National Health Insurance Act, 2003 Act 650 (Revised Edition)

ACT 650
National Health Insurance Act, 2003
ACT 650
NATIONAL HEALTH INSURANCE ACT, 2003
ARRANGEMENT OF SECTIONS
Establishment and Functions of the National Health Insurance Authority
SECTION
1. Establishment of the Authority. 2. Object and functions of the Authority. 3. Governing body of the Authority. 4. Tenure of office of members. 5. Meetings of the Council. 6. Disclosure of interest. 7. Committees of the Council. 8. Health Complaint Committee. 9. Allowances for members. 10. Ministerial directives. Types, Registration and Licensing ofHealth Insurance Schemes
11. Types of health insurance schemes. 12. Qualification for application. 13. Application for registration and licence. 14. Registration and issue of licence. 15. Further conditions. 16. Fee for issue of licence. 17. Duration and renewal of a licence. 18. Variation of conditions of licence. 19. Refusal to register and licence a scheme. 20. Suspension or revocation of licence of a scheme. 21. Interim management of a scheme. 22. Representations to the Minister. 23. Prohibition of provision of health insurance service without licence. 24. Limitation to provision of health insurance. 25.

ations to the Minister. 23. Prohibition of provision of health insurance service without licence. 24. Limitation to provision of health insurance. 25.

Prohibition in use of name unless licensed. 26. Transfer and joint operations. 27. Gazette notification. 28. Display of licence. District Mutual Health Insurance Schemes
29. Establishment of district mutual health insurance scheme. 30. Head office of a district mutual health insurance scheme. 31. Application for membership. 32. Members of district mutual health insurance schemes. 33. Benefit of members and subsidy. Vi- 1001 [Issue 2]

cheme. 31. Application for membership. 32. Members of district mutual health insurance schemes. 33. Benefit of members and subsidy. Vi- 1001 [Issue 2]

ACT 650
National Health Insurance Act, 2003
SECTION
34. Contribution by members. 35. Investments and management of funds, district mutual health insurance scheme. 36. Minimum membership. 37. Transfer of residence. 38. Indigent members. Private Health Insurance Schemes
Private Commercial Health Insurance Schemes
39. Establishment of private commercial health insurance scheme. 40. Membership,
41. Business venture. 42. Contribution of members. 43. Provision of security. 44. Withdrawal from the security deposit. 45.................. Private Mutual Health Insurance Scheme
46. Establishment of private mutual health insurance scheme. 47. Headquarters of a private mutual health insurance schemes. 48. Management of a private mutual health insurance scheme. 49. Security deposit. 50. Benefit of members. 51. Contribution by members. 52. Minimum membership. 53. No subsidy for private mutual health insurance scheme. General Provisions Applicable to Operation ofHealth Insurance Schemes
54. Governing body, appointment of scheme managers and other employees. 55. Participation by dependants. 56. Financial obligation of schemes. 57. Annual icports, accounts and audit of schemes. 58.

gers and other employees. 55. Participation by dependants. 56. Financial obligation of schemes. 57. Annual icports, accounts and audit of schemes. 58.

Amendment of annual report. 59. Standards of principal officers of scheme. 60. Notification of certain changes. 61. Furnishing of infoi mation to the Authority. 62. Inspection of annual report. 63. Financial year of schemes. 64. Minimum health care benefits. 65. Health insurance identity card. 66. Termination or suspension of membership. 67. Settlement of complaints. 68. Quality assurance. 69. Safeguards to prevent over or under use of healthcare services. [Issue 2] VI- 1002

embership. 67. Settlement of complaints. 68. Quality assurance. 69. Safeguards to prevent over or under use of healthcare services. [Issue 2] VI- 1002

ACT 650
National Health Insurance Act, 2003
SECTION
70. Accreditation of healthcare providers and health facilities. 71. Tariffs payable to healthcare providers. 72. Actuary. 73. Powers of actuary. 74. Inspection of schemes. 75. Directives of Council. National Health Insurance Fund
76. Establishment of a National Health Insurance Fund. 77. Object of the Fund. 78. Sources of money for the Fund. 79. Formula for disbursement from the Fund. 80. Bank account for the Fund. 81. Conditions for provision of subsidy to district mutual health insurance schemes. 82. Management of the Fund. 83. Investment of the Fund. 84. Expenses of the Fund. 85. Accounts, auditing and annual report. National Health Insurance Levy
86. Imposition of national health insurance levy. 87. Exempt supply. 88. Zero-rated supply. 89. Relief from levy. 90. Collection of the levy. 91. Payment of levy into the Fund. Administrative, Financial and Miscellaneous Provisions
92. Executive Secretary of the Authority. 93. Unitsof the Authority. 94. Appointment of internal auditor. 95. Appointment of other staff. 96. Delegation of appointment. 97. District offices of the Authority. 98. Expenses of the Authority. 99.

rnal auditor. 95. Appointment of other staff. 96. Delegation of appointment. 97. District offices of the Authority. 98. Expenses of the Authority. 99.

Accounts and audit. 100. Annual report and other reports of the Authority. 101. No cancellation of a scheme registered with Registrar of Companies. 102. Offences. 103. Regulations. 104. Interpretation. 105. Disapplication of Insurance Act, 1989. 106. Transitional provision. VI -1003 [Issue 1]

ies. 102. Offences. 103. Regulations. 104. Interpretation. 105. Disapplication of Insurance Act, 1989. 106. Transitional provision. VI -1003 [Issue 1]

ACT 650
National Health Insurance Act, 2003
SECTION
107. Commencement of payment of levy. SCHEDULE
ACT 650
NATIONAL HEALTH INSURANCE ACT 2003’
AN ACT to secure the provision of basic healthcare services to persons resident in
the country through mutual and private health insurance schemes; to put in
place a body to register, license, and regulate health insurance schemes and to
accredit and monitor healthcare providers operating under health insurance
schemes; to establish a National Health Insurance Fund that will provide subsidy
to licensed district mutual health insurance schemes; to impose a health insur
ance levy and to provide for related matters. Establishment and Functions of the National Health Insurance Authority
1. Establishment of the Authority
(1) There is established by this Act a body corporate to be known as the National
Health Insurance Authority. (2) The Authority shall have perpetual succession an official seal and may sue and be
sued in its own name. (3) The Authority may for the performance of its functions acquire and hold movable
and immovable propeity and may enter into a contract or any other transaction. 2.

ty may for the performance of its functions acquire and hold movable
and immovable propeity and may enter into a contract or any other transaction. 2.

Object and functions of the Authority
(1) The object of the Authority is to secure the implementation of a national health
insurance policy that ensures access to basic healthcare services to all residents. (2) For the purposes of achieving its object, the Authority may
(a) register, licence and regulate health insurance schemes;
(b) supervise the operations of health insurance schemes;
(c) grant accreditation to healthcare providers and monitor their performance;
(d) ensure that healthcare services lendered to beneficiaries of schemes by ac
credited healthcare providers are of good quality;
(e) determine in consultation with licensed district mutual health insurance
schemes, contributions that should be made by their members;
(f) approve health identity cards for members of schemes;
(g) provide a mechanism for resolving complaints by schemes, members of
schemes and healthcare providers;
1. The Act was assented to on the 5th September, 2003, and was notified in the Gazette on the 12th Septem
ber, 2003. (Issue 1] VI -1004

are providers;
1. The Act was assented to on the 5th September, 2003, and was notified in the Gazette on the 12th Septem
ber, 2003. (Issue 1] VI -1004

ACT 650
National Health Insurance Act, 2003
(h) make proposals to the Minister for the formulation of policies on health
insurance;
(i) undertake on its own or in collaboration with other relevant bodies a sus
tained public education on health insurance;
() devise a mechanism for ensuring that the basic healthcare needs of indi
gents are adequately provided for;
(k) maintain a register of licensed health insurance schemes and accredited
healthcare providers;
(1) manage the National Health Insurance Fund;
(m) monitor compliance with this Act and the Regulations and pursue action to
secure compliance; and
(n) perform any other function conferred on it under this Act or that are ancil
lary to the object of the Council. 3.

action to
secure compliance; and
(n) perform any other function conferred on it under this Act or that are ancil
lary to the object of the Council. 3.

Governing body of the Authority
(1) The governing body of the Authority is a Council consisting of
(a) the chairperson,
(b) one representative of
(i) the Ministry of Health not below the rank of a Director,
(ii) the Ghana Health Service not below the rank of a Director,
(iii) the Society of Private Medical and Dental Practitioners nominated
by the Ghana Medical Association,
(iv) the Pharmaceutical Society of Ghana,
(c) one representative each of licensed
(i) mutual health insurance, and
(ii) private health insurance schemes,
(g) one representative of the Minister responsible for Finance not below the
rank of a Director,
(h) one legal practitioner with experience in health insurance nominated by the
Ghana Bar Associations,
(i) one representative of the National Insurance Commission,
() one person representing organised labour,
(k) two persons representing consumers one of whom is a woman,
(I) one representative each from
(i) the Ministry of Local Government, and
(ii) Social Security and National Insurance Trust, and
(tn) the Executive Secretary appointed under section 92.

the Ministry of Local Government, and
(ii) Social Security and National Insurance Trust, and
(tn) the Executive Secretary appointed under section 92.

