How to get health insurance, what services are available?

Health insurance is an annual program. The annual action plan is decided by reviewing the policies and programs of the government, the announcement of the budget, the various kinds of progress made in the past.

This time too, our annual action plan has been prepared. Everything moves forward according to the same action plan.

The purpose of health insurance is to provide quality healthcare to the general public and ensure healthcare. The goal is to make healthcare as accessible as possible.

It is also a family insurance program. According to the universal principle, this program has been carried forward by the provisions of our law and the prevailing law by the annual action plan. 

The track record of this program started from 25th March 2072 is not very long.

It was started in Kailali. Then it was implemented in Baglung and Ilam. Currently, the program has started in 46 districts.

Efforts are being made to reach all 77 districts by next year.

So far, we have provided insurance to 1.81 million citizens. 5 lakh 25 thousand families have been included. Of them, 415,000 are impoverished families.

So far, 53 percent of women and 47 percent of men have participated in health insurance.

How to insure

Before starting an insurance program in a district, there are some basic things to do. In the community where there is a program, the service providers of that district, the government of Nepal, and the private sector are also involved.

One registration assistant is selected in each ward at the local level. Who is also our insurance agent and agent? These helpers go from house to house. They work to get the general public involved in insurance by collecting data.

Insurance is based on the same data, and cards are distributed based on being insured. Shortly after that, the ser

To get service of 1 lakh annually.

The amount of insurance is not given to any particular disease but all kinds of conditions as far as means and resources allow. Services ranging from OPD services, labs, admissions, medicine to pharmacy counseling are available. 3

As a program based on contribution and mutual understanding, some money has to be raised. At present, we have taken 3,500 annually from non-disabled families for the sustainability of the program. We provide service up to Rs. 1 lakh annually for that. We consider a family of five as one unit.

In case of having more than five members, the medical treatment facility is being added at the rate of Rs. If there are senior citizens, the senior citizens will get treatment services of Rs 1 lakh, for which there is no need to make any contribution.

If a family is on the list of the poorest, they do not have to contribute. The Government of Nepal itself contributes on its behalf.

Everything has a limit. If the government provides complete services in any program, it won’t be easy to sustain even with the money in the state coffers.

The state has tried to provide a separate package for the needy and poor. This is a program based on social justice. The constitution has also made provisions. Primary health care is free. The plan is to provide services beyond that. It should not offer complete services for its sustainability.

There are registration assistants in every district ward where the health insurance program has been implemented. If they are not available, they can contact the community and participate in the insurance program. So far, participation has been low.

Health insurance claims are easier than others. In other insurance, the insured has to go to claim himself. The service provider organization itself claims the service from which the insured has received the service.

The card is provided to the insured.

The card is provided to the insured. So the service provider takes the money. They serve as long as there is money on the card. The service provider organization claims to the health care board what service is provided. Based on that, the service provider gets the money.