each tube of cream

HP - IV

Miconazole 30g 0.02 Cream Each tube of cream

HP - IH

Silver Sulphadiazine 30g 0.01 Cream Each tube of cream

HP - IV

ANTIHISTAMINE

Chlorpheniramine Maleate 4mg Tablet Each tablet HP - IV

Chlorpheniramine 2mg/5ml Syrup Each 100ml bottle

HP - IV

Promethazine Hcl 25mg/ml Injection Each Ampoules

HP - IV

Promethazine 25mg Tablet Each Tablet HP - IV

12.DRUGS USED IN OBSTETRICS AND GYNAECOLOGICAL DISORDERS

DRUGS USED IN OBSTETRICS & GYNAECOLOGY

Oxytocin 10iu/ml Injection Each Ampoule HP - IV

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Magnesium Sulphate 0.5 Injection Each Ampoule II - IV

Misoprostol 200mcg Tablet Each tablet I - IV

Mifepristone + Misoprostol 200mcg/800mcg Tablet Each tablet I - IV

13.DRUGS ACTING ON THE ENDOCRINE SYSTEM

CORTICOSTEROIDS

Prednisolone 5mg Tablet Each Tablet II - IV

Hydrocortisone 100mg Injection Each Ampoule HC - IV

Dexamethasone 4mg Tablets Each tablet II - IV

Dexamethasone 4mg/ml Injection Each Ampoule II - IV

Methylprednisolone 40mg/ml Injection Each Ampoule II - IV

ANTITHYROID DRUGS

Carbimazole 5mg Tablet Each tablet II-IV

Propylthiouracil 50mg Tablet Each tablet III-IV

Levothyroxine Sodium 25mg Tablet Each tablet II - IV

14. DRUGS ACTING ON THE RESPIRATORY SYSTEM

BRONCHODILATORS

Aminophylline 25ml/ml Injection Each Ampoule I - IV

Aminophylline 100mg Tablets Each tablet I - IV

Salbutamol 2mg Tablets Each tablet I - IV

Salbutamol 2.5mg Nebules Each nebule II - IV

Salbutamol 0.1mg Inhaler Each Canister I - IV

Beclomethasone 50mcg Inhaler Each Canister I - IV

15. ANTIMALARIALS

Artemether + Lumefantrine 20/120 mg (6) Tablet Each box of 6 tablets

HP, HC, I - IV

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HP, HC, I - IV


HP, HC, I - IV


HP, HC, I - IV

Quinine di-HCL, 300mg/ml,2ml Amp IV Inj. Each vial HP, HC, I - IV

Quinine Sulphate, Sugar coated 300 mg Tablet Each tablet HP, HC, I - IV

Sulphadoxine / Pyrimethamine 500/25 mg Tablet Each Tablet HP, HC, I - IV

Artesunate 50mg +Amodiaquine Hydrochloride 150mg 50mg/150mg Tablet Each Tablet I - IV

Artesunate 60mg 60mg Inj. Each Ampoule HP, HC, I - IV

16. REPRODUCTIVE HEALTH

Ethinyloestradiol/Levonorgestrel Blister of 28 Tabs 130mg/150mcg Tablet 1 cycle of 28 tablets

HP, HC, I - IV

Levonogestrel Implant Contraceptive 10 rods 750mcg/rod Sub-dermal Each implant HP, HC, I - IV

IUD Copper T, 380A, 10 Pieces N/A Device Each Device HP, HC, I - IV

Levonogestrel 0.03mg Tablet 1 cycle of 28 tablets

HP, HC, I - IV

Levonogestrel 0.75mg Tablet Each Tablet HP, HC, I - IV

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Medroxyprogesterone Acetate 150mg Injection Each vial HP, HC, I - IV

Norethisterone Enanthate, 1ML Amp 200mg/ml Injection Each ampoule HP, HC, I - IV

Etonogestrel single rod subdermal contraceptive implant 68mg Sub-dermal Each implant HP, HC, I - IV

17. OTHERS

Anti-rabies Vaccine injection injection each vial I - IV

Dextrose 50% injection injection each vial I - IV

ultravist injection(iopromide) 300/ml injection each vial of 20ml

I - IV

Anti-snake venom 10ml 10ml Injection 1 vial I - IV

Tetanus Toxoid Vaccine 0.5ml 0.5ml Injection Each vial I - IV

EXCLUDED SERVICES Health Care Services not listed in this package are not covered by the NHIS. These include but not limited to the following:-

• Public health care services under government or Donor vertical programs, epidemic and disasters,

• Purchases of cosmetic items, wheelchairs or prosthetic appliances not listed,

• Illegal abortion and illicit drug use,

• Employment injuries or illness arising from occupational hazards which are compensated under other schemes,

• Cosmetic surgery and aesthetic treatments (unless where medically required),

• All costs for operations, medicines, treatment and procedures for cosmetic purposes,

• Holidays for recuperative purposes, and

• Medicines and consumables not registered with ZAMRA including;

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• Toiletries, perfumes, deodorants and other beauty preparations,

• Slimming products,

• Homemade remedies, and

• Alternative medicines.

• Where a beneficiary is required to pay a penalty to any service provider which penalty is levied by health provider due to beneficiary not keeping an appointment,

• Costs of services rendered by or in respect of;

• Persons not registered with recognized professional body in terms of legislation,

• Any institutions not registered in terms of legislation,

• Any procedure or treatment not supported by National treatment protocols or scheme protocols, and

• Any procedure, treatment or medication that is provided to members in the course of a clinical trial unless authorized by the scheme subsequent to an authorization request from a member. Treatment or participation in any health service deemed to be experimental. Experimental, for this policy, refers to treatment, medicine or other procedures that are a part of a research programme and have not been approved by the relevant medical board and/or accreditation authority.

• Trans-sexual surgery,

• Long-term in-patient nursing care (over 90 days per admission and 180 days per year for the insured person),

• Medical treatment of motor vehicle accident injuries covered by other insurance/funds arrangements, such as motor vehicle insurance and a Motor Vehicle Accident Fund,

• Treatment of occupational accidents and illness covered by Worker’s Compensation Fund,

• Treatment of injuries resulting from declared national disasters in collaboration with the National Disaster Management and Mitigation Unit,

• Fertility treatment according to set criteria,

• Telephone charges, and

• Treatment Abroad.

NATIONAL HEALTH INSURANCE MANAGEMENT ......2 The following is the Detailed Benefit package of the...

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Transcript of NATIONAL HEALTH INSURANCE MANAGEMENT ......2 The following is the Detailed Benefit package of the...