(2) The chairperson and the other members of the Council shall be appointed by the
President in accordance with article 70 of the constitution. VI -1005 [Issue 1]

rperson and the other members of the Council shall be appointed by the
President in accordance with article 70 of the constitution. VI -1005 [Issue 1]

ACT 650
National Health Insurance Act, 2003
4. Tenure of office of members
(1) A member of the Council other than an ex-officio member shall hold office for a
period not exceeding three years and is eligible for re-appointment, but a person shall not
hold office for more than two terms in succession. (2) Where a member of the Council resigns, dies, is removed from office or is for
sufficient reason unable to act as a member of the Council, the chairperson shall notify
the President through the Minister, of the vacancy and the President shall on the advice of
the nominating authority, where applicable, and acting in accordance with article 70 of
the Constitution, appoint another person to hold office for the unexpired portion of the
member’s term of office. (3) A member of the Council may at any time resign from office in writing addressed
to the President through the Minister. (4) A member of the Council who is absent from three consecutive meetings of the
Council without sufficient cause ceases to be a member of the Council.

4) A member of the Council who is absent from three consecutive meetings of the
Council without sufficient cause ceases to be a member of the Council.

(5) The President shall by letter addressed to a member nominated by a body as its
representative on the Council revoke the appointment of that member at the request of
that body. (6) A member may be removed from the Council by the President for stated misbe
haviour or for a just cause. (7) The chaiiperson shall through the Minister notify the President in writing of a va
cancy that occurs on the Council within thirty days of the occurrence of the vacancy. 5. Meetings of the Council
(1) The Council shall meet at least once early thiee months for the despatch of busi
ness at the times and places Council determined by the chairperson. (2) The chaiiperson shall at the request in writing of not less than one third of the
membership of the Council convene an extraordinary meeting of the Council at the place
and time determined by the chairperson. (3) The quorum at a meeting of the Council is seven members of the Council includ
ing the Executive Secretary. (4) The chairperson shall preside at the meetings of Council and in the absence of the
chairperson, by a member of the Council elected by the members present from among
their number shall preside.

ngs of Council and in the absence of the
chairperson, by a member of the Council elected by the members present from among
their number shall preside.

(5) Matters before the Council shall be decided by a majority of the members present
and voting and in the event of a tie of votes, the person presiding shall have casting vote. (6) The Council may co-opt a person to attend a Council meeting but that person is
not entitled to vote on a matter for decision by the Council. (7) The proceedings of the Council shall not be invalidated because of a vacancy
among the members or a defect in the appointment or qualification of a member. (8) Subject to this section, the Council shall determine the procedure for its meetings. (Issue 1] VI -1006

appointment or qualification of a member. (8) Subject to this section, the Council shall determine the procedure for its meetings. (Issue 1] VI -1006

ACT 650
National Health Insurance Act, 2003
6. Disclosure of interest
(1) A member of the Council who has an interest in a contract, or any other transaction
proposed to be entered into with the Authority or an application before the Council shall
disclose in writing the nature of the interest and is disqualified from participating in the
deliberations of the Council in respect of the contract, application or than other transaction. (2) A member who infringes subsection (1) ceases to be a member of the Council. 7. Committees of the Council
The Council may for the performance of its functions appoint committees composed
of members of the Council or non-members or both and assign to the committees any of
its functions but a committee composed entirely of non-members may only advise the
Council. 8. Health Complaint Committee
(1) Without limiting the scope of section 7, there is hereby established the Health
Complaint Committee of the Council. (2) The composition of the Health Complaint Committee shall be determined by the
Council, but the chairperson shall be a member of the Council.

uncil. (2) The composition of the Health Complaint Committee shall be determined by the
Council, but the chairperson shall be a member of the Council.

(3) The Health Complaint Committee
(a) is responsible for hearing and resolving complaints that may be submitted
to the Council by members of health insurance schemes, the schemes and
healthcare providers; and
(b) shall perform any other functions determined by the Council. (4) The Health Complaint Committee shall be decentralized and established in every
district office of the Authority. (5) The procedure of the Committee and sanctions that may be imposed by the Coun
cil on recommendation of the Committee shall be prescribed by the Regulations. 9. Allowances for members
The members of the Council, members of a committee of the Council and persons co
opted to attend meetings of the Council shall be paid the travelling and any other allow
ances approved by the Minister in consultation with the Minister responsible for Finance. 10. Ministerial directives
The Minister may give to the Council directives of a general nature on matters of pol
icy and the Council shall comply with the directives. Types, Registration and Licensing ofHealth Insurance Schemes
11.

eneral nature on matters of pol
icy and the Council shall comply with the directives. Types, Registration and Licensing ofHealth Insurance Schemes
11.

Types of health insurance schemes
The following types of health insurance schemes may be established and operated in
the country:
(a) district mutual health insurance schemes,
VI -1007 [Issue 1]

ing types of health insurance schemes may be established and operated in
the country:
(a) district mutual health insurance schemes,
VI -1007 [Issue 1]

ACT 650
National Health Insurance Act, 2003
(b) private commercial health insurance schemes, and
(c) private mutual health insurance schemes. 12. Qualification for application
A person does not qualify to apply to operate a health insurance scheme in this coun
try unless,
(a) in the case of a district mutual or private mutual health insurance scheme, it
is registered as a company limited by guarantee, or
(b) in the case of a private commercial health insurance scheme, it is registered
as a limited liability company,
under the Companies Act, 1963 (Act 179). 13. Application for registration and licence
(1) Application for registration and licence to operate a health insurance scheme shall
be made to the Council in the prescribed form.

ion and licence
(1) Application for registration and licence to operate a health insurance scheme shall
be made to the Council in the prescribed form.

(2) The application shall be submitted with the following documents, information and
particulars as are relevant:
(a) two copies of the constitution, by-laws or rules intended to govern the op
eration of the scheme;
(b) the names, and particulars of members of the governing body of the pro
posed scheme;
(c) the persons proposed to manage or administer the scheme and the qualifi
cations of the persons;
(d) a statement of the minimum number of persons to be covered by the
scheme;
(e) the proposed healthcare providers and healthcare facilities available to or
pioposed to be used by the scheme;
() the healthcare benefits available under the scheme;
(g) the proposed minimum contribution for membership; and
(h) evidence of the availability of any minimum financial security, where ap
plicable, required in respect of the type of scheme. (3) The Council may require an applicant to furnish it with any other information that
the Council considers necessary to determine the application. 14.

) The Council may require an applicant to furnish it with any other information that
the Council considers necessary to determine the application. 14.

Registration and issue of licence
(1) The Council may register an applicant and issue it a licence to operate the rele
vant scheme applied for, where the Council is of the opinion that,
(a) the applicant qualifies to be registered and licensed having regard to the
scheme to which the application relates,
(b) the applicant has qualified officers to manage and administer the scheme,
[Issue I] VI -1008

egard to the
scheme to which the application relates,
(b) the applicant has qualified officers to manage and administer the scheme,
[Issue I] VI -1008

ACT 650
National Health Insurance Act, 2003
(c) the applicant intends not to carry on any other activity except the operation
of the health insurance scheme applied for, and
(d) the applicant has complied with the requirements under this Act and any
other enactment applicable to the type of health insurance scheme applied
for. (2) A person shall not operate a health insurance scheme of any type in this country
unless it has been registered with the Authority and issued a licence for the purpose. 15. Further conditions
Despite section 14, the Council may, as a condition for issuing a licence, impose any
other terms and conditions that are prescribed by the Regulations. 16. Fee for issue of licence
The Council, in consultation with the Minister, may by Regulations impose fees for
the issue of a licence under this Act. 17. Duration and renewal of a licence
(1) A licence to operate a health insurance scheme expires two years from the date of
issue of the licence. (2) The licence may on an application be renewed for further periods of two years at
a time. (3) An application for renewal of a licence shall be made not later than three months
before the expiry of the licence.

eriods of two years at
a time. (3) An application for renewal of a licence shall be made not later than three months
before the expiry of the licence.

