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Participants at a two-day National Health Insurance Scheme stakeholder dialogue have maintained that the current cost structure of the scheme is unsustainable and that the high and increasing funding gap as evidenced by the income and expenditure trend over the past five years call for a fundamental structural review. At a stakeholder meeting held over the weekend at the La Palm Royal Beach Hotel in Accra the participants in unison called for a dispassionate, critical and bipartisan review of the NHIS benefit package by using evidence-based strategies which are consistent with international best 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 and that the scheme must provide for what it can fund without denying the poor and vulnerable financial assess to health care. The forum further tasked the Ministry of Health and the National Health Insurance Authority (NHIA) to consider a post 2015 review of the broad NHIS exemption regime for all under 18 years, all 70 years and above, all pregnant women and all SSNIT contributors for the purpose of equity, efficiency and sustainability of the scheme. Among others, the 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 to provide a more efficient and realistic NHIS tariff and medicine pricing regime based on evidence. The NHIA was also among others advised to consider engaging only Clinicians to add value to its operations and refocus on the poor and vulnerable, intensification of clinical audits and other efficiency measures in the immediate term as well as consideration for co-payment in the medium to long-term. The forum consequently called for an increase in the National Health Insurance Levy or a significant budgetary allocation for the 2015 fiscal year or both if the scheme is to survive the first quarter of 2015. It therefore recommended that Government considers assigning at least 25% of the Communication Service Tax to the NHIA to keep the scheme afloat.