Health insurance in Zambia — NHIMA and private

Short answerChecked 31 October 2026

Zambia has a compulsory National Health Insurance Scheme, run by NHIMA under the National Health Insurance Act 2018: citizens and established residents over 18 must be registered, and contributions are 1% of basic salary from the employee and 1% from the employer. On top of it, licensed insurers sell private health policies; the PIA reports that health insurance made up 54% of long-term insurance premiums in 2025. Foreigners must hold valid health insurance during their stay (section 14 of the Act). Check any private insurer on the PIA's list of licensed entities before you pay.

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Answers come from the law, the regulator and the insurers' own documents, with the source under each answer. General information, not advice.

Does the cover include outpatient care?How do waiting periods work?What should I check before I buy?

On this page · 5 sections

Two layers of health cover
Private health insurance
Before you buy a private health policy
FAQ
Sources

Two layers of health cover

	NHIMA (national scheme)	Private health policy
Who	Citizens and established residents above 18, with spouse and up to 5 children under 18	Anyone the insurer accepts
Compulsory?	Yes (NHI Act, section 13)	No
Cost	1% + 1% of basic salary, or 1% of declared income	The premium the insurer sets
Where it pays	NHIMA-accredited providers, Zambia only	As the policy says
Regulator	NHIMA, Ministry of Health	Pensions and Insurance Authority

NHIMA: registration · benefits · contribution calculator.

Private health insurance

The PIA's Q4 2025 industry report says motor insurance and health insurance accounted for 66% and 54% of short-term and long-term business respectively, and names high claims costs "on health and motor insurance" among the industry's challenges (PIA, Q4 2025).

The PIA describes health insurance as a contract in which the insurer commits to pay part of your medical costs, up to a pre-determined amount, when you get sick or are involved in an accident (key life events). The Insurance Act separately defines "medical scheme fund management business": taking contributions from members to pay their health expenses (Insurance Act 2021, section 2).

Among the long-term insurers on the 2026 list, Specialty Emergency Services Limited (SES) is one of the five largest by premiums (11% in 2025) (PIA list, Q4 2025).

Before you buy a private health policy

Check the insurer, and the agent or broker, on the PIA's list of licensed insurance entities for 2026. It is an offence to insure with an unlicensed insurer (Insurance Act, section 166).
Ask which hospitals the policy pays and whether it duplicates what NHIMA already pays at accredited providers.
Get the terms in writing. Every licensed insurer must lodge its policy forms with the Registrar 30 days before use (section 23) and print terms in a legible font (section 24).

Already insured?

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Next step

1. Find the cover that fits

Frequently asked questions

Is health insurance compulsory in Zambia?

The National Health Insurance Scheme is compulsory for citizens and established residents above 18 (NHI Act 2018, section 13). Private health insurance is voluntary.

How much is NHIMA a month?

1% of basic salary from the employee and 1% from the employer; 1% of declared income for the self-employed.

Who regulates private health insurance in Zambia?

The Pensions and Insurance Authority, under the Insurance Act No. 38 of 2021. NHIMA runs the national scheme.

Which health insurer is the best in Zambia?

Tulinde does not rank insurers. Check that the insurer is on the PIA list, compare the hospitals each policy pays and the limits, and keep NHIMA in mind.