(4) Where an application for renewal is made and the licence expires before the
Council determines the application, the licence shall be deemed to be in force until the
application for renewal is determined by the Council. 18. Variation of conditions of licence
(1) Subject to conditions prescribed by the Regulations, the Council may, on giving
reasonable written notice to a scheme,
(a) vary or revoke any condition of a licence, or
(b) impose new conditions. (2) A scheme may apply to the Authority in writing for a condition of a licence to be
revoked or varied. (3) Where, on an application made under subsection (2), the Council is satisfied that
the condition for a licence is no longer necessary or should be varied, it may revoke or
vary the condition. (4) Where the Council revokes or varies a condition for a licence or imposes a new
condition, the scheme shall deliver its licence to the Council for the licence to be varied
accordingly. VI-1009 [Issue 1]

a licence or imposes a new
condition, the scheme shall deliver its licence to the Council for the licence to be varied
accordingly. VI-1009 [Issue 1]

ACT 650
National Health Insurance Act, 2003
19. Refusal to register and licence a scheme
(1) The Council may refuse to register and issue a licence for a scheme and it shall
notify the applicant in writing of its decision, stating the reasons. (2) Where the refusal to register and issue a licence is as a result of a non-material
defect in the application, the Council may in the notice require the applicant to rectify the
application within a specified period. 20. Suspension or revocation of licence of a scheme
(1) The Council may suspend or revoke the licence of a scheme where the Council is
satisfied that the scheme
(a) has in any manner acted fraudulently;
(b) has lost its financial ability to continue to operate;
(c) is not operating in accordance with good administrative and accounting
practices and procedures; or
(d) has failed to comply with a provision of this Act, the Regulations or any
other enactment applicable to the scheme. (2) The Council shall before suspending or revoking the licence, give the scheme no
tice of the default and provide it an opportunity to make representations to the Council.

efore suspending or revoking the licence, give the scheme no
tice of the default and provide it an opportunity to make representations to the Council.

(3) Where a licence expires, is revoked or suspended, the Authority may apply to a
Court for an order to protect and preserve the contribution of members and for the order
that the Court considers appropriate having regard to the best interest of members of the
scheme. 21. Interim management of a scheme
The Council, after consultation with the governing body of a scheme, may on sus
pending or revoking the licence,
(a) place the scheme under an interim management team; or
(b) arrange for the transfer of the activities or business of the scheme to an
other scheme subject to conditions that are agreed on by the parties and ap
proved by the Council. 22. Representations to the Minister
(1) A person refused registration or whose licence is suspended or revoked by the
Council may within sixty days after the date of receipt of notification of the refusal, sus
pension or revocation make representations to the Minister for a determination. (2) The Minister shall make a determination within thirty days of receipt of the repre
sentations. (3) A person dissatisfied with the determination of the Minister may seek the remedy
open to that person in the Courts. (Issue 1] VI-1010

sentations. (3) A person dissatisfied with the determination of the Minister may seek the remedy
open to that person in the Courts. (Issue 1] VI-1010

ACT 650
National Health Insurance Act, 2003
23. Prohibition of provision of health insurance service without licence
(1) A person shall not provide health insurance service or operate a health insurance
scheme unless the scheme is registered with the Authority and issued with a licence for
the purpose by the Council. (2) A person who acts contrary to subsection (1) commits an offence and is liable on
summary conviction to a fine of not less than two hundred penalty units or to a term of
imprisonment for a minimum term of six months or both the fine and the imprisonment. 24. Limitation to provision of health insurance
A health insurance scheme registered and licensed under this Act shall not carry on
any activities other than securing provision of healthcare to its members. 25. Prohibition in use of name unless licensed
(1) A person shall not conduct an activity under a name which includes “health
scheme”, “medical insurance scheme”, “health insurance scheme” or similar name which
is calculated or likely to lead people to believe that that person operates a health insur
ance scheme unless the scheme is registered and licensed under this Act.

or likely to lead people to believe that that person operates a health insur
ance scheme unless the scheme is registered and licensed under this Act.

(2) A person who acts contrary to subsection (1) commits an offence and is liable on
summary conviction to a fine not exceeding one hundred penalty units or to a term of
imprisonment not exceeding three months. 26. Transfer and joint operations
(1) A health insurance scheme licensed under this Act shall not transfer its activities
or operate its activities jointly with another scheme unless it has the prior written ap
proval of the Council. (2) An application for approval under subsection (1) shall be made jointly to the Au
thority by the schemes involved and shall contain the information prescribed under this
Act. (3) Before determining an application for approval under subsection (1), the Council
shall cause to be conducted an investigation into the desirability of the change having
regard to the best interest of the members of the schemes. (4) The Council may conduct a hearing before determining an application under this
section and may hear the representatives of the schemes, members of the schemes and a
person the Council considers is sufficiently concerned in the matter to entitle that person
to a hearing by the Council.

members of the schemes and a
person the Council considers is sufficiently concerned in the matter to entitle that person
to a hearing by the Council.

(5) The Council after the hearing shall make a determination which shall be binding
on the parties and their members. (6) A person dissatisfied with the decision of the Council may apply to the Minister
for a review of the decision. VI-1011 (Issue 1]

nd their members. (6) A person dissatisfied with the decision of the Council may apply to the Minister
for a review of the decision. VI-1011 (Issue 1]

ACT 650
National Health Insurance Act, 2003
27. Gazette notification
On the licensing, suspension or revocation of the licence of a scheme, the Council
shall publish the name and particulars of the scheme in the Gazette and newspapers of
national circulation that the Council shall determine. 28. Display of licence
A licensed scheme shall display its licence in a prominent place at its offices where
the licence is visible to all members and prospective members. District Mutual Health Insurance Schemes
29. Establishment of district mutual health insurance scheme
(1) There shall be established in every district in the country a mutual health insur
ance scheme for the residents of the district. (2) A District Assembly shall identify promoters to initiate action for the registration
of the scheme as a company limited by guarantee under the Companies Act, 1963 (Act
179) for the relevant district within sixty days of the coming into force of this Act or
within a further period that the Council may direct. (3) The Council may permit the establishment of units of a scheme within a district
as it considers necessary for the effective management of the scheme. 30.

Council may permit the establishment of units of a scheme within a district
as it considers necessary for the effective management of the scheme. 30.

Head office of a district mutual health insurance scheme
A district mutual health insurance scheme shall have its headquarters within the dis
trict and shall notify the Authority of the addresses and any other particulars of the head
quarters as the Council may prescribe. 31. Application for membership
(1) A person resident in Ghana other than a member of the Armed Forces of Ghana
and the Police Service shall belong to a health insurance scheme licensed under this Act. (2) A person resident in a district, who is not a member of a private health insurance
scheme or any other district scheme registered under this Act, shall apply to be enrolled
as a member of the district mutual health insurance scheme in the relevant district. 32. Members of a district mutual health insurance schemes
A district mutual health insurance scheme established in a district shall be composed
of the enrolled members and shall be operated in accordance with this Act and the
Regulations. 33. Benefit of members and subsidy
(1) A district mutual health insurance scheme shall be operated exclusively for the
benefit of the members.

ations. 33. Benefit of members and subsidy
(1) A district mutual health insurance scheme shall be operated exclusively for the
benefit of the members.

(2) A district mutual health insurance scheme shall be provided with subsidy from
the National Health Insurance Fund. [issue 1] VI-1012

(2) A district mutual health insurance scheme shall be provided with subsidy from
the National Health Insurance Fund. [issue 1] VI-1012

ACT 650
National Health Insurance Act, 2003
34. by members
(1) A person seeking membership of a district mutual health insurance scheme shall,
as a prior condition for membership, pay the membership contribution determined by the
scheme in accordance with guidelines provided by the Council. (2) The mode and time of payment of the contribution shall be prescribed in the
Regulations. (3) Despite subsection (1), the Regulations shall prescribe for exemptions of certain
categories of persons from the payment of contributions. (4) Where the monthly contribution of a contributor to the Social Security Pensions
Scheme Fund amounts to or exceeds the minimum monthly contribution required under a
district mutual health insurance scheme, the contributor is entitled to the minimum health
care benefits under the district mutual health insurance scheme without a further contri
bution to the district mutual health insurance scheme. (5) Without prejudice to subsection (3), a pensioner under the Social Security Pen
sion Scheme is entitled to the minimum health care benefit under this Act without the
payment of contribution to the district mutual health insurance scheme. 35.

is entitled to the minimum health care benefit under this Act without the
payment of contribution to the district mutual health insurance scheme. 35.

Investments and management of funds, district mutual health insurance
scheme
(1) A district mutual health insurance scheme shall not invest the funds of the scheme
unless the investment is made with the prior authorisation of the Council. (2) The Council shall determine the rules and procedures that govern the manage
ment of the funds of a district mutual health insurance scheme. 36. Minimum membership
(1) A district mutual health insurance scheme shall at all times have the minimum
members determined by the Council. (2) Despite subsection (1), a district mutual health insurance scheme may be licensed
on the condition that the number of its members shall reach the minimum determined by
the Council within a specified period and on failure the Council may revoke its licence. (3) A licensed district mutual health insurance scheme shall provide a clear method
of enrolment of members and give the necessary assistance to non-literate or any other
disadvantaged applicants. (4) Membership takes effect within six months from the date of enrolment of the ap
plicant on the payment of the initial contribution. 37.

applicants. (4) Membership takes effect within six months from the date of enrolment of the ap
plicant on the payment of the initial contribution. 37.

