Health Insurance Board Warns Hospitals Against Charging Insured Patients for Covered Medications

Kathmandu. The Health Insurance Board has issued a stern warning to health institutions that force insured patients to pay cash for medications or discriminate against them during service delivery.

In a notice issued on Monday, the Board stated that it has received widespread complaints that some service-providing health institutions are compelling patients to purchase medications and medical supplies covered under the insurance package from external pharmacies or their own pharmacies using cash.

According to the Board, such actions are in violation of Clause (a) of Sub-rule (1) of Rule 19 of the Health Insurance Regulations, 2075, and warned that those found engaging in such practices will face legal action.

The Board expressed serious concern over reports that some hospitals are forcing insured patients to book appointments in advance and treating them with discrimination. The Board has warned that if such activities do not cease, it will terminate the agreements with the health institutions in accordance with Section 12 of the Health Insurance Act, 2074. 

The Board has also issued directives regarding the rates for medications and other services. The directive states that if a hospital's own rate for any medication or service is lower than the rate mentioned in the insurance benefit package, the hospital must claim at the minimum rate.