The utmost goal of every health insurance provider is to pay claims promptly as and when it arises to pave way for policyholders to enjoy an uninterrupted healthcare provision at all times. This goal can only be achieved if proper measures are put in place for the right amount of premium to be charged by health insurance providers based on an accurate forecast of the future total claim amount to be paid within a particular time frame by the health insurance providers. This exceptional piece of work addresses the factors that affects the national health insurance scheme in Ghana. A comprehensive study using a triple-hurdle statistical model to determine the major factors that influences total claim amount over the period of existence of the scheme. this high rocketed claim amounts has led to a serious financial burden on successive governments since its inception. the recommendations made in this work can greatly impact the mutual health insurance industry across the globe.