Transfer of residence
A member of a district mutual health insurance scheme who moves to reside in an
area other than the area where the scheme on which the member is enrolled, is entitled to
have the membership transferred to the district mutual health insurance scheme in the
new area of residence. VI -1013 [Issue 1]

rolled, is entitled to
have the membership transferred to the district mutual health insurance scheme in the
new area of residence. VI -1013 [Issue 1]

ACT 650
National Health Insurance Act, 2003
38. Indigent members
(1) The Minister, on the advice of the Council, shall prescribe a means test for deter
mining persons who are indigent. (2) A district mutual health insurance scheme shall, on the basis of the means test,
identify and keep a list of members registered with it who are indigent. (3) The list shall be submitted to the Authority at the time determined by the Council. (4) The Council shall, in consultation with the managers of district mutual health in
surance schemes, determine the method to secure the provision of the minimum health
care benefits to indigents. (5) The Minister responsible for Finance shall, in consultation with the Council, de
termine at least six months in advance the Budget for the support of indigents. Private Health Insurance Schemes
Private Commercial Health Insurance Schemes
39. Establishment of private commercial health insurance schemes
A body corporate registered as a limited liability company under the Companies
Act, 1973 (Act 179) may operate as a private commercial health insurance scheme. 40. Membership
A person may enrol to be a member of a private commercial health insurance scheme. 41.

as a private commercial health insurance scheme. 40. Membership
A person may enrol to be a member of a private commercial health insurance scheme. 41.

Business venture
A private commercial health insurance scheme is a business venture. 42. Contribution of members
The contribution of members to a private commercial health insurance scheme shall
be determined by the governing body of the scheme and shall be paid in the manner and
at the time determined by the governing body of the scheme. 43. Provision of security
(1) A private commercial health insurance scheme shall be required as a condition for
registration and licensing by the Authority to deposit with the Bank of Ghana an amount
of money that the Council shall prescribe as security for its members. (2) The security referred to under subsection (1) shall be maintained throughout the
period that the business of private commercial health insurance is carried on. (3) The Council may review the level of the security deposit. 44. Withdrawal from the security deposit
(1) Where a private commercial health insurance scheme suffers a substantial loss,
arising from liability to members and the loss cannot reasonably be met from its available
resources, the Council may, after ascertaining the nature of the claim, and on application
[Issue 1] VI-1014

nnot reasonably be met from its available
resources, the Council may, after ascertaining the nature of the claim, and on application
[Issue 1] VI-1014

ACT 650
National Health Insurance Act, 2003
made to it by the scheme, approve the withdrawal from the security deposit of the scheme
of an amount of not more than ten percent of the security deposit, and an amount with
drawn shall be replaced by the scheme not later than ninety days after the date of the
withdrawal. (2) The security deposit is the assets of the private commercial health insurance
scheme, but except as provided in subsection (1), it shall be available to the scheme only
in the event of the closure or winding up of the health insurance business for the dis
charge of the liabilities arising out of policies transacted by the insurer and remaining
undischarged at the time of the closure or winding up of the insurance business. 45. Repealed.2
Private Mutual Health Insurance Scheme
46. Establishment of private mutual health insurance scheme
A group of persons resident in the country may form and operate a private mutual
health insurance scheme. 47. Headquarters of a private mutual health insurance scheme
(1) A private mutual health insurance scheme shall have its headquarters at the place
that the governing body of the scheme shall determine.

ce scheme
(1) A private mutual health insurance scheme shall have its headquarters at the place
that the governing body of the scheme shall determine.

(2) The address and any other particulars of the headquarters shall be notified in writ
ing to the Authority. 48. Management of a private mutual health insurance scheme
(1) A private mutual health insurance scheme may be managed by an independent
manager appointed by its governing body and approved by the Council. (2) The manager of a private mutual health insurance scheme may be a body corpo
rate registered by guarantee under the Companies Act, 1963 (Act 179). 49. Security deposit
(1) The Council may require a private mutual health insurance scheme to maintain a
reserve fund equivalent to six months operational income as the Council may determine. (2) The reserve fund shall be constituted within three years after the commencement
of the scheme. 50. Benefit of members
A private mutual health insurance scheme shall be operated exclusively for the benefit
of the members and shall provide the members with the health benefits that the governing
body of the scheme shall determine. 2. Repealed by section 214 (1) of the Insurance Act, 2006 (Act 724). VI-1015 [Issue 1]

benefits that the governing
body of the scheme shall determine. 2. Repealed by section 214 (1) of the Insurance Act, 2006 (Act 724). VI-1015 [Issue 1]

ACT 650
National Health Insurance Act, 2003
51. Contribution by members
(1) Contribution of members shall be determined by the governing body of the
scheme.
(2) The contribution shall be paid in the manner that the governing body of the
scheme shall direct.
52. Minimum membership
(1) A private mutual health insurance scheme shall have the minimum membership
that the governing body of the scheme shall determine.
(2) A private mutual health insurance scheme shall provide a clear method of enrol
ment of members.
(3) Membership takes effect from the date that the governing body may determine on
the payment of the initial contribution.
53. No subsidy for private mutual health insurance scheme
A private mutual health insurance scheme is not entitled to receive subsidy from the
National Health Insurance Fund established under this Act.
continued on page VI -1017
(issue 2] VI-1016

me is not entitled to receive subsidy from the
National Health Insurance Fund established under this Act.
continued on page VI -1017
(issue 2] VI-1016

ACT 650
National Health Insurance Act, 2003
General Provisions Applicable to Operation of Health Insurance Schemes
54. Governing body, appointment of scheme managers and other employees
(1) A scheme shall have a governing body which shall be responsible for the direc
tion of the policies of the scheme and appointment of employees. (2) A scheme shall have a scheme manager who shall be responsible for the man
agement of the scheme. (3) A scheme manager may be an independent body corporate or committee. (4) A scheme shall in addition to the scheme manager, appoint other officers and em
ployees for the effective management of the scheme. (5) Where a scheme manager or a person on the management team of a scheme
ceases to be employed by the scheme, the governing body of the scheme shall inform the
Authority in writing and take immediate steps to appoint a new manager or any other
person for the scheme. (6) The Minister may, by Legislative Instrument, provide further for the qualifica
tions of directors, scheme managers and any other employees of schemes. 55.

Minister may, by Legislative Instrument, provide further for the qualifica
tions of directors, scheme managers and any other employees of schemes. 55.

Participation by dependants
The dependants of a member may, in accordance with the constitution of the scheme,
participate in the scheme and receive the same benefits as the member subject to the rea
sonable variation in the level of contribution by the member, based on the number of the
dependants. 56. Financial obligation of schemes
(1) The Council shall determine the financial security deposit that should be depos
ited by a scheme as security to meet the liabilities of the scheme. (2) The Regulations may provide further in respect of financial security deposit of
schemes. 57. Annual reports, accounts and audit of schemes
(1) A licensed scheme shall keep books of account and proper record in respect of the
accounts. (2) In addition to the provisions in the Companies Act, 1924 (Act 179), a licensed
scheme shall submit an annual report in a prescribed form to in the Council covering its
activities for the period from 1st January and ending on 31st December within three
months after the 31st December of the preceding year. (3) A licensed scheme shall have its accounts audited by its auditors and a copy of
the audit reports shall be submitted with its annual report to the Council.

ensed scheme shall have its accounts audited by its auditors and a copy of
the audit reports shall be submitted with its annual report to the Council.

(4) An auditor shall not be an employee, manager, or director of the scheme. (5) The Council may without notice cause to be audited the accounts of a scheme
which receives subsidy from the National Health Insurance Fund. VI-1017 (Issue 1]

ncil may without notice cause to be audited the accounts of a scheme
which receives subsidy from the National Health Insurance Fund. VI-1017 (Issue 1]

ACT 650
National Health Insurance Act, 2003
58. Amendment of annual report
(1) Where in the opinion of the Council an annual report furnished by a scheme to the
Council is incorrect or is not prepared as prescribed, the Council may, by notice in writ
ing call on the scheme to amend the report or to furnish a correct report. (2) Where the scheme fails to comply with a notice referred to in subsection (1) to the
satisfaction of the Council, the Council may itself either amend the report and give the
scheme particulars of the amendment or it may reject the report. (3) A report amended by a scheme or the Council under this section shall be treated
as if it had been originally submitted in its amended form. (4) Where the scheme is dissatisfied with the amendment by the Council, the scheme
may appeal to the Minister. (5) The appeal shall be lodged with the Minister within thirty days after receipt by
the scheme of the amended report. 59. Standards of principal officers of scheme
(1) A scheme shall have at all times high calibre directors, principal officers and ex
pert technical and professional staff and shall maintain the standards prescribed or as may
be directed by the Council.

ors, principal officers and ex
pert technical and professional staff and shall maintain the standards prescribed or as may
be directed by the Council.

