NHIMA benefits: what is covered, card, complaints

Short answerChecked 31 October 2026

The NHIMA benefit package covers members and their registered family at accredited healthcare providers: consultations and diagnostics, admission (including ICU), minor and major surgery, maternity and newborn care (normal and caesarean deliveries), generic medicines on the essential medicines list, physiotherapy, dental care and spectacles once every three years. It does not cover treatment abroad, cosmetic surgery, weight-loss treatment, inpatient nursing beyond 90 days, or injuries from road and work accidents that motor insurance or the Workers' Compensation Fund cover (Fourth Schedule, SI 63 of 2019). You do not pay at the facility for NHIMA services; you show your NHIMA ID or NRC and your fingerprint.

Free PDF: NHIMA guide 2026: registration, contributions, card and benefits

5 chapters in one PDF, every source listed. Free, no sign-up.

Get the free PDF

Your situation is different? Ask.

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 · 6 sections

What the benefit package covers
What it does not cover
Using NHIMA at a hospital or clinic
How to complain to NHIMA
FAQ
Sources

What the benefit package covers

Benefit	What NHIMA says it includes
Medical care	Consultations and examinations, laboratory and radiology (X-ray, CT scan, MRI, ultrasound, mammogram), nursing care, admission in an ordinary or private ward, ICU and high-dependency unit
Surgery	Minor, major, orthopaedic, ENT and diagnostic surgery, with anaesthesia, medicines, dressings and orthopaedic implants
Maternity and newborn	Antenatal care, normal and caesarean deliveries, postnatal, newborn and paediatric services
Medicines	Generic medicines on the National Essential Medicines List, medical supplies, blood products
Dental	Fillings, gum disease, extractions, braces, dentures and root canal treatment
Eye care	Spectacles once every three years; cataract, glaucoma and trauma care
Other	Physiotherapy and rehabilitation, medical and orthopaedic appliances and prostheses, cancer and oncology services

From NHIMA's benefit package page and the Fourth Schedule of SI 63 of 2019. NHIMA adds that the scheme is a family cover but benefits are per insured individual.

What it does not cover

Treatment abroad.
Cosmetic surgery and aesthetic treatment, except medically required reconstructive surgery.
Weight-loss procedures and treatment.
Long-term inpatient nursing care over 90 days.
Treatment of road accident injuries covered by motor vehicle insurance or a similar fund: see claiming from the driver's insurer.
Treatment of occupational accidents and diseases covered by the Workers' Compensation Fund: see workers' compensation.
Injuries from declared national disasters; fertility treatment according to set criteria.

Fourth Schedule, National Health Insurance (General) Regulations, 2019.

Using NHIMA at a hospital or clinic

Go to an accredited provider: NHIMA lists them on its accredited providers page and its leaflet speaks of over 380 healthcare providers countrywide (customer journey). An accredited provider must display its certificate of accreditation (regulation 13).
Carry your NHIMA ID or NRC. The provider checks your identity with your fingerprint, and takes your fingerprints if they are not yet in the system.
After treatment, confirm the services received with your fingerprint and sign off electronically.
NHIMA says you will not be asked to pay for NHIMA services; report any request to the member services assistant, on 8000, or at an NHIMA office (customer journey).

If a member dies, the registered family keeps the benefits for four months (National Health Insurance Act, section 21(2)). Benefits of a member who pays directly may be suspended while a contribution is unpaid (section 22).

How to complain to NHIMA

Submit the complaint: on nhima.co.zm, on the toll-free line 8000, or at an NHIMA office (customer journey). The complaint form is on the resources page.
NHIMA logs the complaint, gives you a reference number and investigates within 48 hours; if it is resolved you hear from Customer Care within 24 hours.
If it is not resolved within 30 business days, NHIMA gives you a status update and a final timeframe.
Not satisfied with the outcome: appeal within 30 days to the Health Complaints Committee of the Board, then within 30 days to the Board, then to the High Court (complaints procedure).

Already insured?

Check my motor certificate Understand my policy Prepare a claim

Next step

1. Find the cover that fits

Frequently asked questions

What does NHIMA cover?

Consultations, diagnostics, admission and ICU, surgery, maternity and newborn care, generic medicines on the essential medicines list, physiotherapy, dental care and spectacles once every three years, at accredited providers.

Does NHIMA cover road accident injuries?

Not when motor insurance or a similar fund covers them (Fourth Schedule, SI 63 of 2019). The victim claims from the driver's insurer under the Road Traffic Act.

Do I pay at the hospital with NHIMA?

NHIMA says you will not be required to pay for NHIMA services at an accredited provider. Show your NHIMA ID or NRC and confirm with your fingerprint.

How long does NHIMA take to answer a complaint?

It acknowledges and investigates within 48 hours and updates you if the complaint is not resolved within 30 business days. You can appeal within 30 days to the Health Complaints Committee, then the Board, then the High Court.