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Participants at the just ended stakeholder conference on National Health Insurance Scheme (NHIS) have suggested to the government to review the exemption package for all under 18 years, 70 years and above, pregnant women and Social Security and National Insurance Trust (SSNIT) contributors to ensure equity, efficiency and sustainability of the scheme. Per the laws governing the NHIS, the above mentioned categories of beneficiaries are exempted from paying premium. SSNIT contributors in particular were included on the exemption list because they pay 2.5 % NHIS levy, which is deducted at source. A bird has, however, whispered into the ears of The Chronicle that the proposal, if accepted by the government, will see SSNIT contributors paying more premium than what is being currently deducted at source. The forum, which was attended by medical practitioners, health insurance providers, Members of Parliament and donors among a host of others, noted that the current cost structure of the NHIS is unsustainable. They contended that the high and increasing funding gap as shown by the income and expenditure trend over the past five years call for a fundamental structural review. The Chief Executive Officer (CEO) of the NHIS, Mr. Sylvester Mensah, had earlier told the forum that the NHIS had a generous benefit package that covered over 90 per cent of diseases in the country, despite the fact that the scheme had a deficit in its income and expenditure. This, he noted, called for review of the whole structure of the NHIS. It is, however, not known whether Sylvester Mensah�s alarm triggered the call on the government by the forum to review the exemption package. The Forum, however, thinks there should be a dispassionate, critical and bipartisan review of the NHIS benefit package, using evidence based tactics consistent with internationally accepted practices. They further observed that epidemiological and demographic changes over the past 10 years demands a rationalization of the benefit package for equity and value for money. The forum observed that the NHIS must provide for what it can fund without denying the poor and vulnerable financial access to health care. Among others, stakeholders recommended the setting up of a technical stakeholder group under the leadership of the MOH to undertake a comprehensive cost assessment of health care delivery, using the Health Technology Assessment (HTA) approach to provide a more efficient and realistic NHIS tariff and medicine pricing regime based on evidence. The participants also advised NHIA to consider engaging only clinicians to add value to its operations and refocus on the poor and vulnerable. The forum called for an increase in the NHIL or significant budgetary allocation for the 2015 fiscal year or both, if the scheme is to survive the first quarter of 2015. The forum recommended that Government considers assigning at least 25% of communication service tax to the NHIA among others.