(2) Without prejudice to subsection (1), a person does not qualify to be a director,
manager, secretary or any other officer of a health insurance scheme if that person
(a) is certified by a medical practitioner to be a person suffering from mental
disorder,
(b) is adjudged or otherwise declared bankrupt by a Court,
(c) compounds with the creditors, or
(d) is convicted by a Court of an offence involving fraud or dishonesty. (3) Except with the express authority of the Council a person who has participated in
the management or direction of an insurance company which has been wound up pursu
ant to an order of a Court, shall not participate in the management or direction of a health
insurance scheme. 60. Notification of certain changes
A scheme shall, within two months after the end of each financial year notify the Au
thority in writing of a change in the senior executive personnel or technical operation of
the scheme which occurred in that financial year and of the particulars relating to the
change. 61.

nior executive personnel or technical operation of
the scheme which occurred in that financial year and of the particulars relating to the
change. 61.

Furnishing of information to the Authority
A scheme shall furnish the Authority with the essential information concerning its
capitalization, its reserves and any other information required by the Council. [Issue 1] VI-1018

hority with the essential information concerning its
capitalization, its reserves and any other information required by the Council. [Issue 1] VI-1018

ACT 650
National Health Insurance Act, 2003
62. Inspection of annual report
(1) A member of a scheme may inspect a copy of the annual report of the scheme
during normal business hours at the principal office of the scheme. (2) A fee shall not be paid to the scheme for an inspection under subsection (1). (3) On a request by a member for a copy of the annual report and on payment to the
scheme of the relevant fee, the scheme shall supply a copy of the report to the member. 63. Financial year of schemes
The financial year of a scheme shall be from 1st January to 31st December. 64. Minimum health care benefits
A licensed scheme shall provide to its members the minimum healthcare benefits that
the Minister may, on the advice of the Council by legislative instrument prescribe. 65. Health insurance identity card
(1) On the registration by a scheme of an individual as a member, the scheme shall
issue to the member a health insurance identity card within the prescribed period.

stration by a scheme of an individual as a member, the scheme shall
issue to the member a health insurance identity card within the prescribed period.

(2) The following materials shall be issued with the Card:
(a) a booklet containing membership rights, obligations and privileges,
(b) a list of the healthcare benefits available under the scheme, and
(c) a list of healthcare providers and health institutions accredited by the Au
thority to the scheme and the periods or time of their availability. (3) The Card shall have a number which shall be unique to the member and shall be as
signed permanently to the member although the member may change the place of residence. (4) In the event of loss, the Card shall be replaced on payment of a prescribed fee. (5) A member who applies for the replacement of a Card for a reason other than the
expiration or loss of the Card shall be required to surrender the unexpired Card. (6) Despite any other provision of this section, the Council may accept the use of an
identity card authorised under an enactment to be used for all purposes of identification in
this country. 66.

n, the Council may accept the use of an
identity card authorised under an enactment to be used for all purposes of identification in
this country. 66.

Termination or suspension of membership
A scheme may terminate or suspend a member on any of the following grounds only:
(a) failure to pay contribution within the stipulated time;
(b) submission of false or fraudulent claim;
(c) commission of any act of fraud in relation to the scheme; or
(d) non-disclosure of material information requested by the scheme. VI-1019 [Issue 1]

(c) commission of any act of fraud in relation to the scheme; or
(d) non-disclosure of material information requested by the scheme. VI-1019 [Issue 1]

ACT 650
National Health Insurance Act, 2003
(2) A district mutual health insurance scheme shall not suspend the membership of an
indigent without the scheme first informing the Council within the period directed by the
Council. (3) Where a member dies, a dependant of the deceased member may, subject to the
payment of the deceased member’s contribution, continue to receive the benefits avail
able to the deceased member until the marriage or attainment of the age of eighteen years
of the dependant and subject to the other conditions provided in the constitution of the
scheme. (4) The Regulations may provide further for matters relating to termination or sus
pension of members of schemes. 67. Settlement of complaints
A scheme shall provide a procedure for settlement of complaints from its members
and its healthcare providers and ensure that the members and healthcare providers are
aware of their right to submit complaint to the Council where there is failure to settle a
complaint raised with the scheme. 68.

lthcare providers are
aware of their right to submit complaint to the Council where there is failure to settle a
complaint raised with the scheme. 68.

Quality assurance
The Council shall endeavour through the means determined by the Council including
accreditation, that healthcare providers put in place programmes that secure quality as
surance, utilisation review and technology assessment to ensure that
(a) the quality of healthcare services delivered are of reasonably good quality
and high standard;
(b) the basic healthcare services are of standards that are uniform, throughout
the country;
(c) the use of medical technology and equipments are consistent with actual
need and standards of medical practice;
(d) medical procedures and the administration of drugs are appropriate, neces
sary and comply with accepted medical practice and ethics; and
(e) drugs and medication used for the provision of healthcare in the country are
those included in the National Health Insurance Drug List of the Ministry
of Health. 69.

ation used for the provision of healthcare in the country are
those included in the National Health Insurance Drug List of the Ministry
of Health. 69.

Safeguards to prevent over or under use of healthcare services
A scheme shall comply with the National Health Insurance Drug List to prevent
(a) over or under use of healthcare services,
(b) unnecessary diagnostic and therapeutic procedures and intervention,
(c) irrational medication and prescriptions, and
(cl) inappropriate referral practices. (Issue 1} VI - 1020

d therapeutic procedures and intervention,
(c) irrational medication and prescriptions, and
(cl) inappropriate referral practices. (Issue 1} VI - 1020

ACT 650
National Health Insurance Act, 2003
70. Accreditation of healthcare providers and health facilities
(1) A scheme shall not use the services of a healthcare provider or a health facility in
the operation of the scheme unless the healthcare provider or the health facility has been
approved and accredited to the scheme by the Authority. (2) The Regulations may prescribe the qualifications, requirements and any other
matters that the Council considers necessary in respect of healthcare providers and
healthcare facilities that operate under the schemes. 71. Tariffs payable to healthcare providers
(1) Tariffs payable to healthcare providers shall be paid within four weeks by
schemes to the healthcare providers directly. (2) The Regulations may prescribe further for matters relating to the payment of tar
iffs to healthcare providers. (3) A scheme may deny or reduce the tariff claim of a healthcare provider where,
(a) the scheme considers that the claim is false, incorrect or there is provision
of insufficient information, or
(b) the healthcare provider without just cause fails to comply with a provision
of this Act or of the Regulations. 72.

of insufficient information, or
(b) the healthcare provider without just cause fails to comply with a provision
of this Act or of the Regulations. 72.

Actuary
The Council may
(a) where it has reasonable grounds to believe that a licensed health insurance
scheme or a manager of the scheme has contravened a provision of this Act
or of the Regulations and the contravention adversely affects the interest of
the members, or
(b) at the request of a health insurance scheme,
appoint an actuary to investigate and report to the Council the activities and affairs of the
scheme. 73. Powers of actuary
An actuary appointed under section 72
(a) shall have access to any information or document in the possession, or un
der the control, of the scheme where the actuary reasonably requires access
for the proper performance of the actuary’s functions;
(b) may require a manager or an employee of the scheme to answer questions
or produce documents for the purpose of enabling the actuary to perform
properly the actuary’s functions;
(c) may attend meetings of the governing body of the scheme on matters that
relate or affect the financial affairs of the scheme; and
(d) shall have and exercise any other powers necessary for the effective per
formance of the actuary’s functions. VI -1021 [Issue 1]

f the scheme; and
(d) shall have and exercise any other powers necessary for the effective per
formance of the actuary’s functions. VI -1021 [Issue 1]

ACT 650
National Health Insurance Act, 2003
74. Inspection of schemes
(1) The Council may for the purposes of supervision of health insurance schemes,
(a) inspect the premises, business and affairs, including the procedures and
systems of a scheme;
(b) inspect the assets, including cash, belonging to or in the possession or con
trol of a person who has a relation with the scheme;
(c) examine and make copies of documents, including accounting records, that
belong to or are in the possession or control of a person who in the opinion
of the Council has activities that relate to the activities of a scheme. (2) The Authority may employ suitably qualified and experienced persons to assist it
or carry out an inspection on its behalf. (3) Without limiting subsection (1), the Council shall ensure that an inspection is car
ried out in respect of a licensed health insurance scheme at least once in every twelve
months. (4) The Council shall after an inspection compile a report stating the status of the
scheme and shall submit a copy of the report including its recommendations to the
scheme for compliance where applicable. 75.

tating the status of the
scheme and shall submit a copy of the report including its recommendations to the
scheme for compliance where applicable. 75.

Directives of Council
The Council may direct a scheme or an officer of a scheme to comply with the direc
tions of the Council specified in writing and where there is failure to comply, the Author
ity may seek an order from the High Court to order that person to comply. National Health Insurance Fund
76. Establishment of a National health Insurance Fund
There is established by this Act a National Health Insurance Fund. 77. Object of the Fund
(1) The object of the Fund is to provide finance to subsidise the cost of provision of
healthcare services to members of district mutual health insurances schemes licensed by
the Authority.

e finance to subsidise the cost of provision of
healthcare services to members of district mutual health insurances schemes licensed by
the Authority.

