Health Insurance Board Clarifies No Reduction in NPR 100,000 Treatment Coverage for Insured Individuals

Kathmandu. The Health Insurance Board has clarified that the treatment service facility of NPR 100,000 that insured individuals have been receiving has not been reduced. The Board's Information Officer, Bikesh Malla, informed that the treatment fee equivalent to NPR 100,000 for which insurance was purchased remains unchanged. He stated that the annual total treatment service limit of NPR 100,000 available to a family of five under the insurance program, based on a contribution of NPR 3,500, remains the same.

Information Officer Malla stated that the Board has allocated NPR 25,000 for OPD services and NPR 75,000 for hospitalization and emergency services. Under the health insurance program, health service coverage up to NPR 100,000 is provided to families of up to five members based on a contribution of NPR 3,500. Furthermore, there is a provision where the contribution amount increases by NPR 700 per additional member, and the service coverage increases by NPR 20,000 per additional member.

The Board has urged the use of funds according to the allocations made for separate service categories such as OPD, hospitalization, and surgery, in order to prevent unnecessary use of OPD services and duplication, and to ensure resources for the treatment of serious, complex, and life-threatening diseases. Information Officer Malla said, "There is a provision for a family of five to avail a maximum of NPR 2,500 worth of outpatient services (OPD) throughout the year. For families with more than five members, an additional NPR 5,000 worth of OPD service has been maintained per additional member."

Currently, more than 70 percent of the health insurance budget is being spent on OPD services for common ailments. Experts suggest that this situation leads to the insurance amount being insufficient when a family member suffers from a serious illness or requires expensive surgery, forcing the patient to spend a large amount from their own pocket.

Board's Information Officer Malla urged compliance with the allocations set for separate headings such as OPD, hospitalization, and surgery, with the objective of spending the insurance amount on the treatment of genuine patients.