National Health Insurance Scheme (NHIS) was designed in 2004 by the Federal Government of Nigeria to complement sources of financing the health sector and it has evidently improved access to health care for the majority of Nigerians. The most significant of these impacts, studies suggest was on financial protection and healthcare utilisation. As a result of this development as well as to achieve Universal Health Coverage, governments at the state level began to replicate the scheme. The coming in of these states, is playing a complementary role and it has challenged the healthcare service delivery as well as the operational guidelines of the national health insurance scheme. When the NHIS is placed beside the health insurance schemes in four states of Cross River, Edo Lagos and Osun, evidence shows there are differences in governance, benefits, implementation, and accessibility between the two categories of the scheme. This collaborative report by Usman Aliyu, Blessing Oladunjoye, Rasheed Adebiyi and Umo Akwang compares the peculiarities of each scheme vis-a-vis the gains and limitations.