(2) For the purpose of implementing the object, the moneys from the Fund shall be
expended as follows:
(a) to provide subsidy of a level determined by the Council to district mutual
health insurance schemes;
(b) to reinsure district mutual health insurance schemes against random fluc
tuations on cost under conditions to be determined by the Council;
(c) to set aside some monies from the Fund to provide for the Health care cost
of indigents;
(d) to provide support to facilitate provision of or access to health service;
(e) to invest in any other facilitating programme to promote access to health
service determined by the Minister in consultation with the Council. [Issue 1] VI -1022

n any other facilitating programme to promote access to health
service determined by the Minister in consultation with the Council. [Issue 1] VI -1022

ACT 650
National Health Insurance Act, 2003
78. Sources of money for the Fund
(1) The sources of money for the Fund are as follows:
(a) the health insurance levy provided for under section 86;
(b) two and one half percent of each person’s seventeen and one half percent
contribution to the Social Security and Pensions Scheme Fund;
(c) the money that may be allocated to the Fund by Parliament;
(d) money that accrues to the Fund from investments made by the Council; and
(e) grants, donations, gifts and any other voluntary contribution made to the
Fund. (2) The Director-General of the Social Security and National Insurance Trust shall at
the end of each month transfer to the Fund two and one half percent of each person’s sev
enteen and one half per cent of social security contributions for the preceding month. (3) The contribution under subsection (1) shall be without prejudice to the benefits
due the contributors under the Social Security Pensions Scheme.

. (3) The contribution under subsection (1) shall be without prejudice to the benefits
due the contributors under the Social Security Pensions Scheme.

(4) Where there is a default in the payment of benefits by the Social Security and Na
tional Insurance Trust to contributors arising from the payment of the contribution into
Fund under subsection (1) (b), there shall be paid by Government into the Social Security
Trust Fund the amount of money required to enable the benefits to be paid to the
contributor. (5) The Council may by Regulations review the sources of funding to keep pace with
developments in the health insurance industry. 79. Formula for disbursement from the Fund
(1) The Council shall annually submit to Parliament for approval, the formula for dis
tribution of subsidies to be paid to licensed district mutual health insurance schemes. (2) The Council shall in the disbursement of moneys from the Fund make specific
provision annually towards the health needs of indigents and prescribe the method for
distributing the monies involved. 80. Bank account for the Fund
Moneys of the Fund shall be paid into the bank accounts determined by the Council
with the approval of the Accountant-General. 81.

ccount for the Fund
Moneys of the Fund shall be paid into the bank accounts determined by the Council
with the approval of the Accountant-General. 81.

Conditions for provision of subsidy to district mutual health insurance schemes
(1) Subject to subsection (2), the Council shall provide subsidies from the Fund to li
censed district mutual health insurance schemes that offer the minimum healthcare bene
fits prescribed by the Minister. (2) Subsidy shall not be granted under subsection (1) unless the Council is satisfied
that,
(a) the district mutual health insurance scheme is open to the residents in the
geographical area of the relevant District Assembly;
VI-1023 [Issue 1]

(a) the district mutual health insurance scheme is open to the residents in the
geographical area of the relevant District Assembly;
VI-1023 [Issue 1]

ACT 650
National Health Insurance Act, 2003
(b) the scheme is operated in such a manner that it is answerable to its members;
(c) the annual report and financial accounts submitted to its governing body
and copied to the Authority are acceptable to the Council;
((1 ) a person is not excluded from enrolment on the scheme because of physical
disability, social, economic or health status;
(e) the scheme allows for portability, namely, availability of the benefits to a
member who moves outside the geographical area of the scheme of which
the person is a member; and
(f) the tariff payable to healthcare providers under the scheme are in accor
dance with guidelines set by the Council. (3) A district mutual health insurance scheme shall apply for subsidy from the Fund
in the form and at the time directed by the Council. 82. Management of the Fund
(1) The Fund shall be managed by the Council.

or subsidy from the Fund
in the form and at the time directed by the Council. 82. Management of the Fund
(1) The Fund shall be managed by the Council.

(2) The Council in the management of the Fund shall have the following functions:
(a) formulate and implement policies towards achieving the object of the Fund;
(b) collect or arrange to be collected monies lawfully due to the Fund;
(c) account for the money in the Fund;
(cl) provide formula for the distribution of moneys from the Fund;
(e) approve any other expenditure charged on the Fund under this Act or any
other enactment;
(f) set aside an amount for indigents; and
(g) perform any other function ancillary to the object of the Fund. 83. Investment of the Fund
The Council may invest a part of the Fund that it considers appropriate in the securi
ties approved by the Minister responsible for Finance. 84. Expenses of the Fund
The expenses attendant to the management of the Fund shall be charged on the Fund. 85. Accounts, auditing and annual report
The provisions in section 99 to 100 on accounts, auditing and annual report to Parlia
ment apply to the Fund. National Health Insurance Levy
86.

eport
The provisions in section 99 to 100 on accounts, auditing and annual report to Parlia
ment apply to the Fund. National Health Insurance Levy
86.

Imposition of national health insurance levy
(1) There is imposed by this Act a national health insurance levy charge at the rate of
two and one half percent calculated on,
(a) every supply of goods and services made or provided in Ghana,
[Issue 1] VI -1024

evy charge at the rate of
two and one half percent calculated on,
(a) every supply of goods and services made or provided in Ghana,
[Issue 1] VI -1024

ACT 650
National Health Insurance Act, 2003
(b) every importation of goods, and
(c) supply of an imported service,
unless otherwise exempted in this Act or under the Regulations. (2) The levy is payable at the time the goods and services are supplied or imported. (3) For the purposes of the natural health insurance levy the provisions on supply of
goods and services in the enactment that establishes the revenue or collection agency
charged with responsibility for the collection of this levy by the Minister shall apply. 87. Exempt supply
A supply in respect of any of the matters set out in the Schedule Part One is exempt
from the levy imposed under section 86 (1). 88. Zero-rated supply
A supply in respect of any of the matters specified in the Schedule Part Two is zero
rated. 89. Relief from levy
There is hereby granted relief from the payment of the levy to the individuals, organi
sations and in respect of the matteis specified in the Schedule Part Three. 90. Collection of the levy
(1) The levy shall be collected by the revenue or collection agency determined by the
Minister responsible for Finance.

ee. 90. Collection of the levy
(1) The levy shall be collected by the revenue or collection agency determined by the
Minister responsible for Finance.

(2) On the determination by the Minister responsible for Finance of the revenue or
collection agency to collect the levy, the enactment of the relevant revenue agency for the
collection of tax or levy shall apply, with the modifications that are necessary for the col
lection of the levy imposed under this Act. 91. Payment of levy into the Fund
The revenue or collection agency charged with the collection of the levy shall within
thirty days of collection of the levy, pay the levy directly into the Fund. Administrative, Financial and Miscellaneous Provisions
92. Executive Secretary of the Authority
(1) There shall be appointed for the Authority by the President in accordance with ar
ticle 195 of the Constitution, an Executive Secretary of the Authority who shall be the
chief executive of the Authority. (2) The Executive Secretary shall hold office on terms and conditions specified in the
letter of appointment. (3) Subject to the directions of the Council, the Executive Secretary is responsible for
the day to day administration of the affair of the Authority and implementation of the
decisions of the Council. VI -1025 (Issue 1]

is responsible for
the day to day administration of the affair of the Authority and implementation of the
decisions of the Council. VI -1025 (Issue 1]

ACT 650
National Health Insurance Act, 2003
(4) The Executive Secietary may delegate any of the functions of office to any other
officer of the secretariat of the Authority; but the Executive Secretary shall not be re
lieved from ultimate responsibility for the performance of the delegated function. 93. Units of the Authority
(1) For the purposes of implementing its functions under this Act, the Council may
establish the units or divisions of the Authority that the Council considers necessary. (2) Without limiting the effect of subsection (1), the following are hereby established
as units of the Authority:
(a) Registration and Licensing Unit,
(b) Planning, Monitoring and Evaluation Unit,
(c) Administration, Management Support and Training Unit, and
id) Fund Management and investment Unit. (3) Each unit shall have as its head a technical director who is responsible, subject to
the direction of the Executive Secretary, for overseeing and implementing the functions
assigned to the unit. (4) The staff strength and the detailed functions of each unit shall be determined by
the Council
94. Appointment of interna!

ns
assigned to the unit. (4) The staff strength and the detailed functions of each unit shall be determined by
the Council
94. Appointment of interna!

auditor
(1) There shall be appointed an internal auditor for the Authority who is responsible
to the Executive Secretary in the performance of the functions of office. (2) The internal auditor shall at the end of every three months submit a report of the au
dit of the Fund carried out by the internal auditor in respect of that period to the Council. (3) The chairperson of the Council shall submit a copy of the report to the Minister
and the Minister responsible for Finance. (4) This section shall be read and construed as one with the Internal Audit Agency
Act, 2003 (Act 658) and where there is a conflict that Act shall prevail. 95. Appointment of other staff
(1) The Piesident shall in accordance with article 195 of the Constitution, and on the
terms and conditions determined by the President appoint other staff for the Authority. (2) Other public officers may be transferred or seconded to the Authority or may oth
erwise give assistance to it. 96. Delegation of appointment
The Piesident may in accordance with article 195 (2) of the Constitution delegate the
power of appointment of public officers under this Act. 97.

ment
The Piesident may in accordance with article 195 (2) of the Constitution delegate the
power of appointment of public officers under this Act. 97.

