The Universal Health Coverage Bill of 2022 in Tanzania

The Universal Health Coverage Bill of 2022 (the Bill) was tabled before Parliament in September 2022. The Bill is currently with the Social Services and Community Development Committee for further consultation.

A key element of the Bill is its impact on the insurance sector. Is the sector deep enough to cater for the predicted and required increase in insurance coverage? Will this lead to an increase in the number of insurance providers? Will it lead to consolidation in the market?  

We analyse the Bill and its possible impact as it transitions into law.

Key Definitions 

The following are key terms defined in the Bill:

“Authority” means the Tanzania Insurance Regulatory Authority established by the Insurance Act No. 10 of 2009 (as amended) (the Insurance Act);

“Beneficiary” means any person entitled to receive medical benefits under the Bill;

“Contracted healthcare centre” means a healthcare centre that has entered into an agreement with an insurance scheme to serve beneficiaries in accordance with the Bill;

“Contribution amount” means the rate from salary or any other source of income payable to an insurance scheme;

“Dependent” means:

(a) a member's parents or their spouse's parents;

(b) a biological or adopted child of a member who is under 21 years; or

(c) a member’s blood relative who is under 21 years;

“Healthcare centre” means a clinic, health centre, laboratory, pharmacy, or any other facility providing health care;

“Health insurance scheme" means a public or private health insurance or a special category of insurance recognised under the Bill;

“Minister” means the Minister of Health;

“Ministry" means the Ministry of Health;

“Public health insurance scheme" means a health insurance scheme established and recognised under the Bill;

“Salary” for the purpose of:

(a) a public servant, means a salary that does not include additional payments, entitlements or allowances; or

(b) a private sector employee, means a salary that includes all legal entitlements paid as part of an employee's salary,

“Service provider” means a healthcare centre and a health insurance scheme recognised by the Bill; and

“Universal health coverage” means the procedure defined in accordance with the Bill that requires every citizen to have health insurance.

Objectives of the Bill

The Bill proposes enactment of a Universal Health Insurance law to establish a management and control system for the provision of health insurance services. This will guarantee all citizens and residents access to health services without financial constraints. The Bill proposes a mandatory requirement for every individual to register with the health insurance system which will include:

(a) employers and employees from public and private sectors;

(b) employees from the informal sector;

(c) health insurance schemes (Insurance Schemes);

(d) financially challenged individuals;

(e) healthcare centres; and

(f) the Authority.

Pursuant to the Bill, the Authority shall be the main regulator for health insurance services in Tanzania. For the purpose of implementing a sound healthcare system, duties of the Authority shall include:

(a) to register the Insurance Schemes;

(b) to monitor the quality of health services provided by healthcare centres;

(c) to ensure that health insurance policies provide basic benefits in accordance with the Bill;

(d) to ensure that the services provided align with level of contributions;

(e) to provide guidelines for the payment of service providers; and

(f) to maintain a database for contracted healthcare centres.

The Insurance Schemes

According to the Bill, the National Health Insurance Fund which was established in accordance with the National Health Insurance Fund Act, Cap 395 (NHIF Act) shall be recognised as a public health insurance scheme. The Minister in consultation with the Authority shall have power to improve the public health insurance scheme with the aim of achieving health insurance coverage for all individuals.

With regards to the private health insurance scheme, the Bill permits any company or entity authorised to provide insurance services, before the commencement of the law proposed by the Bill, to continue providing such services under the category of a private health insurance scheme. Please note that provision of insurance services under the private health insurance scheme shall be subject to the fulfilment of the conditions to be specified under the Bill.

Any other insurance scheme not falling within the category of a public or private health insurance scheme shall be regarded as a special health insurance scheme.

The Bill prohibits the operation of a health insurance scheme without a certificate of registration issued by the Authority. The Authority shall maintain a register of all registered Insurance Schemes with the aim of ensuring coordination and management of the Insurance Schemes. An issued certificate of registration may be cancelled:

(a) upon the repeal of the NHIF Act. This applies to the public health insurance scheme;

(b) upon violation of the provisions of the Bill or relevant regulations and guidelines;

(c) where the health insurance scheme ceases to provide services or becomes insolvent;

(d) upon a request for cancellation by the insurance scheme and where the Authority has approved such request; and

(e) where the insurance scheme has lost its qualifications prescribed under the Bill.

Registration and Membership

Registration under a health insurance scheme affords a member or dependent basic benefits for a period of one year from the date of registration. The Minister shall specify basic benefits through a notice to be published in the Government Gazette if the Bill is successfully passed into a law. Furthermore, the Bill allows the provision of additional services over and above what is covered under a basic benefit package in accordance with the guidelines issued by the Authority.

Membership under a health insurance scheme shall include:

(a) persons who were members of a specific insurance scheme prior to the passing of the Bill;

(b) persons who will have attained 21 years of age at the time of passing the Bill;

(c) persons under the age of 21 years but qualify as members of a scheme at the time of passing the Bill;

(d) employees of both public and the private sector;

(e) self-employed persons;

(f) financially challenged persons; and

(g) any other group of persons as specified by the Minister.

Please note that a member may register their spouse and not more than four of their dependants as beneficiaries under a health insurance scheme.

The Bill requires all employers in the public and private sector to register all their employees in a health insurance scheme within thirty days from the commencement of an employment contract.

Every employer under the public and private sector shall be required to submit six percent of the employee’s salary to the health insurance scheme. Out of the six percent, half or more than half will be submitted by the employer while the rest will be contributed by the employee.

Monitoring of the Insurance Schemes

Insurance Schemes are required to conduct a viability and sustainability assessment every three years or at any time directed by the Authority. The assessment report shall be submitted to the Authority and a copy sent to the Minister. Additionally, the Authority shall issue guidelines stipulating the maximum limit of operating costs under the public health insurance scheme.

Complaints and Disputes

All disputes in relation to universal health insurance shall be resolved in accordance with the provisions of the Insurance Act. The Bill further proposes a restriction on access to certain services without proof of membership in an Insurance Scheme. Such services include, issuance of a driver’s licence, motor vehicle insurance, Taxpayer Identification Number (TIN) and a business licence.

Consequential Amendments

The Bill proposes consequential amendments to the NHIF Act, the Insurance Act, Passports and Travel Documents Act (Cap 42), the Tax Administration Act (Cap 438 R.E. 2019), the Business Licensing Act No. 25 of 1972, the Employment and Labour Relations Act (Cap 366 R.E. 2019) and the Law of the Child Act (Cap 13 R.E. 2019), among others.