District offices of the Authority
(1) The Council may establish district offices as it considers necessary. [Issue 1] VI -1026

District offices of the Authority
(1) The Council may establish district offices as it considers necessary. [Issue 1] VI -1026

ACT 650
National Health insurance Act, 2003
(2) A district office of the Authority shall be provided with the public officers that
the President acting in accordance with the advice of the Council given in consultation
with the Public Services Commission shall determine. (3) A district office of the Authority shall perform the functions of the Authority in
the district as directed by the Council. 98. Expenses of the Authority
(1) The salaries of employees of the Authority shall be the same as those applicable
to employees of equivalent status in the Public Services and shall be paid out of the mon
eys allocated by Parliament from the Fund on the recommendation of the Minister re
sponsible for Finance. (2) The administrative expenses of the Authority shall be paid out of the Fund subject to
the approval of the Minister acting in consultation with the Minister responsible for Finance. 99. Accounts and audit
(1) The Authority shall keep books of account and proper records in relation to them
in the form approved by the Auditor-General. (2) The accounts of the Authority shall be audited within six months after the end of
each financial year by the Auditor-General.

the Auditor-General. (2) The accounts of the Authority shall be audited within six months after the end of
each financial year by the Auditor-General.

(3) The Auditor-General shall, not later than six months after the end of each finan
cial year, forward to the Minister a copy of the audited accounts of the Authority for the
preceding financial year. (4) The financial year of the Authority shall be the same as the financial year of the
Government. 100. Annual report and other reports of the Authority
(1) The Council shall as soon as practicable after the expiry of each financial year but
within eight months after the end of the year submit to the Minister an annual report cov
ering the activities of the Authority for the year to which the report relates. (2) The annual report submitted under subsection (1) shall include,
(a) the report of the Auditor-General,
(b) a report of the effect of the implementation of the national health insurance
policy on the nation, and
(c) a report on the Fund specifying the total disbursement, reserve and the av
erage cost provided from the Fund to beneficiaries under the schemes. (3) The Minister shall within two months of the receipt of the annual report submit
the report to Parliament with a statement that the Minister considers necessary.

er shall within two months of the receipt of the annual report submit
the report to Parliament with a statement that the Minister considers necessary.

(4) The Council shall also submit to the Minister any other reports that the Minister
may in writing require. 101. No cancellation of a scheme registered with Registrar of Companies
The registration of a scheme licensed under this Act shall not be cancelled or altered
by the Registrar of companies without the prior written authorisation of the Council. VI-1027 [Issue 1]

der this Act shall not be cancelled or altered
by the Registrar of companies without the prior written authorisation of the Council. VI-1027 [Issue 1]

ACT 650
National Health Insurance Act, 2003
102.

ACT 650
National Health Insurance Act, 2003
102.

Offences
A licensed scheme which,
(a) carries on an activity contrary to section 24 other than the provision of
healthcare services to its members,
(b) without the prior approval of the Council transfers or jointly operates the
scheme with another scheme contrary to section 26,
(c) operates a mutual health scheme for profit except for its members,
(d) fails to keep books of account and proper records in respect of the
accounts,
(e) fails to provide the minimum healthcare benefits specified by this Act or
the Regulations,
() falsifies or connives with a person to falsify tariffs payable to a healthcare
provider, or
(g) obstructs an actuary, an inspector or a person authorised by the Council or
this Act in the performance of a function under this Act,
commits an offence and is liable on summary conviction to a fine of not less than two
hundred penalty units and not exceeding fifteen thousand penalty units or to a term of
imprisonment of not less than twelve months and not exceeding ten years; and every
principal officer or manager of the scheme shall be deemed to have committed the of
fence unless it is proved that the offence was committed without the knowledge or con
nivance of the principal officer or manager.

ve committed the of
fence unless it is proved that the offence was committed without the knowledge or con
nivance of the principal officer or manager.

(2) Where a contributor to a scheme cheats or attempts to cheat the scheme by con
niving with a healthcare provider or a non-contributor to make a claim for,
(a) a service which has not been provided,
(b) a seivice which the contributor does not need but which the healthcare pro
vider purports to have provided, or
(c) drug prescriptions which the contributor does not require or which is far in
excess of what the contributor requires,
the contributor commits an offence and is liable on summary conviction to a fine not ex
ceeding one thousand penalty units or to a term of imprisonment not exceeding five years
or to both the fine and the imprisonment.

on to a fine not ex
ceeding one thousand penalty units or to a term of imprisonment not exceeding five years
or to both the fine and the imprisonment.

(3) A health care provider who cheats or attempts to cheat a scheme by presenting to
a scheme for payment tariffs for,
(a) a service which the healthcare provider has not provided,
(b) a service which the contributor, in respect of whom the tariff claim is
made, does not need but which the healthcare provider purports to have
provided, or
(c) drug prescriptions which the contributor, in respect of whom the tariff
claim is made, does not require or which is far in excess of what the con
tributor requires,
commits an offence and in addition to any other disciplinary measure which the Council
may adopt, is liable on summaiy conviction to a fine not exceeding five thousand penalty
[Issue 1] VI -1028

her disciplinary measure which the Council
may adopt, is liable on summaiy conviction to a fine not exceeding five thousand penalty
[Issue 1] VI -1028

ACT 650
National Health Insurance Act, 2003
units of to a term of imprisonment not exceeding ten years or to both the fine and the
imprisonment. 103. Regulations
(1) The Minister on the advice of the Council may, by legislative instrument, make
Regulations for the effective implementation of this Act.

gulations
(1) The Minister on the advice of the Council may, by legislative instrument, make
Regulations for the effective implementation of this Act.

(2) Without limiting the scope of subsection (1), the Regulations may
(a) provide further for registration and licensing of schemes;
(b) prescribe reports to be submitted to the Authority;
(c) prescribe matters relating to health identity cards;
(d) prescribe the mode of payment of contributions by members of district mu
tual health insurance schemes;
(e) prescribe the qualification of managers and principal officers of schemes;
(f) prescribe financial deposit or other financial security to be paid by
schemes;
(g) provide for matters relating to healthcare benefits;
(h) prescribe the means test for indigents;
(i) prescribe accreditation of healthcare providers and health facilities;
() provide procedure for resolution of disputes and complaints by the Council;
(k) provide further for matters relating to suspension and termination of a
member from a scheme;
(I) prescribe matters relating to quality assurance;
(m) provide for matters relating to the payment of tariffs to healthcare providers
and health institutions within the schemes;
(ri) prescribe further conditions for grant of subsidy from the Fund;
(o) provide for matters relating to accounts of district mutual health insurance
schemes;
(p) prescribe the minimum healthcare benefits;
(q) provide for forms;
(?

for matters relating to accounts of district mutual health insurance
schemes;
(p) prescribe the minimum healthcare benefits;
(q) provide for forms;
(?

) provide for the imposition of fees for a licence;
(s) provide conditions for variation and revocation of conditions of a licence;
(t) provide for the terms and conditions for the issue of a licence; and
(u) provide for the exemption from the payment of the national health insur
ance levy payable under this Act. 104. Interpretation
In this Act, unless the context otherwise requires,
“actuary” means an insurance risk analyst;
VI-1029 [Issue 1]

e under this Act. 104. Interpretation
In this Act, unless the context otherwise requires,
“actuary” means an insurance risk analyst;
VI-1029 [Issue 1]

ACT 650
National Health Insurance Act, 2003
“accreditation” means a process by which the qualification and capability of a
healthcare provider is verified for the purpose of enabling that person to provide
healthcare services under a scheme;
“Auditor-General” includes an auditor appointed by the Auditor-General;
“Authority” means the National Health Authority established by section 1;
"beneficiary" means a person entitled to healthcare services under this Act;
“Card” means a health identity Card issued under this Act;
“contribution” means the amount of money paid by or on behalf of a member to
a scheme for membership of the scheme;
“Council” means the governing body of the Authority established by section 3;
“dependant” in relation to a beneficiary or member means,
(a) a spouse of a member;
(b) unmarried and unemployed child below eighteen years;
(c) a child who is eighteen yeais or above but suffering from congenital disabil
ity, either physical or mental, or any disability that renders the person totally
dependent on the member for support or is still in school or learning a trade;
(d) a parent of sixty years old or above and whose monthly income if any, is
below an amount determined by the Council;
“district” means the geographical area of one or more District Assemblies;
“District Assembly” includes a Metropolitan and a Municipal Assembly;
“functions” includes powers and duties;
“Fund” means the National Health Insurance Fund established by section 76;
“healthcare facility” includes a hospital, nursing home, laboratory, maternity
home, dental clinic, polyclinic, clinic and pharmacy and other facilities that the Coun
cil may determine;
“healthcare provider” means a healthcare professional or practitioner licensed to
practice in Ghana in accordance with an enactment in force;
“indigent” means a person who does not have a visible or adequate means of in
come or who does not have a person to support him or her and by the means test
qualifies as an indigent;
“means test” means the process by which a mutual health insurance scheme de
termines the ability of individuals or households to pay varying levels of contributions
to the scheme ranging from contributions that would be fully paid by the Government,
through contributions that are subsidised by the Government to contributions that do
not require subsidy;
“member” means a person registered by a scheme as a beneficiary of the scheme;
“Minister” means the Minister responsible for Health;
[Issue 1] VI -1030

member” means a person registered by a scheme as a beneficiary of the scheme;
“Minister” means the Minister responsible for Health;
[Issue 1] VI -1030

ACT 650
National Health Insurance Act, 2003
“mutual health insurance scheme” means a community based health insurance
scheme composed of members of the community in the relevant district and operated
exclusively for the benefit of the members;
“quality assurance” means a formal set of activities to review and ensure the
quality of healthcare services provided to members of health insurance schemes;
“Regulations” means the relevant Regulations made under this Act;
“resident” means a person who lives in this country for six months or more in any
period of twelve months;
“scheme” means a district mutual, a private mutual or a private commercial health
insurance scheme or a body registered and licensed under this Act. 105. Disapplication of Insurance Act, 1989
Except as otherwise expressly provided in this Act under section 45 in respect of pri
vate commercial health insurance schemes, the Insurance Act, 19893 shall not apply to
health insurance schemes. 106.

nder section 45 in respect of pri
vate commercial health insurance schemes, the Insurance Act, 19893 shall not apply to
health insurance schemes. 106.

Transitional provision
On the coming into force of this Act, a group of persons operating a health insurance
scheme who desires to continue the operation of the scheme, shall within six month of the
appointment of the Council apply to the Authority for the registration and licensing of the
scheme in compliance with the provisions of this Act. 107. Commencement of payment of levy
The national health insurance levy imposed under section 86 of this Act shall become
payable on the date prescribed by the Minister by legislative instrument. SCHEDULE
[Section 87]
PART ONE
Exempt Supplies
Item No
1. (a) Medical sei vices. (b) Pharmaceuticals. Description
Essential drug list under Chapter 30 of the Har
monised Systems Commodities Classification
Code, 1999 produced or supplied by retail in
Ghana, and the active ingredients for essential
drugs specified by law. Imported special drugs determined by the Min
ister of Health and approved by Parliament. 3. P.N.D.C.L. 227. VI-1031 [Issue 2]

drugs specified by law. Imported special drugs determined by the Min
ister of Health and approved by Parliament. 3. P.N.D.C.L. 227. VI-1031 [Issue 2]

ACT 650
National Health Insurance Act, 2003
PART ONE—continued
Item No. Description
2. Mosquito net. Mosquito nets of man-made textile material
whether or not impregnated with chemicals. 3. Goods for the disabled. Articles designed exclusively for use by per
sons with disability. 4. Water. Expenditure on water, excluding bottled and
distilled water. 5. Education. Expenditure on educational services at any
level by an educational establishment approved
by the Minister for education, folly assembled
computers imported or produced locally by
educational establishments that are approved by
the Minister of Education, Laboratory equip
ment for educational purposes and library
equipment. 6. Live Animals. Cattle, sheep, goat, swine and poultry but ex
cluding horses, asses, mules and hinnies, and
similar exotic animals. 7. Animals, livestock and poultry imported
for breeding pinposes. Live asses, mules and hinnies; live bovine ani
mals; live swine; live sheep and goats; live ma
rine mammals, live fish and aquatic
invertebrates. 8. Animal product in its raw state.

live bovine ani
mals; live swine; live sheep and goats; live ma
rine mammals, live fish and aquatic
invertebrates. 8. Animal product in its raw state.

Edible meat and offal of the animals listed in
item 6 provided any processing is restricted to
salting, smoking or similar process, but exclud
ing pate, fatty livers of geese and ducks and
similar products. 9. Agricultural and aquatic food products in
its raw state produced in Ghana. Fish, crustaceans, and molluscs (but excluding
ornamental fish); vegetables and fruits, nuts,
coffee, cocoa, shea butter, maize, sorghum, mil
let, tubers, guinea com and rice. 10. Seeds, bulbs Footings, and other forms of
propagation. 11. Agricultural inputs. Of edible fruits, nuts, cereals tubers and vege
tables. Chemicals including all forms of fertilizers,
acaricides, fungicides, nematicides, growth
regulation, pesticides, veterinary drugs and vac
cines, feed and feed ingredient. 12. Fishing equipment. Boats, nets, floats, twines, hooks and fishing
gear. 13. Salt. Denatured salt, compressed salt used in animal
feeding and salt for human consumption includ
ing table salt. 14. Land, buildings and construction.

lt. Denatured salt, compressed salt used in animal
feeding and salt for human consumption includ
ing table salt. 14. Land, buildings and construction.

(a) Land and buildings: the granting of as
signment or surrender of an interest in land
or building; the right to occupy land or
buildings excluding hotel accommodation,
warehousing, storage and similar occu
pancy incidental to the provision of the
relevant services;
(b) Civil engineering work;
[Issue 2] VI- 1032

tion,
warehousing, storage and similar occu
pancy incidental to the provision of the
relevant services;
(b) Civil engineering work;
[Issue 2] VI- 1032

ACT 650
National Health Insurance Act, 2003
19. Crude oil and hydrocarbon products. Petrol, diesel, liquefied petroleum gas, kerosene
and residual fuel oil. PART ONE—continued
Item No. Description
(c) Services supplied in the course of construc
tion, demolition, alteration, maintenance, to
buildings or other works under (a) and (b)
above, including the provision of labour,
but excluding professional services such as
architectural or surveying. 15. Electricity. Domestic use of electricity up to minimum con
sumption level prescribed in Regulations by the
Minister, and Compact Fluorescent Lamps. 16. Transportation. Includes transportation by bus and similar vehi
cles, train, boat, and air. 17. Postal services. 18. Machinery. Purchase of postage stamps. Machinery, apparatus appliances and parts
thereof, designed for use in
(a) agriculture, veterinary, fishing and
horticulture;
(b) industry;
(c) mining as specified in the mining list and
dredging; and
(d) railway and tramway. 1. Export of taxable goods and services. 2. Goods shipped as stores on vessels and aircrafts leaving the territories of Ghana. 20. Financial services.

1. Export of taxable goods and services. 2. Goods shipped as stores on vessels and aircrafts leaving the territories of Ghana. 20. Financial services.

Provision of insurance; issue, transfer, receipt
of, or dealing with money (including foreign
exchange) or any note or order of payment of
money; provision of credit; operation of any
bank (or similar institution) account; but ex
cluding professional advice such as accoun
tancy, investment and legal. 21. Printed matter. Books and newspapers fully printed or pro
duced by any duplicating process, including at
lases, books, charts, maps, music, but excluding
imported newspapers, plans and drawings, sci
entific and technical works, periodicals, maga
zines, trade catalogue, price lists, greeting
cards, almanacs, calendars and stationery. 22. Transfer of going concern. The supply of goods as part of the transfer of a
business as a going concern by one taxable per
son to another taxable person. PART TWO
Zero-Rated Supplies
[Section 88]
VI-1033 [Issue 1]

ransfer of a
business as a going concern by one taxable per
son to another taxable person. PART TWO
Zero-Rated Supplies
[Section 88]
VI-1033 [Issue 1]

ACT 650
National Health Insurance Act, 2003
r l
PART THREE 1
Relief i[Section 89]
1. President of the Republic of Ghana.
2. For the official use of any Commonwealth or Foreign Embassy, Mission or Consulate
(relief applies only to levy on imported goods). .
3. For use of a permanent member of the Diplomatic Service of any Common wealth or '
Foreign Embassy, Mission or Consulate (relief applies only to levy on imported
goods).
Note: Provided that with regard to items 2 and 3 of this Part a similar privilege is
accorded by such Commonwealth or Foreign Country to the Ghana representa
tive in that country.
4. For use of an international agency or technical assistance scheme where the terms of
the agreement made with the Government include exemption from domestic taxes.
5. Emergency relief items approved by Parliament.
[Issue 1] VI -1034